Transoral Endoscopic Localization of the Parapharyngeal Internal Carotid ArteryFunding This study was funded by Huashan Hospital.
Objectives To define transoral endoscopic surgical landmarks for the parapharyngeal segment of the internal carotid artery (ppICA) using cadaveric dissection.
Methods Ten fresh cadaveric heads were dissected to demonstrate the parapharyngeal space anatomy and course of the ppICA as seen in a transoral approach. Anatomical measurements of the distance between the ppICA and bony landmarks were recorded and analyzed.
Results The stylohyoid ligament, styloglossus, and stylopharyngeus could be considered to be the safe anterior boundary of the ppICA in the transoral approach; among them, the styloid ligament was the most rigid tissue. Dissection between the stylopharyngeus muscle and superior pharyngeal constrictor muscle provides direct access to the ppICA. At the level of the skull base, the distance from the root of the styloid process to the lateral margin of the external aperture of the carotid canal on the left side and on the right side was 8.57 ± 1.97 and 8.80 ± 1.21 mm, respectively. At the level of the maxillary tuberosity, the distance from the ppICA to the maxillary tuberosity on the left side and on the right side was 31.48 ± 2.24 and 31.01 ± 2.88 mm, respectively.
Conclusion The endoscopic-assisted transoral approach can facilitate exposure of the ppICA. The root of the styloid process, styloid ligament, and maxillary tuberosity are critical landmarks in the identification of the ppICA in the transoral approach.
Keywordsparapharyngeal internal carotid artery - anatomic landmarks - transoral surgery - endoscope
Eingereicht: 15. Mai 2020
Angenommen: 04. Februar 2021
Artikel online veröffentlicht:
04. Februar 2021
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- 1 van Hees T, van Weert S, Witte B, René Leemans C. Tumors of the parapharyngeal space: the VU University Medical Center experience over a 20-year period. Eur Arch Otorhinolaryngol 2018; 275 (04) 967-972
- 2 Lemos-Rodriguez AM, Sreenath SB, Rawal RB, Overton LJ, Farzal Z, Zanation AM. Carotid artery and lower cranial nerve exposure with increasing surgical complexity to the parapharyngeal space. Laryngoscope 2017; 127 (03) 585-591
- 3 Chen Z, Chen YL, Yu Q. et al. Excision of tumors in the parapharyngeal space using an endoscopically assisted transoral approach: a case series and literature review. J Int Med Res 2019; 47 (03) 1103-1113
- 4 Chen H, Sun G, Tang E, Hu Q. Surgical treatment of primary parapharyngeal space tumors: a single-institution review of 28 cases. J Oral Maxillofac Surg 2019; 77 (07) 1520.e1-1520.e16
- 5 Panda S, Sikka K, Thakar A, Sharma SC, Krishnamurthy P. Transoral robotic surgery for the parapharyngeal space: expanding the transoral corridor. J Robot Surg 2019; 14 (01) 61-67
- 6 Maglione MG, Guida A, Pavone E. et al. Transoral robotic surgery of parapharyngeal space tumours: a series of four cases. Int J Oral Maxillofac Surg 2018; 47 (08) 971-975
- 7 Wang C, Kundaria S, Fernandez-Miranda J, Duvvuri U. A description of arterial variants in the transoral approach to the parapharyngeal space. Clin Anat 2014; 27 (07) 1016-1022
- 8 Abuhaimed AK, Menezes RG. Anatomy, head and neck, styloid process. In: StatPearls. StatPearls Publishing LLC; Treasure Island, FL: 2019
- 9 Ozgur Z, Celik S, Govsa F, Aktug H, Ozgur T. A study of the course of the internal carotid artery in the parapharyngeal space and its clinical importance. Eur Arch Otorhinolaryngol 2007; 264 (12) 1483-1489
- 10 Ferrari M, Schreiber A, Mattavelli D. et al. Surgical anatomy of the parapharyngeal space: multiperspective, quantification-based study. Head Neck 2019; 41 (03) 642-656
- 11 Iseri M, Ozturk M, Kara A, Ucar S, Aydin O, Keskin G. Endoscope-assisted transoral approach to parapharyngeal space tumors. Head Neck 2015; 37 (02) 243-248
- 12 Chu F, De Berardinis R, Tagliabue M, Zorzi S, Bandi F, Ansarin M. The role of transoral robotic surgery for parapharyngeal space: experience of a tertiary center. J Craniofac Surg 2020; 31 (01) 117-120
- 13 Tanjararak K, Upadhyay S, Thiensri T. et al. Potential surgical exposure of the parapharyngeal internal carotid artery by endonasal, transoral, and transcervical approaches. J Neurol Surg B Skull Base 2018; 79 (03) 241-249