Abstract
Introduction Understanding the anatomic features of the zygomatic nerve is critical for performing
the endoscopic transmaxillary approach properly. Injury to the zygomatic nerve can
result in facial numbness and corneal problems.
Objective To evaluate the surgical anatomy of the zygomatic nerve and its segments from an
endoscopic endonasal perspective for clinical implications of performing the endoscopic
transmaxillary approach.
Methods The origin, course, length, and segments of the zygomatic nerve were studied in four
specimens from an endonasal perspective.
Results The zygomatic nerve arises 4.1 ± 1.7 mm from the foramen rotundum of the maxillary
nerve in the superolateral pterygopalatine fossa (PPF). According to its anatomic
region in endonasal endoscopic surgery, we divided the zygomatic nerve into two segments:
the PPF segment, from origin to the point of entry under Muller's muscle, which runs
superolaterally to the inferior orbital fissure (IOF) (length, 4.6 ± 1.3 mm), and
the IOF segment, starting at the entry point in Muller's muscle and terminating at
the exit point in the IOF, which travels between Muller's muscle and the great wing
of the sphenoid bone (length, 19.6 ± 3.6 mm). In the transmaxillary approach, the
zygomatic nerve is a critical landmark in the superolateral PPF.
Conclusion The zygomatic nerve travels in the PPF and the IOF; better visualization and preservation
of this nerve during endonasal endoscopic surgery are crucial for successful outcomes.
Keywords
endonasal endoscopic surgery - foramen rotundum - zygomatic nerve
