The Lateral Pharyngeal Tubercle as a Key Landmark to Estimate Approximation of Neurovascular Structures (Internal Carotid Artery + Lower Cranial Nerves)

Background: The location of the lower clivus could be considered a challenging region in the skull base surgery to access. In the vicinity of the lower clivus, are located some important neurovascular structures (ICA and lower cranial nerves), and the osseous key landmarks could represent an importance for estimating it. This could help the surgeon to plan the approach. In this scientific work, we remark on the importance and represent the anatomic features of the lateral pharyngeal tubercle (LPT), and the ventral jugular tubercle (vJT).

Materials and Methods: Specimens were obtained from the anthropology department of the Faculty of Medicine of the National Autonomous University of Mexico, and the Surgical Neuroanatomy Laboratory of the University La Salle, Mexican Faculty of Medicine. Craniums were used to analyze and measure using a caliper, the proximity from the lateral pharyngeal tubercle and the ventral jugular tubercle from the carotid canal, caudal petroclival fissure, medial pharyngeal tubercle, atlanto-occipital articulation, and foramen lacerum. Additionally, an EEA was performed to the lower clivus, and was obtained to get the proximity of LPT and vJT to the ICA and lower cranial nerves (IX, X, XI, and XII).

Results: Nineteen craniums, corresponding to 37 sides, were analyzed, and 1 specimen was explored via EEA for the lower clivus to visualize the proximity with the neurovascular structures (ICA + lower cranial nerves). The most important features adjacent to the LPT and vJT were analyzed. The variants and the morphometric differences between the lateral pharyngeal tubercle, the jugular tubercle, and the medial pharyngeal tubercle were described.

Conclusion: The lateral pharyngeal tubercle may be used to gain the estimated proximity to the parapharyngeal internal carotid artery during an endoscopic endonasal approach to the lower clivus. The lateral pharyngeal tubercle is an independent prominence from the ventral jugular tubercle, and it could be used to get an approximation of the neurovascular structures (ICA + lower cranial nerves). The lateral pharyngeal tubercle and the ventral jugular tubercle represent different osseous landmarks.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
07 February 2025