A description of the anatomy of the glossopharyngeal nerve as encountered in transoral surgery

Wang, Chengyuan; Kundaria, Summit; Fernández-Miranda, Juan C.; Duvvuri, Umamaheswar

doi:10.1002/lary.25706

Cited by 23 publications

(20 citation statements)

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“…After exiting the jugular foreman, the glossopharyngeal nerve is located between the internal carotid artery and internal jugular vein, descending deep to the styloid process. 3 GN is divided into 3 segments based on its relationship with stylopharyngeus muscle, i.e. upper, middle and lower.…”

Section: Discussionmentioning

confidence: 99%

“…Lower segment starts from to intersection of the GN with the inferior border of the stylopharyngeus muscle to its end at the tongue base. 3 The middle segment of the GN is covered by the stylopharyngeus muscle anteriorly. In this segment, it gives off branches innervating the stylopharyngeus muscle and branches to pharyngeal wall.…”

Section: Discussionmentioning

confidence: 99%

“…The lingual branch of the glossopharyngeal nerve provides sensation to the posterior tongue and enters the tongue base by traveling through the constrictor muscles in the area of the lingulotonsillar sulcus. 3 on swallowing. Patient underwent tonsillectomy and transoral styloidectomy elsewhere 2 years back for chronic tonsillitis with elongated styloid process.…”

Section: Introductionmentioning

confidence: 99%

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Glossopharyngeal neuralgia due to exposed glossopharyngeal nerve post tonsillectomy and transoral styloidectomy

Mahalingappa

Gupta

Ramakrishnan

2020

Int J Otorhinolaryngol Head Neck Surg

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<p>Glossopharyngeal neuralgia (GN) is a rare facial pain syndrome, characterized by paroxysm of excruciating radiating pain in the sensory distribution of the auricular and pharyngeal branches of glossopharyngeal and vagus nerves. In relation to the tonsil, the glossopharyngeal nerve passes deep to the styloid process and related muscles attaching to styloid process. The lingual branch of the glossopharyngeal nerve provides sensation to the posterior tongue and enters the tongue base by traveling through the constrictor muscles in the area of the lingulotonsillar sulcus. Post tonsillectomy fossa with exposed nerve causing intractable pain is a rare entity. We report a case of 64 year male patient, post tonsillectomy and transoral styloidectomy, with complaint of severe throat pain on left side for 2 years, radiating upwards to the ipsilateral ear, face and eye. Glossopharyngeal nerve and its branches were found exposed in the posterior and inferior aspect of tonsillar bed. Surgical resection of exposed glossopharyngeal nerve and its branches was carried out in view of failure to respond to oral carbamazepine. Patient was symptom free during 10 months of follow up visit. GN is a rare condition following tonsillectomy and styloidectomy. Radical dissection of tonsillar bed during tonsillectomy and not suturing tonsillar bed properly after styloidectomy can lead to exposure of glossopharyngeal nerve and its branches, resulting in intractable GN.</p>

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Glossopharyngeal neuralgia due to exposed glossopharyngeal nerve post tonsillectomy and transoral styloidectomy

Mahalingappa

Gupta

Ramakrishnan

2020

Int J Otorhinolaryngol Head Neck Surg

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“…Some studies reported that the base of the styloid process, the styloid muscles, transverse process of the atlas and the internal and external carotid arteries are clinically available to identify the GPn in the extraoral or intraoral surgical procedures (Bejjani et al ., ; Özveren et al ., ; Prades et al ., ; Wang et al ., , ). Apart from the atlas that was not examined, this study also suggests that these structures are useful to find the GPn.…”

Section: Discussionmentioning

confidence: 99%

“…Contrarily, the intraoral approach leaves no scars and is a relatively straightforward and less time-consuming procedure; however, it does not permit the complete exposure of the surgical field and is accompanied by the poor exposure to control bleeding with a higher risk of deep cervical infection. Previously, surgical anatomical studies have revealed that some structures, such as the styloid muscles, are clinically available to identify the GPn (Bejjani et al, 1998;Özveren et al, 2003;Prades et al, 2014, Wang et al, 2016. A study reported that the GPn was found deeply to the superior constrictor and at the intersection of the palatopharyngeal arch with the base of the tongue in the intraoral approach (Lim et al, 2013).…”

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confidence: 99%

Morphological Features of the Glossopharyngeal Nerve in the Peripharyngeal Space, the Oropharynx, and the Tongue

Sakamoto

2018

The Anatomical Record

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The glossopharyngeal nerve comprises sensory, motor and parasympathetic fibers, and its problem results in several disorders. This study investigated the glossopharyngeal nerve to elucidate the characteristics of its extracranial course and branching pattern. The nerve and adjacent structures were gross anatomically examined in 32 cadavers. The glossopharyngeal nerve descended from the jugular foramen in the peripharyngeal space. It dodged between the carotid arteries and the internal jugular vein and distributed the carotid and pharyngeal branches that formed the plexus with the branches of the vagus and sympathetic nerves. The glossopharyngeal nerve curved anteriorly around the stylopharyngeus and supplied it and the glossopharyngeus. However, it occasionally disappeared because it penetrated the stylopharyngeus. The nerve passed medially to the stylohyoid ligament to enter the oropharynx, with its entry located medially to the facial artery. It appeared anteriorly to the stylopharyngeus and the palatopharyngeus and inferiorly to the palatine tonsil in the oropharynx. Its appearance was obscured beneath the tonsil and, sometimes, beneath the longitudinal muscles. The nerve distributed the branches to the palatine tonsil, which formed a plexus with those that pierced the glossopharyngeus from the outside. At the root of the tongue, the nerve ramified into the posterior branches to the epiglottic vallecula, the medial ones the lingual tonsil and the vallate papillae and the anterior ones the vallate and foliate papillae. This study suggests that, occasionally, the detection of the glossopharyngeal nerve is challenging, and its association with the pharyngeal muscles and the facial artery can facilitate its localization. Anat Rec, 302:630–638, 2019. © 2018 Wiley Periodicals, Inc.

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Advances in anatomical visualization on the head and neck through robotic surgery: A Brazilian perspective

Dias

2021

The Anatomical Record

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Trans Oral Robotic Surgery (TORS) is an emerging technique that provides several benefits over existing treatment regimens for head and neck cancer, including smaller incisions, less bleeding, shorter term inpatient hospitalization, and reduced intensive care unit (ICU) length of stay. TORS allows a high resolution, magnified, three-dimensional wide view of the surgical field through an endoscope, avoiding large external cervical incisions and split-lip mandibulotomy, usually required in cancer surgeries of the oropharynx. The anatomy of the Oropharynx viewed from the perspective of the robotic surgeon is different from the anatomy taught in medical schools and residence/fellowship programs, which is more directly related to emergency procedures, open field surgery, and imaging exams. Developing an understanding of the anatomic relationships and landmarks from the "inside out" perspective is critical for any surgeon willing to perform surgical procedures through a transoral robotic approach. Here we address the major anatomic landmarks and structures in head and neck robotic surgeries and advantages and disadvantages of this approach. We emphasize the importance of imaging for successful outcomes, pointing out important anatomic landmarks considered as blind spots for surgeons in clinical and endoscopic evaluations. We also describe the Brazilian current scenario and future perspectives of Robotic Surgery in terms of training and access to this technique, including institutions that currently offer this service in the different regions of Brazil.

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A description of the anatomy of the glossopharyngeal nerve as encountered in transoral surgery

Abstract: N/A. Laryngoscope, 126:2010-2015, 2016.

Cited by 23 publications

References 14 publications

Glossopharyngeal neuralgia due to exposed glossopharyngeal nerve post tonsillectomy and transoral styloidectomy

Glossopharyngeal neuralgia due to exposed glossopharyngeal nerve post tonsillectomy and transoral styloidectomy

Morphological Features of the Glossopharyngeal Nerve in the Peripharyngeal Space, the Oropharynx, and the Tongue

Advances in anatomical visualization on the head and neck through robotic surgery: A Brazilian perspective

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