Endoscopic endonasal nasopharyngectomy: tensor veli palatine muscle as a landmark for the parapharyngeal internal carotid artery

Liu, Chiung-Lin; Hsu, Ning-I; Shen, Ping‐Hung

doi:10.1002/alr.21921

Cited by 14 publications

(15 citation statements)

References 21 publications

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“…The root of the pterygoid process and medial pterygoid plate were drilled to expose the PPS. The TVPM and the tensor-vascular-styloid fascia were used to locate the parapharyngeal ICA ( 17 ). The pharyngobasilar fascia was used to indicate the lacerum segment of the ICA.…”

Section: Discussionmentioning

confidence: 99%

Types of Transnasal Endoscopic Nasopharyngectomy for Recurrent Nasopharyngeal Carcinoma: Shanghai EENT Hospital Experience

Liu

Sun

et al. 2021

Front. Oncol.

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BackgroundTransnasal endoscopic nasopharyngectomy (TEN) has become increasingly used for recurrent nasopharyngeal carcinoma (rNPC); however, there is no report on the definitive resectable contour for TEN according to the latest staging system for nasopharyngeal carcinoma. The aim of this study was to establish the types of TEN for rNPC.Materials and MethodsA total of 101 rNPC patients underwent TEN from January 2016 to April 2019 at the authors’ institution. TEN was categorized into four types, which included type I (n=40) with resection of the nasopharynx and sinuses; type II (n=10) with lateral extension to the parapharyngeal space; type III (n=40) with lateral extension to the floor of the middle cranial fossa and the infratemporal fossa and superior extension to the orbital apex and the cavernous sinus back to the prevertebral region; and type IV (n=11) with the resection of the involved internal carotid artery following type III. The 2-year overall survival rate (OS) and local recurrence-free survival rate (LRFS) were assessed.ResultsThe median time of follow-up was 20 months. Twenty-five patients reoccurred. Nineteen patients died. Independent predictors of outcome on multivariate analysis were recurrent T stage (P = 0.039), types of TEN (P = 0.002) and surgical margin (P = 0.003). The 2-year OS and LRFS was 76.2% and 53.6%, respectively.ConclusionsThe result of TEN in the treatment of rNPC is promising. The types of TEN will provide effective guideline for surgical treatment of rNPC.

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Section: Discussionmentioning

confidence: 99%

Types of Transnasal Endoscopic Nasopharyngectomy for Recurrent Nasopharyngeal Carcinoma: Shanghai EENT Hospital Experience

Liu

Sun

et al. 2021

Front. Oncol.

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“…Intracranial invasion is not typically addressed with an endoscopic approach. Identification of key surgical landmarks and their relationship to the ICA is critical to minimize the risk of injury . Stereotactic image‐guided navigation is commonly used during the operation.…”

Section: Sinonasal Malignanciesmentioning

confidence: 99%

ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

160

279

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Background Endoscopic skull‐base surgery (ESBS) is employed in the management of diverse skull‐base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull‐base surgery have produced the International Consensus Statement on Endoscopic Skull‐Base Surgery (ICAR:ESBS). Methods Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence‐based review or evidence‐based review with recommendations format. Subsequently, each topic was written and then reviewed by skull‐base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. Results The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull‐base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. Conclusion A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence‐based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull‐base community to embrace these opportunities and collaboratively address these shortcomings.

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“…The tensor and levator veli palatini muscles are located, respectively, at the anterolateral and anteroinferior aspects of the cartilaginous segment of Eustachian tube, which constitutes the medial wall of the UPPS . The sphenoid spine is the origin of the tensor veli palatini muscle, which lies anterior to the parapharyngeal ICA; thus, both structures can serve as landmarks for the identification and preservation of Eustachian tube and parapharyngeal ICA during the resection of benign tumors in this region . For the management of malignant lesions, however, sacrifice of the aforementioned structures and the neurovascular component of the pterygopalatine and infratemporal fossae is required to ensure tumor free margin.…”

Section: Discussionmentioning

confidence: 99%

Endonasal endoscopic transpterygoid approach to the upper parapharyngeal space

London

Prevedello

et al. 2020

Head & Neck

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Background Lesions of the upper parapharyngeal space (UPPS) present a surgical challenge. The objective of this study was to ascertain the feasibility of a novel technique of modified transpterygoid approach to the UPPS. Methods Six fresh cadaveric specimens (12 sides) were dissected, developing a technique that includes en bloc mobilization of the lateral pterygoid plate and muscle to access the UPPS. Results Following an endoscopic Denker's approach and the removal of posterolateral wall of the antrum, the lateral pterygoid plate was detached from the pterygoid process. Subsequently, the lateral pterygoid plate and muscle were displaced laterally as a unit, allowing the identification of the posterior trunk of V3 and the fat in prestyloid compartment. Dissecting off the styloid aponeurosis affords entering the poststyloid UPPS exposing the internal carotid artery, internal jugular vein, and cranial nerves IX to XII. Conclusion This novel modification of the endonasal transpterygoid approach offers a viable alternative for access to the UPPS.

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Endoscopic endonasal nasopharyngectomy: tensor veli palatine muscle as a landmark for the parapharyngeal internal carotid artery

Cited by 14 publications

References 21 publications

Types of Transnasal Endoscopic Nasopharyngectomy for Recurrent Nasopharyngeal Carcinoma: Shanghai EENT Hospital Experience

Types of Transnasal Endoscopic Nasopharyngectomy for Recurrent Nasopharyngeal Carcinoma: Shanghai EENT Hospital Experience

ICAR: endoscopic skull‐base surgery

Endonasal endoscopic transpterygoid approach to the upper parapharyngeal space

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