Unilateral Upper and Lower Subtotal Maxillectomy Approaches to the Cranial Base: Microsurgical Anatomy

Hitotsumatsu, Tsutomu; Rhoton, Albert L.

doi:10.1097/00006123-200006000-00025

Cited by 47 publications

(29 citation statements)

References 22 publications

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“…After extensive lateral wall resection, Goldberg et al (2000) found an average of 5.9 mm reduction in exophthalmos, which offers a reduction of 0-0.5 mm in proptosis for each cubic millimeter of orbital volume expansion because of its location (Gonzalez et al, 2002). It has also been reported that removal of up to 25 mm of the lateral wall of the orbital rim yields only 2-2.9 cc of volume (Hitotsumatsu and Rhoton, 2000;Unal et al, 2003;Beden et al, 2007). Baldeschi et al (2005) stated that removal of the lateral wall reduces exophthalmos by 2.3 mm, with a 13% incidence of new-onset diplopia, which usually resolves spontaneously in 4-6 months.…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, surgical complications are less when approaching the lateral orbital wall (Beden et al, 2007). Some authors have converted a deep lateral wall decompression with fat debulking as the firstline surgical treatment and have reduced the risk of postoperative strabismus (Harris et al, 1998;Hitotsumatsu and Rhoton, 2000;Gonzalez et al, 2002;Graham et al, 2003). After extensive lateral wall resection, Goldberg et al (2000) found an average of 5.9 mm reduction in exophthalmos, which offers a reduction of 0-0.5 mm in proptosis for each cubic millimeter of orbital volume expansion because of its location (Gonzalez et al, 2002).…”

Section: Discussionmentioning

confidence: 99%

“…Baldeschi et al (2005) stated that removal of the lateral wall reduces exophthalmos by 2.3 mm, with a 13% incidence of new-onset diplopia, which usually resolves spontaneously in 4-6 months. The removal of intraconal fat augments proptosis reduction with orbital decompression procedures (Hitotsumatsu and Rhoton, 2000;Andaluz et al, 2003;Baldeschi et al, 2005).…”

Section: Discussionmentioning

confidence: 99%

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A morphometric study of the inferior orbital fissure using three‐dimensional anatomical landmarks: Application to orbital surgery

2009

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The inferior orbital fissure (IOF) is an important structure during orbital surgery, however, neither its anatomical features nor the procedures necessary to expose the IOF have been examined in detail. A morphometric analysis of the IOF was performed on 232 orbits using computer software. The longest and shortest borders of the IOF were 18.2 +/- 4.9 and 1.9 +/- 1.3 mm, respectively. The outer and the inner angles were 138.9 +/- 32.7 degrees and 38.4 +/- 24.7 degrees , respectively. The perimeter of the IOF was 50.6 +/- 13.5 mm and its area was 61.3 +/- 39.1 mm(2). Eight types of IOF were observed. Type 1 IOF was observed in 42.2% and the Type 2 IOF was identified in 15.9%. A statistically significant relation was found between the longest edge and area and the widest edge and area of the IOF. The findings of our study suggest that the removal of the lateral wall should begin inferiorly, just lateral to the IOF and extended superolaterally. These data may be useful during surgical approaches to the orbit.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A morphometric study of the inferior orbital fissure using three‐dimensional anatomical landmarks: Application to orbital surgery

2009

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“…The picture consisting of orbital pain plus oculosympathetic palsy (ptosis and miosis) had, in consequence, an important clinical localizing value before the development of modern imaging methods. Advances in micro n e u ro s u rg e ry and better understanding of the microanatomy of the cavernous sinus 4 , 5 , pet rous apex 6 , 7 , orbit 8 and infratemporal fossa 9 , associated with the introduction of modern staining techniques, re t rograde axonal mapping 1 0 , 1 1 a n d i m m u n o c y t o c h e m i s t ry 1 2 yielded more complete i n f o rmation about the skull base innervation and its relation with pathophysiologic events involved in the genesis of Raeder's neuralgia.…”

Section: Dr Daniel Monte Serrat Prevedello -Rua Alcides Munhoz 433 -mentioning

confidence: 99%

Raeder's syndrome after embolization of a giant intracavernous carotid artery aneurysm: pathophysiological considerations

Tatsui

Prevedello

Koerbel

et al. 2005

Arq. Neuro-Psiquiatr.

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-We present the case of a 47 years old woman submitted to an endovascular trapping of a left c a v e rnous internal carotid art e ry aneurysm, in which the distal balloon was inflated, as usually done, within the cavernous segment of the internal carotid art e ry, diff e rent from the proximal one which was inflated inside the carotid canal due to technical problems. Consequently, a clinical picture of Raeder's paratrigeminal neuralgia took place. This is the first case report in the literature with theses characteristics. A review of the anatomic pathways and further considerations about the possible pathophysiological mechanisms involved are presented.KEY WORDS: Raeder's paratrigeminal neuralgia, headache, cephalalgia, neuroendovascular procedures.S í n d rome de Raeder após embolização de aneurisma gigante de artéria carótida intracavernosa: considerações fisiopatológicas RESUMO -Apresentamos o caso de uma mulher de 47 anos submetida a obliteração endovascular de um aneurisma gigante de carótida interna cavernosa à esquerda, no qual o balão distal foi inflado, tal como usual, dentro do segmento cavernoso da artéria carótida interna, diferente do proximal, o qual foi inflado dentro do canal carotídeo devido a problemas técnicos. Conseqüentemente, um quadro clínico de neuralgia paratrigeminal de Raeder se instalou. Este é o primeiro relato na literatura com estas característi-cas. Uma revisão das vias anatômicas e maiores considerações a respeito de possíveis mecanismos fisiopatológicos envolvidos são apresentados. PALAVRAS-CHAVE: neuralgia paratrigeminal de Raeder, cefaléia, procedimentos neuroendovasculares.

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“…Contém o ramo V2, o gânglio esfenopalatino e a porção terminal da artéria maxilar [19][20][21][22][23][24] .…”

Section: Casounclassified

Schwanoma do ramo mandibular do nervo trigêmeo: relato de caso

Neto

Stamm

Braga

2001

Arq. Neuro-Psiquiatr.

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, Fernando de Menezes Braga 3RESUMO -Relatamos um caso de schwanoma do ramo mandibular do nervo trigêmeo, localizado na fossa infratemporal e ptérigo-palatina, com pequena extensão intracraniana e que foi totalmente extirpado por via transmaxilar. A revisão da literatura mostrou tratar-se de tumor raro nesta localização. PALAVRAS-CHAVE: schwanoma, nervo trigêmeo, fossa infratemporal, fossa pterigo-palatina. Mandibular trigeminal schwannoma: case reportABSTRACT -We report one case of peripheral trigeminal schwannoma originated from the mandibular branch (V3) and located inside the infratemporal and pterygopalatine fossae with slight intracranial extension. The tumor was completelly removed by a transmaxilar approach. The revision of the literature showed to be a very rare tumor in this location.KEY WORDS: Schwannoma, trigeminal nerve, pterygopalatine fossae, infratemporal fossae. . No nervo trigêmeo, podem originar-se em qualquer porção: na raiz, no cavo-de-Meckel ou em ramo perifé-rico. Os schwanomas do trigêmeo são tumores incomuns e benignos, constituindo 0,07 a 0,36% dos tumores intracranianos ou 0,8 a 8% dos schwanomas cranianos [2][3][4][5][6][7][8] . Schwanomas com origem em ramos periféricos do nervo trigêmeo são raramente relatados, sendo esta a razão principal do presente relato de schwanoma do ramo mandibular do nervo trigêmeo (V3). CASOTrata-se de paciente do sexo feminino, 62 anos, que há seis meses apresentava dor na hemiface esquerda, latejante e contínua, que melhorava parcialmente após o uso de carbamazepina. Apresentava hipoacusia esquerda acentuada desde há cerca de quinze anos. Não apresentava hipoestesia na face nem alteração da musculatura mastigatória. Todo o restante do exame neurológico era normal. Não apresentava manifestações cutâneas ou história familiar sugestiva de neurofibromatose. Na investigação diagnóstica, a ressonância magnética do encéfalo (RM) e a tomografia computadorizada de crânio (TC) mostraram imagens sugestivas de neoplasia de 2,3x2,0x3,0 cm, ocupando as fossas ptérigo-palatina e infratemporal esquerda, com contornos regulares e captação homogênea de contraste. O tumor erodia a base do osso temporal, alargava um forame considerado como o forame oval e avançava 5mm para o interior da fossa média (Figs 1 e 2).A paciente foi submetida a procedimento cirúrgico por acesso médio facial, incisão sublabial mais extensa à esquerda, incisão transeptal e circunvestibular nasal. Seguiuse união das incisões sublabial e nasal para posterior elevação dos tecidos moles do terço médio da face, com exposição da parede anterior e medial do seio maxilar e união da cavidade do nariz com o seio maxilar. Foi realizada remoção da parede posterior do seio maxilar com exposição das fossas ptérigo-palatina e infratemporal e coagulação da artéria maxilar e de seus ramos distais. Identificou-se tumor de consistência sólida ocupando ambas as fossas, sendo retirado em bloco após secção de V3. Houve pequena abertura da dura-máter da fossa média, que foi reparada com músculo e cola de fibrina. A cavidade

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Unilateral Upper and Lower Subtotal Maxillectomy Approaches to the Cranial Base: Microsurgical Anatomy

Abstract: The upper and lower subtotal maxillectomy approaches provide wide but differing access to large parts of the central and lateral cranial base depending on the site of the osteotomies.

Cited by 47 publications

References 22 publications

A morphometric study of the inferior orbital fissure using three‐dimensional anatomical landmarks: Application to orbital surgery

A morphometric study of the inferior orbital fissure using three‐dimensional anatomical landmarks: Application to orbital surgery

Raeder's syndrome after embolization of a giant intracavernous carotid artery aneurysm: pathophysiological considerations

Schwanoma do ramo mandibular do nervo trigêmeo: relato de caso

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