RESUMEN
The canalis sinuosus is an anatomical variation whereby the infraorbital canal sometimes generates a small, lateral branch (canal) close to its midpoint, to allow the passage of the anterior superior alveolar neurovascular bundle in the anterior maxilla. This article focuses on an incidental finding of this variant, in a 74-year-old Trinidadian female of Afro-Caribbean descent with an endodontic presenting complaint. The canalis sinuosus shadow on conventional radiography resulted in uncertainty as to the offending tooth until a 3-dimensional scan was undertaken in this region. This report will discuss the implications of the presence of this canal from radiologic, endodontic, and surgical perspectives.
Asunto(s)
Enfermedades Periapicales , Humanos , Femenino , Anciano , Diagnóstico Diferencial , Enfermedades Periapicales/diagnóstico por imagen , Hallazgos Incidentales , Maxilar/diagnóstico por imagen , Variación Anatómica , Imagenología Tridimensional , Tomografía Computarizada de Haz Cónico , Nervio Maxilar/diagnóstico por imagen , Nervio Maxilar/anatomía & histología , Radiografía PanorámicaRESUMEN
Experimental maxillofacial surgery is commonly performed in pigs; however, locoregional anesthesia of this area has not been described. This study evaluated the feasibility of a novel maxillary nerve block approach. In part I, cadavers were used to determine anatomic landmarks and assess maxillary nerve dye staining by using 0.03 mL kg-1 of a 1:10 mixture of commercial food dye and 0.5% bupivacaine. In part II, 10 additional pig cadavers underwent bilateral ultrasound-guided maxillary nerve blocks by using trans-infraorbital canal needle placement. The maxillary nerve was harvested and scored based on degree of staining (0 and 1, absent or incomplete staining; 2, staining; >1 cm circumferentially). Intracranial and intraconal spread of dye was evaluated. A Kruskal-Wallis test was used to compare infraorbital canal length estimated either externally via landmarks, internally via ultrasound, or actually measured after dissection. In 18 of 20 (90%) injections, successful staining (score = 2) of maxillary nerves was obtained for a nerve length of 2.4 ± 0.3 cm. Two of 20 cases (10%) had inadequate staining (score <2). At dissection of these 2 cases, the needle tip was observed to have collided with an unerupted tooth (third molar). No intracranial or intraconal spread of dye was observed. We detected no statistical differences between the estimated external, estimated internal, or actual dissection methods for measurement of infraorbital canal length (P = 0.3). Ultrasound-guided trans-infraorbital maxillary nerve block in pigs is a feasible technique, warranting further work to evaluate its in vivo efficacy and safety.
Asunto(s)
Estudios de Factibilidad , Nervio Maxilar , Bloqueo Nervioso , Animales , Nervio Maxilar/anatomía & histología , Porcinos , Bloqueo Nervioso/métodos , Bloqueo Nervioso/veterinaria , Cadáver , Ultrasonografía Intervencional/métodos , Bupivacaína/administración & dosificación , Anestésicos Locales/administración & dosificación , Órbita/anatomía & histología , Órbita/diagnóstico por imagenRESUMEN
PURPOSE: To develop and evaluate a transorbital endoscopic approach to the foramen rotundum to excise the maxillary nerve and infraorbital nerve branch. METHODS: Cadaveric dissection study of 10 cadaver heads (20 orbits). This technique is predicated upon 1) an inferior orbital fissure release to facilitate access to the orbital apex and 2) the removal of the posterior maxillary wall to enter the pterygopalatine fossa (PPF). Angulations along the infraorbital nerve were quantified as follows: the first angulation was measured between the orbitomaxillary segment within the orbital floor and the pterygopalatine segment suspended within the PPF, while the second angulation was taken between the pterygopalatine segment and maxillary nerve as it exited the foramen rotundum. With refinement of the technique, the minimum amount of posterior maxillary wall removal was quantified in the final 5 cadaver heads (10 orbits). RESULTS: The mean distance from the inferior orbital rim to the foramen rotundum was 45.55 ± 3.24 mm. The first angulation of the infraorbital nerve was 133.10 ± 16.28 degrees, and the second angulation was 124.95 ± 18.01 degrees. The minimum posterior maxillary wall removal to reach the PPF was 11.10 ± 2.56 mm (vertical) and 11.10 ± 2.08 mm (horizontal). CONCLUSIONS: The transorbital endoscopic approach to an en bloc resection of the infraorbital nerve branch up to its maxillary nerve origin provides a pathway to the PPF. This is relevant for nerve stripping in the context of perineural spread. Other applications include access to the superior portion of the PPF in selective biopsy cases or in concurrent orbital pathology.
Asunto(s)
Cadáver , Endoscopía , Nervio Maxilar , Órbita , Humanos , Nervio Maxilar/cirugía , Nervio Maxilar/anatomía & histología , Órbita/inervación , Órbita/cirugía , Endoscopía/métodos , Fosa Pterigopalatina/cirugía , Fosa Pterigopalatina/inervaciónRESUMEN
OBJECTIVE: To investigate and describe an extraoral approach to perform a maxillary nerve block in guinea pigs. STUDY DESIGN: Prospective, randomized, blinded, descriptive, cadaveric study. ANIMALS: A total of 14 adult guinea pig cadavers. METHODS: Two cadavers were used for anatomic dissection and determination of maxillary nerve block approach. A maxillary nerve block via infraorbital approach was then performed in 12 cadavers. A low volume (0.1 mL) or high volume (0.2 mL) of diluted methylene blue injectate was randomly assigned to the right or left side, with the other volume used for the contralateral side. The maxillary nerve was dissected after each injection by an investigator blinded to injectate volume. The region of dye distribution was identified, and the degree of staining assigned an accuracy score (0-2). Nerve coverage was considered adequate if ≥6 mm of circumferential staining was present. RESULTS: Accuracy evaluation indicated successful dye deposition in 10/12 [2 (0-2), median (range)] injections in the low volume group and 8/12 [2 (1-2)] injections in the high volume group. The majority (79.2%) of injections resulted in adequate nerve staining. There were no statistically significant differences between injectate volumes for accuracy (p = 0.64) or adequacy (p > 0.99) of staining. CONCLUSIONS: The infraorbital approach is a simple and practical method for maxillary nerve blockade in guinea pigs. An injectate volume of 0.1 mL results in adequate maxillary nerve coverage; however, additional studies are needed to assess the efficacy in clinical use.
Asunto(s)
Bloqueo Nervioso , Animales , Cobayas , Cadáver , Inyecciones/veterinaria , Nervio Maxilar/anatomía & histología , Bloqueo Nervioso/veterinaria , Bloqueo Nervioso/métodos , Estudios Prospectivos , Ultrasonografía Intervencional/métodos , Ultrasonografía Intervencional/veterinaria , Distribución AleatoriaRESUMEN
OBJECTIVE: To establish a new method for fast exposure of the internal maxillary artery (IMA) during extracranial-intracranial bypass surgery. METHODS: To explore the positional relationship between the IMA and the maxillary nerve and pterygomaxillary fissure, 11 formalin-fixed cadaveric specimens were dissected. Three bone windows of the middle fossa were created for further analysis. Then the IMA length that could be pulled up above the middle fossa was measured after different degrees of removal of bony structure. The IMA branches under each bone window were also explored in detail. RESULTS: The top of the pterygomaxillary fissure was located 11.50 mm anterolateral to the foramen rotundum. The IMA could be identified just inferior to the infratemporal segment maxillary nerve in all specimens. After drilling of the first bone window, the IMA length that could be pulled above the middle fossa bone was 6.85 mm. After drilling of the second bone window and further mobilization, the IMA length that could be harvested was significantly longer (9.04 mm vs. 6.85 mm; P < 0.001). Removal of the third bone window did not significantly improve the IMA length that could be harvested. CONCLUSIONS: The maxillary nerve could be used as a reliable landmark for the exposure of the IMA in the pterygopalatine fossa. With our technique, the IMA could be easily exposed and sufficiently dissected without zygomatic osteotomy and extensive middle fossa floor removal.
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Revascularización Cerebral , Arteria Maxilar , Humanos , Arteria Maxilar/cirugía , Nervio Maxilar/cirugía , Nervio Maxilar/anatomía & histología , Procedimientos Neuroquirúrgicos/métodos , Craneotomía , Revascularización Cerebral/métodos , CadáverRESUMEN
The infraorbital canal serves as a conduit for the infraorbital nerve. The canal travels anteriorly beneath the globe where it emerges onto the face at the infraorbital foramen. Variations in the morphology of the infraorbital canal have been reported and classified based on their relationship with the maxillary sinus. Similarly to the other orbital fat compartments, fat in the infraorbital canal serves as protection to the structures it surrounds. Generally, the orbital fat compartments do not undergo hypertrophy without a pathological etiology, therefore, it has been hypothesized that herniations of orbital fat are a result of age-related bony changes in the orbit. The inferior orbital rim, in particular, acts to support structures of the orbit including the fat compartments, ligaments, and muscles. The most commonly reported herniations are those of the infraorbital fat pads, which either prolapse into the inferior orbital fissure or move anteriorly to give patients the appearance of a bulging lower eyelid. Additionally, there are reports of traumatic injuries that result in herniation of the buccal fat pad into the maxillary sinus. Herein, we report a rare case of a herniation of the infraorbital canal fat into the maxillary sinus and review the salient literature.
Asunto(s)
Seno Maxilar , Órbita , Humanos , Seno Maxilar/diagnóstico por imagen , Órbita/anatomía & histología , Mejilla , Nervio Maxilar/anatomía & histología , CadáverRESUMEN
BACKGROUND: The posterior auricular nerve (PAN) is an inspiring candidate for the additional axonal source in long-term facial paralysis to improve the functional results of the cross-facial nerve (FN) graft technique. However, no studies have analyzed the PAN's axonal load and its microscopic anatomy to assess its utilization in facial reanimation. The present study aims to examine the anatomical and microscopic features of the PAN to analyze its feasibility as a donor nerve. METHODS: The bilateral facial side of 14 fresh frozen adult human cadavers was examined for the study. The PAN's anatomical course was recorded, and nerve specimens from the PAN and zygomatic nerve (ZN) were obtained to compare their microscopic anatomy and axon counts using a light microscope and transmission electron microscope. RESULTS: The PAN's average branching distance and its course length were 5.8 ± 2.69 mm and 59.2 ± 5.85, respectively. The mean number of myelinated axons was 600.28 ± 69.97 in the PAN and 728.85 ± 166.31 in the ZN. This difference between the two nerves was statistically significant (p = 0.002). However, considering the gender variable, the mean axon counts of PAN and ZN were statistically similar for face sides and their average. Furthermore, the ultrastructural anatomy of both nerves was similar in electron microscopic evaluation. CONCLUSIONS: The present study confirms that the PAN is a proper candidate to be a supportive donor nerve due to its isolated site, consistent anatomical course, convenient ultrastructural anatomy as well as axonal load.
Asunto(s)
Parálisis Facial , Transferencia de Nervios , Adulto , Cadáver , Cara , Nervio Facial/anatomía & histología , Parálisis Facial/cirugía , Humanos , Nervio Maxilar/anatomía & histología , Transferencia de Nervios/métodosRESUMEN
OBJECTIVES: The maxillary nerve courses very close to the globe, rendering cats - with their large eyes - at risk of globe penetration during infraorbital or maxillary nerve blocks. Therefore, the goals of the study were to compare the distribution and potential complications of three infraorbital or maxillary regional injection techniques. METHODS: Twenty-three bilateral maxillae of cat cadavers were used in a randomised blinded trial. Each maxilla was injected with a 0.2 ml 1:1 mixture of lidocaine 2% and a contrast medium by one of three injection techniques: infraorbital foramen (IOF; n = 14); infraorbital canal (IOC; n = 16); or maxillary foramen (MF; transpalpebral approach; n = 16) using a 25 G 1.6 cm needle. CT imaging of each cadaver head was performed before and after injections. A radiologist scored injectate distribution (none [0], mild [1], moderate [2], large [3]) in four locations: rostral, central and caudal IOC, and at the MF, for which the distribution side was also determined. Comparisons were performed with ordinal logistic mixed effects (P <0.05). RESULTS: The median (range) total distribution score of the IOC and MF technique were significantly higher compared with the IOF technique (6.5 [4-12], 4 [2-8] and 0 [0-10], respectively). The total IOC score was also significantly higher compared with the MF technique. Injectate distribution at the MF was significantly more central following IOC injection compared with MF injection, which distributed centrolaterally. None of the techniques resulted in intraocular injection. CONCLUSIONS AND RELEVANCE: The IOC and MF techniques produced a satisfactory spread of the mixture that could result in effective maxillary anaesthesia in cats. Further studies are required to determine the effectiveness and safety of these techniques.
Asunto(s)
Anestésicos , Enfermedades de los Gatos , Animales , Cadáver , Gatos , Maxilar , Nervio Maxilar/anatomía & histología , Órbita/inervaciónRESUMEN
PURPOSE: The importance of the infraorbital canal in the growth of the maxilla and associated mid-facial region has significance for innervation of this region as well as the associated dentition, yet little is known about the development of the canal. An analysis of its dimensions and morphology during the late prenatal and early postnatal periods was thus undertaken. The aim of this study was to describe changes in the morphology, size and branching pattern of the infraorbital canal during the late prenatal and early postnatal stages of human growth. METHODS: Fifty human fetal and neonatal maxillae were analyzed. The sample included 27 late prenatal individuals (30 gestational weeks and birth) and 23 early postnatal individuals (birth and 1 year). Maxillae were scanned using a Nikon XTH 225 L micro-CT unit and analyzed using VG studiomax v3.2. Measurements included the maximum width, height and surface area of each foramen associated with the infraorbital canal and the total length of the canal, bilaterally. RESULTS: All the measurements of the canal were greater in the early postnatal group than in the late prenatal group, while the walls and branching pattern of the canal were better developed in the postnatal group. Bone development occurred within the walls as development proceeded. Variations in the branching pattern of the canal were found. CONCLUSION: The morphology of the infraorbital canal reflected the developmental stage of associated structures such as the dentition, maxillary sinus and orbit.
Asunto(s)
Maxilar/anatomía & histología , Seno Maxilar/anatomía & histología , Puntos Anatómicos de Referencia , Variación Anatómica , Cadáver , Feto , Humanos , Lactante , Recién Nacido , Maxilar/diagnóstico por imagen , Maxilar/crecimiento & desarrollo , Nervio Maxilar/anatomía & histología , Nervio Maxilar/diagnóstico por imagen , Seno Maxilar/diagnóstico por imagen , Seno Maxilar/crecimiento & desarrollo , Microtomografía por Rayos XRESUMEN
âPURPOSE: Suprazygomatic maxillary nerve blocks (SMB) are used in adult and pediatric patients to provide analgesia for midface surgery and chronic maxillofacial pain syndromes. The ultrasound-guided SMB technique ensures visualisation of the needle tip, avoidance of the maxillary artery and confirmation of local anesthetic spread. The goal of this study was to correctly identify SMB sonoanatomical landmarks to ensure the nerve block is performed safely and effectively. METHODS: Following an ultrasound-guided SMB with dye injection on 2 embalmed cadavers, pre-tragal face-lift style incision with a full thickness flap dissection was performed allowing accurate visualization of the bony landmarks being used for sonography and identification of the location of the injected dye. RESULTS: This study identifies the correct sonoanatomic landmarks as the maxilla and the coronoid process of the mandible which suggests that the block needle tip and local anesthetic injection are within the infratemporal fossa as opposed to the previously reported pterygopalatine fossa. CONCLUSION: An improved understanding of the sonoanatomy will aid clinicians who are learning, performing and teaching the ultrasound-guided suprazygomatic approach to the maxillary nerve block.
Asunto(s)
Anestesia de Conducción , Bloqueo Nervioso , Adulto , Cadáver , Niño , Humanos , Nervio Maxilar/anatomía & histología , Nervio Maxilar/diagnóstico por imagen , Ultrasonografía , Ultrasonografía IntervencionalRESUMEN
The anatomical variations of the maxillary sinus septa, greater palatine artery, and posterior superior alveolar arteries might cause unexpected complications when they are damaged. Dentists who know these structures well might hope to learn more practical knowledge to avoid and assess injury preoperatively. Therefore, this review paper aimed to review the reported anatomy and variations of the maxillary sinus septa, greater palatine artery/nerve, and posterior superior alveolar artery, and to discuss what has to be assessed preoperatively to avoid iatrogenic injury. To assess the risk of injury of surgically significant anatomical structures in the maxillary sinus and hard palate, the operator should have preoperative three-dimensional images in their mind based on anatomical knowledge and palpation. Additionally, knowledge of the average measurement results from previous studies is important.
Asunto(s)
Variación Anatómica , Implantación Dental Endoósea/efectos adversos , Complicaciones Intraoperatorias/prevención & control , Seno Maxilar/anomalías , Tomografía Computarizada de Haz Cónico , Implantación Dental Endoósea/métodos , Encía/trasplante , Humanos , Imagenología Tridimensional , Complicaciones Intraoperatorias/etiología , Arteria Maxilar/anatomía & histología , Arteria Maxilar/diagnóstico por imagen , Arteria Maxilar/lesiones , Nervio Maxilar/anatomía & histología , Nervio Maxilar/diagnóstico por imagen , Nervio Maxilar/lesiones , Seno Maxilar/diagnóstico por imagen , Seno Maxilar/cirugía , Osteotomía Le Fort/efectos adversos , Paladar Duro/irrigación sanguínea , Paladar Duro/diagnóstico por imagen , Paladar Duro/inervación , Factores de Riesgo , Elevación del Piso del Seno Maxilar/efectos adversos , Recolección de Tejidos y Órganos/efectos adversosRESUMEN
PURPOSE: Anatomical knowledge of the zygomatic region is important, because the zygomatic nerve and its branches may suffer lesions during surgical procedures in the periorbital region. The position and frequency of zygomaticofacial foramina (ZFF) may vary between individuals, and between one side and the other in the same individual. In the present study, we analysed the presence and location of ZFF, as well as the distance between them and the orbital cavity, in macerated skulls of adult individuals. METHODS: We examined 287 macerated skulls, of individuals of both sexes, analysing the frequency and location of ZFF and the distance from the ZFF to the margin of the orbital cavity (OC). RESULTS: Zygomaticofacial foramina are very frequent structures which tend to appear singly. They are generally located in the temporal process of the zygomatic bone, but in many cases, they may be located in the mid portion of the bone. They also tend to appear at the same distance from the OC when left and right sides are compared. Sex was an important factor in determining differences in ZFF; the distance from the ZFF to the margin of the OC was greater in males than in females. Sex, age, side and skin colour did not affect the frequency and location of the ZFF. CONCLUSION: We consider that the mid portion of the zygomatic bone is the safest place to anchor zygomatic implants (ZI), since ZFF are less frequently located there than in the temporal process of the zygomatic bone.
Asunto(s)
Variación Anatómica , Implantación Dental/efectos adversos , Nervio Maxilar/anatomía & histología , Complicaciones Posoperatorias/prevención & control , Cigoma/inervación , Adolescente , Adulto , Factores de Edad , Implantación Dental/instrumentación , Implantación Dental/métodos , Implantes Dentales/efectos adversos , Femenino , Hormonas Esteroides Gonadales , Humanos , Masculino , Nervio Maxilar/lesiones , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Adulto Joven , Cigoma/cirugíaRESUMEN
The infraorbital nerve (ION) and artery (IOA) course in the infraorbital canal (IOC) to exit through the infraorbital foramen (IOF). Few previous studies brought evidence of accessory IOF. Evaluation of the IOF in Cone Beam Computed Tomography (CBCT) is more accurate to determine whether or not foramina of maxilla are supplied by canaliculi deriving from the IOC. We performed a retrospective anatomical study of the CBCT files of 200 patients. An accessory infraorbital foramen located inferior to the infraorbital margin (AIOF) was found in 18/200 right maxillae and in 13/200 left ones. Canaliculi deriving from the IOC supplied accessory foramina in the sutura notha- AIOF(SN) - in 15 maxillae. Noteworthy, the AIOF(SN)-negative maxillae displayed the SN and the vascular foramina of Macalister. In 94% of cases the AIOF were unique. A single maxilla (3%) had a double AIOF. In a different case (3%) were found three accessory infraorbital foraminules transforming the anterior wall of the antrum into a veritable lamina cribriformis infraorbitalis. A single prior study distinguished AIOF from AIOF(SN), while most of different other ones were performed on dry bones. Therefore, the reports of prevalence for the number and location of AIOF should be regarded with caution. Foramina of the SN could equally get intraosseous and extraosseous supply, this distinction being accurately made in CBCT.
Asunto(s)
Variación Anatómica , Maxilar/anatomía & histología , Órbita/anatomía & histología , Cadáver , Arteria Carótida Externa/anatomía & histología , Arteria Carótida Externa/diagnóstico por imagen , Angiografía por Tomografía Computarizada , Tomografía Computarizada de Haz Cónico , Femenino , Humanos , Imagenología Tridimensional , Masculino , Maxilar/diagnóstico por imagen , Nervio Maxilar/anatomía & histología , Nervio Maxilar/diagnóstico por imagen , Órbita/diagnóstico por imagen , Estudios RetrospectivosRESUMEN
BACKGROUND: The aim of this study is to describe the presence, to reveal the frequency and characteristics of accessory canals (ACs) of the canalis sinuosus (CS) by cone beam computed tomography (CBCT). MATERIAL AND METHODS: A total of 326 CBCT examinations were scanned retrospectively. The anatomical views were evaluated on sagittal, axial, coronal and cross sectional imaging. The following parameters were recorded: age, sex, presence or absence of ACs, location in relation to the adjacent teeth and distance to the nasal cavity floor (NCF), alveolar ridge crest (ARC) and buccal cortical bone (BCB), and incisive canal. All the collected data were statistically analyzed. RESULTS: 113 patients (34,7%); presented ACs in total 214 foramina of the sample. There were no statistically sig-nificant changes in the presence of ACs regarding age groups excluding 80-89 years. But there is a statistically significant difference regarding the frequency of ACs and the gender. The prevalence for male patients was higher than female patients. Curved-shape configuration of CS prevalence is found as 69,15%. The prevalence of vertical tracing is 26,16% and Y-shape configuration of CS prevalence is 4,67%. Diameter of the foramens of the CS branches was 1.30 mm. The mean distance of the AC to the NCF, BCB, and ARC were found 13,83 mm, 6,60 mm and 5,32 mm, respectively. CONCLUSIONS: In the anterior palatal region, ACs are mostly related to CS's branches. So; knowing the course of CS branches in surgical planning and radiographic evaluations in this region is extremely important for preventing complications and avoiding misdiagnosis
No disponible
Asunto(s)
Humanos , Masculino , Femenino , Niño , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Maxilar/anatomía & histología , Maxilar/diagnóstico por imagen , Nervio Maxilar/anatomía & histología , Nervio Maxilar/diagnóstico por imagen , Tomografía Computarizada de Haz Cónico/métodos , Hueso Cortical/anatomía & histología , Hueso Cortical/diagnóstico por imagen , Cavidad Nasal/anatomía & histología , Cavidad Nasal/diagnóstico por imagen , Factores de Edad , Factores Sexuales , Estándares de Referencia , Puntos Anatómicos de Referencia , Estudios RetrospectivosRESUMEN
PURPOSE: Although a maxillary nerve (MN) block reportedly provides satisfactory analgesia for midface surgery and chronic maxillofacial pain syndromes, a safe and reliable MN block technique has not been reported. The goal of this anatomical study was to quantify the various angles and depth of the block needle, as well as to evaluate the impact of volume on the extent of injectate spread that might influence anesthetic coverage and block-related complications. METHODS: Following an ultrasound-guided suprazygomatic MN block with dye injection, a dissection was performed in the pterygopalatine fossa (PPF) of four lightly embalmed cadaveric specimens. Half of the specimens were injected with 5 mL of dye, and the other half with 1 mL of dye. The needle depth was measured from the ultrasound images and using rubber markers. Following injection, dissection was performed to map the area of dye spread. RESULTS: The median [interquartile range (IQR)] distance from the skin to the PPF was 37 [36-43] mm and 47 [40-50] mm by ultrasound and rubber marker methods, respectively. The median [IQR] needle orientation was 14 [11-32] degrees inferiorly and 15 [10-17] degrees posteriorly. The PPF was consistently dyed in the 5 mL group, but sporadically dyed in the 1 mL group. In the 5 mL group, spread outside of the PPF was seen. CONCLUSIONS: We showed that 5 mL of injectate far exceeds the capacity of the PPF, leading to drug spread outside of the PPF. Moreover, we found that 1 mL of injectate largely covered the nerve, suggesting a more efficacious and safer block procedure. This finding will need confirmation in future clinical studies.
Asunto(s)
Anestesia de Conducción , Bloqueo Nervioso , Ultrasonografía Intervencional , Cadáver , Humanos , Nervio Maxilar/anatomía & histología , Nervio Maxilar/diagnóstico por imagenRESUMEN
The aim of this paper was to determine the frequency of Canalis Sinuosus (CS) and its anatomic variations. A total of 236 cone beam computed tomography (CBCT) images were studied. Characteristics of the canal such as its form, pathway and diameter were analyzed. The CS was clearly visualized in 100 % of the images with variations in the canal observed in up to 46 % of the cases. In 79 % of the cases the variation was found to be bilateral. The most common variation was an increase in the diameter (> 1mm) of the CS. Considering that the anterior region of the middle third of the face is a common place for clinical interventions, this study supports the need to perform a thorough evaluation of the maxillary region prior to clinical interventions in order to prevent complications such as direct or indirect injury to the anterior superior alveolar neurovascular bundle contained within the CS.
El objetivo de este trabajo fue determinar la frecuencia de Canalis Sinuosus (CS) y sus variaciones anatómicas. Se estudiaron un total de 236 imágenes de tomografía computarizada de haz cónico (CBCT). Se analizaron las características del canal, como su forma, vía y diámetro. El CS se visualizó claramente en el 100 % de las imágenes, observándose variaciones en el canal en hasta el 46 % de los casos. En el 79 % de los casos la variación fue bilateral. La variación más común fue un aumento en el diámetro (> 1 mm) de la CS. Teniendo en cuenta que la región anterior del tercio medio de la cara es un lugar común para las intervenciones clínicas, este estudio apoya la necesidad de realizar una evaluación exhaustiva de la región maxilar antes de las intervenciones clínicas para prevenir complicaciones como lesiones directas o indirectas a el haz neurovascular alveolar superior anterior contenido dentro de la CS.
Asunto(s)
Humanos , Masculino , Femenino , Niño , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Adulto Joven , Tomografía Computarizada de Haz Cónico , Variación Anatómica , Maxilar/diagnóstico por imagen , Prevalencia , Estudios Transversales , Estudios Retrospectivos , Distribución por Edad y Sexo , Maxilar/inervación , Nervio Maxilar/anatomía & histología , Nervio Maxilar/diagnóstico por imagenRESUMEN
BACKGROUND: Lesions located at the petrous apex, cavernous sinus, clivus, medial aspect of the jugular foramen, or condylar regions are still difficult to fully expose using the operating microscope. Although approaches to this region through the middle cranial fossa have been previously described, these approaches afford only limited visualization. We have confirmed a transcranial infratemporal fossa combined microsurgical and endoscopic access to the petrous apex, clivus, medial aspect of the jugular foramen, and occipital condyle. We have presented the results of a micro-anatomical cadaver dissection study and its clinical application. METHODS: Ten latex-injected cadaveric specimens (20 twenty sides) underwent dissection with navigational guidance to achieve an extended anterior petrosal approach combined with a far vidian corridor approach (between the foramen rotundum and foramen ovale). We performed anatomical dissections to confirm the surgical anatomy and the feasibility and limitations of this approach. Anatomical dissections were performed in the skull base laboratory of Lariboisière Hospital and Duke University Medical Center. This approach was then applied to some clinical cases. RESULTS: The combination of the microscope and endoscope, aided by surgical navigation, was extremely effective and provided a wide view of the petrous rhomboid, the entire clivus, and the medial condylar regions. The extended extradural anterior petrosal approach provided a large corridor to petrous and clival lesions. Endoscopic assistance allows for wide and deep exposure of the middle to lower clivus, epipharyngeal space, and bilateral condylar regions. This approach successfully provided adequate surgical access for resection of tumors located in these regions. The depth of the medial aspect of the jugular foramen was 16.3 ± 1.2 mm deep from the geniculate ganglion. The emerging point of the inferior petrosal sinus in the jugular foramen was 16.5 ± 1.8 mm deep from the geniculate ganglion. The hypoglossal canal was 21.6 ± 2.2 mm deep from the geniculate ganglion. The foramen magnum was located 31.5 ± 2.4 mm deep from the gasserian ganglion. The inferior petrosal sinus was found to be a reliable landmark to identify the medial portion of the jugular bulb. The introduction of the endoscope through the middle fossa rhomboid enabled visualization of the medial aspect of the jugular bulb, which otherwise would be hampered by the internal auditory canal under the microscope. CONCLUSION: After microscopic exposure of the middle fossa rhomboid, neuronavigational endoscopic assistance facilitated visualization of the ventral cavernous region, petrous apex, retropharyngeal space, and middle and inferior clivus down to the medial aspect of the jugular bulb and condyle regions. Additional maxillary nerve-mandibular nerve vidian corridor visualization provides a lateral transsphenoidal approach to upper clivus lesions.
Asunto(s)
Microcirugia/métodos , Neuroendoscopía/métodos , Neuronavegación/métodos , Base del Cráneo/anatomía & histología , Base del Cráneo/cirugía , Cadáver , Ganglio Geniculado/anatomía & histología , Humanos , Nervio Maxilar/anatomía & histologíaRESUMEN
BACKGROUND: The accessory infraorbital foramen (AIOF) is an anatomical variation associated with the infraorbital foramen (IOF) and nerve (ION). Its occurrence and neural contents have clinical implications regarding failure of loco-regional anesthesia and risk of neural damage during surgical interventions involving the maxillary region. Thus, morphologic characterization of the AIOF and neural contents as well as the spatial relationships to the IOF are potentially useful for optimizing surgical procedures. Additionally, predictive features of the AIOF based on its relationship to IOF morphology could enable the surgeon to anticipate its presence and proceed accordingly. The purpose of this study was to determine whether the presence of an AIOF and its neural contents affected the size, shape, and composition of the IOF and ION. The specific hypothesis tested was that the topography and fascicular composition of the ION and IOF differs between individuals possessing an AIOF and those lacking this anatomical variant. METHODS: Gross topographic features of the IOF (42 crania) were compared between specimens possessing (test) or lacking (control) an AIOF. Nerve fascicles of ION (60 cadaveric sides) were examined histologically and compared morphometrically between specimens presenting or lacking an AIOF. An additional sample of 30 crania was subjected to cone-beam computed tomography (CBCT) analysis to determine the course of the canal leading to the AIOF. RESULTS: The AIOF incidence was 47.6% (20 crania) and 32.1% of the sides (27 sides). A single AIOF was observed in 24 sides and double AIOF in three sides. The AIOF occurred bilaterally in 7 specimens (16.7%). The majority of AIOF (86.7%) were located superomedial to IOF. A slightly higher frequency of the AIOF was found in left side compared to the right. Using CBCT, a patient sample showed an AIOF incidence in 21 sides of 16 patients (65.6%). A single AIOF was observed in 19 sides. Only 1 double AIOF was found in the scans, whereas 3 were found in the dry skull group. The AIOF occurred bilaterally in 3 scans (10%). The majority of AIOF (90.4%) were located superomedial to the IOF based on the CBCT scans. The AIOF was consistently seen connected to the infraorbital canal and progressed superiorly and medially from the infraorbital canal to the maxillary surface. The size of the ION without an AIOF was not significantly different than the ION in the presence of an AIOF (1.45â×â10/1.32â×â10âµm, Pâ<â0.35) based on fascicular area. However, the number of ION fascicles was greater in specimens without an AIOF compared to those showing this feature (15.15/12.71, Pâ<â0.04) CONCLUSION:: Results indicate that the area of the ION is not affected by an AIOF, suggesting that the field of innervation of this area is not modified by its occurrence. However, the ION appears to divide more proximally into its component branches when the AIOF is present.
Asunto(s)
Maxilar/anatomía & histología , Nervio Maxilar/anatomía & histología , Órbita/inervación , Adulto , Variación Anatómica , Cadáver , Tomografía Computarizada de Haz Cónico , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The sphenoidal tubercle is a bone elevation located in the anterior edge of the infratemporal crest of the sphenoid greater wing, where the temporal and lateral pterygoid muscles have their origin. This bone accident presents varied morphology so its description and denomination are a topic of discussion. 60 dry skulls obtained from the morphology laboratory of the Biomedical Basic Sciences Department of the University of Talca were used for a morphological and morphometric analysis of the sphenoidal tubercle including its morphology, diameters (anteroposterior, transverse and vertical) and the distance to the grooves for the maxillary artery and maxillary nerve. Sphenoidal tubercle had a prevalence of 98.4 % of all dry skulls analyzed with a bilateral presentation in the 76.6 % of the cases. According to its different forms of presentation established by Cáceres et al., (2016) the pyramidal form was the most frequent with a 25.7 %. The average diameters were of 4.12 mm anteroposterior, 5.50 mm transverse and 3.89 mm vertical. The average distance to the grooves of the maxillary artery and maxillary nerve were 9.04 mm and 7.6 mm, respectively. Sphenoidal tubercle is a constant bone accident with a variated morphology and measures. Due to its anatomical relations with important neurovascular elements such as the maxillary artery and the maxillary nerve, it may be used as a reference point for surgical access to the infratemporal fossa. From this analysis we establish that the denomination of "infratemporal process" is more accurate, because the development of this bone accident is from muscular traction performed by the lateral pterygoid muscle and the deep portion of the temporal muscle causing great variations in its morphology, probably due to external and functional parameters or even influenced by the biotype.
El tubérculo esfenoidal es una elevación ósea ubicada en el extremo anterior de la cresta infratemporal del ala mayor del hueso esfenoides, donde presta inserción al músculo temporal y pterigoideo lateral. Presenta morfología variada, por lo que su descripción y denominación resultan motivo de discusión. 60 cráneos secos obtenidos del Laboratorio de Morfología del Departamento de Ciencias Básicas Biomédicas de la Universidad de Talca, fueron utilizados para realizar un análisis morfológico y morfométrico del tubérculo esfenoidal evaluando forma, diámetros (anteroposterior, laterolateral y vertical) y distancia con el surco de la arteria y nervio maxilar. El tubérculo esfenoidal tuvo una prevalencia del 98,4 % del total de cráneos analizados, presentándose bilateralmente en el 76,6 % de los casos. De acuerdo a las diferentes formas de presentación establecidas por Cáceres et al (2016) la forma piramidal fue la más frecuente con un 25,7 %. Los diámetros promedio fueron de 4,12 mm anteroposterior, 5,50 mm laterolateral y 3,89 mm vertical. Las distancias promedio con el surco de la arteria y nervio maxilar fueron de 9,04 mm y 7,6mm, respectivamente. El tubérculo esfenoidal es un accidente óseo constante de morfología y dimensiones variadas. Debido a sus relaciones con elementos vasculares de importancia, tales como la arteria y nervio maxilar, podría ser utilizado como elemento de referencia para el acceso quirúrgico a la fosa infratemporal. A partir de su análisis planteamos que su denominación como "proceso infratemporal" sería más apropiado, debido a que se desarrollaría a partir de la tracción muscular ejercida por el musculo pterigoideo lateral y la porción profunda del músculo temporal, ocasionando variaciones notables en su morfología, probablemente debido a factores externos y funcionales o incluso influenciada por el biotipo.
Asunto(s)
Humanos , Hueso Esfenoides/anatomía & histología , Músculo Temporal/anatomía & histología , Arteria Maxilar/anatomía & histología , Nervio Maxilar/anatomía & histología , Estudios TransversalesRESUMEN
BACKGROUND: Understanding the topography of the blood vessels distributed around the nasolabial fold region is essential for ensuring the safety of dermal filler injections into the nasolabial fold. The purpose of this study was to provide anatomical information on the infraorbital artery distribution and its relationship with the facial artery for use in clinical procedures involving filler injection during nasolabial fold augmentation. METHODS: The infraorbital artery was investigated in the nasolabial fold region divided into zones I to XII based on clock-hour meridians centered on the infraorbital foramen. The running layers of the infraorbital artery and infraorbital nerve were also compared in the infraorbital foramen. Changes in the infraorbital artery were observed according to vascular dominance of the facial artery. RESULTS: The infraorbital artery was divided into three main branches, palpebral, nasal, and labial infraorbital artery branches in 34.7, 100, and 100 percent of the specimens, respectively; with these branches of palpebral, nasal, and labial infraorbital artery observed most commonly in zones I, V, and VI, respectively. Analysis of the bilateral facial artery topography revealed that its vascular dominance was observed in 19.4 percent. The infraorbital artery was thicker and had a wider distribution on the nondominant side of the facial artery, whereas the nasal infraorbital nerve anastomosed with the facial artery in the lateral nasal region in 57.1 percent. CONCLUSION: Investigating and verifying the vascular structure regarding its interactions with the facial artery and infraorbital artery will provide critical information to physicians performing facial surgery and cosmetic procedures.