Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 106
Filtrar
Mais filtros










Intervalo de ano de publicação
1.
J Craniofac Surg ; 30(8): e757-e760, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31348199

RESUMO

Hydatid cyst (echinococcosis) is an infectious disease caused mainly by Echinococcus granulosus, a parasite transmitted by dogs and encountered first in the liver and then in the lungs. Involvement in the head and neck region is uncommon, and pterygopalatine fossa disease resulting from hydatid cyst is extremely rare, with only 4 reported patients. In this report, the authors present a patient with exophthalmus caused by a primary hydatid cyst and involving the pterygopalatine fossa which treated only with endoscopic endonasal approach.


Assuntos
Equinococose/cirurgia , Fossa Pterigopalatina/cirurgia , Adulto , Animais , Equinococose/diagnóstico por imagem , Echinococcus granulosus , Exoftalmia/etiologia , Humanos , Masculino , Neuroendoscopia , Fossa Pterigopalatina/diagnóstico por imagem
2.
Chin Med J (Engl) ; 132(7): 798-804, 2019 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-30897594

RESUMO

BACKGROUND: The endoscopic transnasal approach has been proven to have advantages on the removal of the tumors in pterygopalatine fossa (PPF) and infratemporal fossa (ITF). Herein, this study aimed to describe a modified approach for resection of the tumors in these areas, both in cadaveric specimen and clinical patients. METHODS: The 20 adult cadaveric specimens and five patients with tumors in PPF and ITF were enrolled in this study. For the cadaveric specimens, ten were simulated anterior transmaxillary approach and ten were performed modified endoscopic transnasal transmaxillary approach. The exposure areas were compared between two groups and main anatomic structure were measured. Surgery was operated in the five patients with tumors of PPF and ITF to verify the experience from the anatomy. Perioperative management, intraoperative findings and postoperative complications were recorded and analyzed. RESULTS: The modified endoscopic transnasal transmaxillary approach provided as enough surgical exposure and high operability to the PPF and ITF as the anterior transmaxillary approach did. The diameter of maxillary artery in the PPF was 3.77 ±â€Š0.78 mm (range: 2.06-4.82 mm), the diameter of middle meningeal artery in the ITF was 2.79 ±â€Š0.61 mm (range: 1.54-3.78 mm). Four patients who suffered schwannoma got total removal and one of adenocystic carcinoma got subtotal removal. The main complications were facial numbness and pericoronitis of the wisdom tooth. No permanent complication was found. CONCLUSIONS: With the widespread use of neuroendoscopy, the modified endoscopic transnasal transmaxillary approach is feasible and effective for the resection of tumors located in PPF and ITF, which has significant advantages on less trauma and complications to the patients.


Assuntos
Neoplasias Infratentoriais/patologia , Fossa Pterigopalatina/patologia , Adulto , Feminino , Humanos , Neoplasias Infratentoriais/cirurgia , Masculino , Pessoa de Meia-Idade , Neuroendoscopia , Assistência Perioperatória , Complicações Pós-Operatórias , Fossa Pterigopalatina/cirurgia
3.
J Craniofac Surg ; 30(2): 589-595, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30640855

RESUMO

Selecting an appropriate surgical approach for resection of huge skull base tumors involving pterygopalatine and infratemporal fossa is challenging because of their rarity and high possibility of vital anatomical structure injuries. To suggest the guidance of selecting the appropriate approach by analyzing outcomes and satisfactions of known surgical approaches with our previous experience, the authors retrospectively analyzed skull base tumor cases experienced for 24 years, and condensed to 4 well-known surgical approaches: maxillary swing, infratemporal fossa type C, transzygomatic, and a combined transzygomatic-midfacial degloving approach: to review indications, advantages, and limitations of these approaches. Maxillary swing approach was useful in large-sized tumors as it provided wide surgical field; however, inevitable facial scar was the main drawbacks, especially in adolescents. Infratemporal fossa approach type C was helpful in the involvement of vital vascular structures; however, long incision scar with temporal area depression and permanent conductive hearing loss were the factors of patients' dissatisfaction. Transzygomatic approach could be the good alternative to the infratemporal fossa approach type C; however, en bloc tumor resection was impossible due to its limited operative space. To overcome limitations of these approaches, transzygomatic approach was combined with midfacial degloving approach, and it enabled lateral and anterior access without prominent facial scar and/or deformity while providing wide surgical space. Based on our 24 years of surgical experience in managing huge skull base tumors, the authors recommend the combined transzygomatic-midfacial degloving approach, which enables complete resection with short postoperative healing periods and no disfiguring facial incisions.


Assuntos
Procedimentos Neurocirúrgicos/métodos , Fossa Pterigopalatina/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Neoplasias da Base do Crânio/cirurgia , Adolescente , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
4.
Ann Otol Rhinol Laryngol ; 128(2): 152-156, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30371104

RESUMO

BACKGROUND:: Cervicofacial actinomycosis is an uncommon indolent infection caused by Actinomyces spp that typically affects individuals with innate or adaptive immunodeficiencies. Soft tissues of the face and neck are most commonly involved. Actinomyces osteomyelitis is uncommon; involvement of the skull base and temporal bone is exceedingly rare. The authors present a unique case of refractory cervicofacial actinomycosis with development of skull base and temporal bone osteomyelitis in an otherwise healthy individual. METHODS:: Case report with literature review. RESULTS:: A 69-year-old man presented with a soft tissue infection, culture positive for Actinomyces, over the right maxilla. Previous unsuccessful treatment included local debridement and 6 weeks of intravenous ceftriaxone. He was subsequently treated with conservative debridement and a prolonged course of intravenous followed by oral antibiotic. However, he eventually required multiple procedures, including maxillectomy, pterygopalatine fossa debridement, and a radical mastoidectomy to clear his disease. Postoperatively he was gradually transitioned off intravenous antibiotics. CONCLUSIONS:: Cervicofacial actinomycosis involves soft tissue surrounding the facial skeleton and oral cavity and is typically associated with a history of mucosal trauma, surgery, or immunodeficiency. The patient was appropriately treated but experienced disease progression and escalation of therapy. Although actinomycosis is typically not an aggressive bacterial infection, this case illustrates the need for prompt recognition of persistent disease and earlier surgical intervention in cases of recalcitrant cervicofacial actinomycosis. Chronic actinomycosis has the potential for significant morbidity.


Assuntos
Actinomicose Cervicofacial/microbiologia , Processo Mastoide/microbiologia , Osteomielite/microbiologia , Base do Crânio/microbiologia , Actinomicose Cervicofacial/tratamento farmacológico , Actinomicose Cervicofacial/cirurgia , Administração Intravenosa , Administração Oral , Idoso , Antibacterianos/uso terapêutico , Terapia Combinada , Desbridamento , Progressão da Doença , Humanos , Masculino , Mastoidectomia , Maxila/cirurgia , Osteomielite/tratamento farmacológico , Osteomielite/cirurgia , Fossa Pterigopalatina/cirurgia , Resultado do Tratamento
5.
Artigo em Russo | MEDLINE | ID: mdl-30412162

RESUMO

Meningoencephalocele is a hernial protrusion of the medulla and meninges through a defect in the skull bones. Due to poor accessibility of meningoencephalocele located in the lateral sphenoid recess region, modern surgical treatment of this pathology prefers to use endoscopic transsphenoidal approaches. MATERIAL AND METHODS: The study included 4 patients with meningoencephalocele of the lateral recess of the sphenoid sinus (1 male and 3 females; mean age, 46.8 years). All patients underwent resection of meningoencephalocele and repair of a skull base defect using the lateral extended transsphenoidal endoscopic approach through the pterygopalatine fossa (transpterygoid approach). RESULTS: In all patients, meningoencephalocele was resected to the bone defect level. There was no postoperative liquorrhea. Complications included bacterial meningitis (1 case), asymptomatic imbibition of the temporal lobe pole (1 case), and temporary numbness in the V2 innervation area of the trigeminal nerve (1 case). CONCLUSION: The paper describes and demonstrates advantages of the lateral extended transsphenoidal endoscopic approach through the pterygopalatine fossa (transpterygoid approach) for surgical treatment of patients with meningoencephalocele of the lateral sphenoid recess.


Assuntos
Encefalocele , Fossa Pterigopalatina , Encefalocele/cirurgia , Endoscopia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fossa Pterigopalatina/cirurgia , Osso Esfenoide/cirurgia , Seio Esfenoidal
6.
J Laryngol Otol ; 132(7): 657-660, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29909791

RESUMO

BACKGROUND: Juvenile nasopharyngeal angiofibroma often attaches firmly to the adjoining bony region around the sphenopalatine foramina-sphenopalatine fossa-pterygomaxillary fissure. This can result in hourglass-shaped constriction and predispose to incomplete resection (residual disease) with a transpalatal approach. This paper describes attempts to address this 'inaccessible' area with a novel instrument, used since 2012. METHODS: Measurements of the sphenopalatine foramen, nasal septum, posterior nasopharyngeal wall and hard palate were undertaken in 20 skulls and 10 computed tomography scans (lateral extension). A device was designed (in terms of angulation and length) following several trials with malleable wire. A search of patents was also undertaken. Recurrence rates were compared in cases of device use and non-use. RESULTS: The novelty of the sphenopalatine fossa dissector was established and the device was patented. This device has significantly improved our 17.59 per cent recurrence rate of the past 4 decades; of 63 cases over 3 years, there were only 3 recurrences and 2 residual disease cases. Findings of our previous studies with or without the device are compared. CONCLUSION: Existing evidence supports the incorporation of this inexpensive instrument in the armamentarium for resecting lateral extension of juvenile nasopharyngeal angiofibroma during a transpalatal approach.


Assuntos
Angiofibroma/cirurgia , Neoplasias Nasofaríngeas/cirurgia , Esvaziamento Cervical/instrumentação , Fossa Pterigopalatina/cirurgia , Osso Esfenoide/cirurgia , Angiofibroma/patologia , Cadáver , Criança , Feminino , Humanos , Masculino , Neoplasias Nasofaríngeas/patologia , Nasofaringe/cirurgia , Esvaziamento Cervical/métodos
7.
World Neurosurg ; 116: e169-e178, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29709753

RESUMO

OBJECTIVE: The aim of this study was to identify key anatomic landmarks useful in gaining access to the anteromedial temporal region via the corridor formed by the inferior orbital fissure (IOF), the ophthalmic branch of the trigeminal nerve (V1), and the maxillary branch of the trigeminal nerve (V2) via an endoscopic endonasal approach (EEA). METHODS: An anatomic dissection of 6 cadaver heads was performed to confirm the feasibility and applicability of an EEA for accessing the anteromedial temporal region. RESULTS: After middle turbinectomy, the lateral recess of the sphenoid sinus was opened, the orbital apex was exposed, and the posterior wall of the maxillary sinus was removed, in sequence. The IOF and the pterygopalatine fossa (PPF) were then identified. After opening the foramen rotundum (FR) and removing the bony structure between the FR, V2 was transposed downward. The orbital muscle of Müller was removed. The PPF was mobilized downward exposing the greater wing of the sphenoid bone (GWS). The GWS between V1 and V2 was drilled, therefore exposing the temporal dura. With blunt dissection, the medial temporal dura was peeled away from the cavernous sinus to increase access to the anteromedial temporal region. CONCLUSIONS: The anteromedial temporal fossa was exposed by drilling the V1-V2 triangle corridor via an EEA. Endoscopic endonasal exposure of the anteromedial temporal fossa is feasible and requires limited endonasal work. This approach may be considered as an alternate surgical corridor to the temporomesial lobe that offers the advantages of a direct route with less temporal lobe retraction.


Assuntos
Seio Cavernoso/cirurgia , Endoscopia/métodos , Procedimentos Neurocirúrgicos/métodos , Nariz/cirurgia , Órbita/cirurgia , Fossa Pterigopalatina/cirurgia , Cadáver , Seio Cavernoso/diagnóstico por imagem , Humanos , Fossa Pterigopalatina/diagnóstico por imagem , Tomógrafos Computadorizados
8.
Head Neck ; 40(10): 2288-2294, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29756367

RESUMO

The oral cancer with masticator-space involvement is classified as T4b disease. The limited data suggest that the masticator space is a complex anatomic area and tumors with varying degrees of infiltration may have different oncologic outcomes. It is not advisable to group all T4b tumors as one and consider them for palliative-intent treatment. A group of patients with limited spread (infra-notch) has potential for good outcome. These cancers can be considered for downstaging to T4a classification based on best available data and clinical considerations. The radical surgical resection remains the mainstay of curative-intent treatment and the ability to achieve negative margins at the skull base remains the most important prognostic factor. The alternative approaches to either increase radicality of surgery or to downsize the tumor with neoadjuvant therapies have shown encouraging trends but larger, well designed, and prospective studies will be needed to make meaningful conclusions. It is important to rationalize and form common ground for further research.


Assuntos
Músculos da Mastigação/patologia , Neoplasias Bucais/patologia , Neoplasias Bucais/terapia , Fossa Pterigopalatina/patologia , Osso Temporal/patologia , Terapia Combinada , Humanos , Músculos da Mastigação/cirurgia , Terapia Neoadjuvante , Fossa Pterigopalatina/cirurgia , Osso Temporal/cirurgia
9.
World Neurosurg ; 114: 134-141, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29510274

RESUMO

OBJECTIVE: To describe an endoscopic anterolateral surgical route to the lateral portion of Meckel's cave. METHODS: A sublabial transmaxillary transpterygoid approach was performed in 6 cadaveric heads (12 sides). A craniectomy was drilled between the foramen rotundum (FR) and foramen ovale (FO) with defined borders. Extradural dissection was performed up to the V2-V3 junction of the trigeminal ganglion. The working space was analyzed using anatomic measurements. RESULTS: The approach allowed for extradural dissection to the lateral aspect of Meckel's cave and provided excellent exposure of V2, V3, and the V2-V3 junction at the gasserian ganglion. The mean distance between the FR and FO along the pterygoid process of the sphenoid bone was 21.3 ± 2.8 mm (range, 18-24.4 mm). The mean distance of V2 and V3 segments from their foramina to the gasserian ganglion junction was 12.0 ± 2.3 mm (range, 9.2-14.6 mm) and 15.2 ± 2.7 mm (range, 12.3-18.5 mm), respectively (6 sides). A potential working area (mean area, 89 mm2) is described. Its superior edge is from the FR to the V2-V3 junction at the gasserian ganglion, its inferior edge is from the FO to the V2-V3 junction at the gasserian ganglion, and its base is from the FO to the FR. The surgical anatomy of the infratemporal fossa, pterygopalatine fossa, and lateral Meckel's cave is highlighted. CONCLUSIONS: An endoscopic anterolateral sublabial transmaxillary transpterygoid approach between the FR and FO avoids crossing critical neurovascular structures within the cavernous sinus and pterygopalatine fossa and can provide a safe surgical corridor for laterally based lesions in Meckel's cave.


Assuntos
Dura-Máter/anatomia & histologia , Dura-Máter/cirurgia , Neuroendoscopia/métodos , Procedimentos Neurocirúrgicos/métodos , Fossa Pterigopalatina/anatomia & histologia , Fossa Pterigopalatina/cirurgia , Seio Cavernoso/anatomia & histologia , Seio Cavernoso/patologia , Seio Cavernoso/cirurgia , Craniotomia/métodos , Dura-Máter/patologia , Estudos de Viabilidade , Humanos , Fossa Pterigopalatina/patologia
10.
J Oral Maxillofac Surg ; 76(4): 844-853, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-28939190

RESUMO

PURPOSE: Surgically assisted rapid maxillary expansion (SARME) is a procedure routinely performed to correct transverse maxillary deformities and can be performed with or without pterygomaxillary disjunction (PD). The aim of the present study was to measure the effect of the amount of expansion and stability of SARME with or without PD. PATIENTS AND METHODS: We designed and implemented a double-blind, randomized clinical trial. The patients were randomly assigned to 2 groups: group 1, SARME without PD; and group 2, SARME with PD. Cone-beam computed tomography scans were performed at 3 points: baseline (T0), after maxillary expansion (T1), and at the end of the retention period (T2). Dental and bone expansion and dental inclination at the maxillary canine and first molar regions were assessed. Two-way repeated measures analysis of variance was used to evaluate the differences between the 2 groups at the 3 evaluation periods (T0, T1, and T2), using a level of significance of P < .05. RESULTS: A total of 24 patients underwent maxillary surgical expansion (group 1, n = 12; and group 2, n = 12). Both techniques promoted a significant transverse dental expansion in the first molar at T2 (with PD, 5.4 mm; vs without PD, 6.4 mm; change, -6.18 mm to 1.48 mm). However, no statistically significant differences were observed between the 2 groups. The tipping molars at T2 remained at a higher level in the SARME, no PD group than in the SARME, PD group (with PD, 2.3°; vs no PD, 4.6° for 3 teeth; change, -12.72° to 5.57°; and with PD, 1.6° vs without PD, 3.6° for 14 teeth; change, -9.96° to 9.83°). CONCLUSIONS: SARME with and without PD is a reliable method for obtaining maxillary expansion, with slight differences in the patterns of skeletal and dental alterations.


Assuntos
Osteotomia Maxilar/métodos , Técnica de Expansão Palatina , Adolescente , Adulto , Método Duplo-Cego , Feminino , Humanos , Masculino , Maxila/diagnóstico por imagem , Maxila/patologia , Maxila/cirurgia , Pessoa de Meia-Idade , Fossa Pterigopalatina/patologia , Fossa Pterigopalatina/cirurgia , Tomografia Computadorizada por Raios X , Adulto Jovem
11.
J Craniofac Surg ; 29(2): 275-278, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29077680

RESUMO

The current study aimed at comparing the number and type of undesired outcomes during and after the maxillary expansion performed with HYRAX and HAAS expanders. A total of 90 patients (41 males and 49 females, 45.6% and 54.4%, respectively) aged 18 to 59 (mean age of 26.1; standard deviation [SD] = 7.4) underwent subtotal Le Fort I osteotomy and pterygomaxillary disjunction following surgically assisted rapid maxillary expansion (SARME) carried out using HAAS (n = 29; 48.3% male and 51.7% female; mean age = 27: SD = 7.7) and HYRAX (n = 61; 44.3% male and 55.7% female; mean age = 26; SD = 7.2) expanders. Post-SARME dento-gingival, radiographic, and clinical undesired outcomes were evaluated. A total of 16 (17.8%) patients experienced at least 1 undesired outcome-7 (7.8%) and 9 (10.0%) in HAAS and HYRAX group, respectively. The most common undesired outcomes were radiographic asymmetric expansion-2 (2.2%) and 3 (3.3%) in HAAS and HYRAX group, respectively-followed by pain during out-of-clinic expansion 4 (4.4%) in HAAS group only-dental darkening 5 (5.5%) in HYRAX group, only, requiring root canal treatment, and local infection-2 (2.2%), 1 in each HAAS and HYRAX groups. Excepting for complications arising from the acrylic stop plate in HAAS expander, the number and severity of complications observed in the current study did not differ due to the use of HAAS and HYRAX appliances to perform maxillary expansion. Hygiene issues do not rule out the use of HAAS. The wider maxillary expansion performed, the more frequent are the cases of asymmetric expansion.


Assuntos
Aparelhos Ortodônticos/efeitos adversos , Técnica de Expansão Palatina/instrumentação , Adolescente , Adulto , Animais , Cor , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteotomia de Le Fort , Dor/etiologia , Fossa Pterigopalatina/cirurgia , Adulto Jovem
12.
Clinics (Sao Paulo) ; 72(9): 554-561, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29069259

RESUMO

OBJECTIVES: Access to the pterygopalatine fossa is very difficult due to its complex anatomy. Therefore, an open approach is traditionally used, but morbidity is unavoidable. To overcome this problem, an endoscopic endonasal approach was developed as a minimally invasive procedure. The surgical aim of the present study was to evaluate the utility of the endoscopic endonasal approach for the management of both benign and malignant tumors of the pterygopalatine fossa. METHOD: We report our experience with the endoscopic endonasal approach for the management of both benign and malignant tumors and summarize recent recommendations. A total of 13 patients underwent surgery via the endoscopic endonasal approach for pterygopalatine fossa masses from 2014 to 2016. This case group consisted of 12 benign tumors (10 juvenile nasopharyngeal angiofibromas and two schwannomas) and one malignant tumor. RESULTS: No recurrent tumor developed during the follow-up period. One residual tumor (juvenile nasopharyngeal angiofibroma) that remained in the cavernous sinus was stable. There were no significant complications. Typical sequelae included hypesthesia of the maxillary nerve, trismus, and dry eye syndrome. CONCLUSION: The low frequency of complications together with the high efficacy of resection support the use of the endoscopic endonasal approach as a feasible, safe, and beneficial technique for the management of masses in the pterygopalatine fossa.


Assuntos
Angiofibroma/cirurgia , Neoplasias Nasofaríngeas/cirurgia , Neurilemoma/cirurgia , Fossa Pterigopalatina/cirurgia , Cirurgia Endoscópica Transanal/métodos , Adolescente , Adulto , Angiofibroma/diagnóstico por imagem , Angiofibroma/patologia , Carcinoma/diagnóstico por imagem , Carcinoma/patologia , Carcinoma/cirurgia , Embolização Terapêutica/métodos , Feminino , Seguimentos , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Neoplasias Nasofaríngeas/diagnóstico por imagem , Neoplasias Nasofaríngeas/patologia , Gradação de Tumores , Neurilemoma/diagnóstico por imagem , Neurilemoma/patologia , Neoplasias Nasais/diagnóstico por imagem , Neoplasias Nasais/patologia , Neoplasias Nasais/cirurgia , Fossa Pterigopalatina/diagnóstico por imagem , Fossa Pterigopalatina/patologia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Adulto Jovem
13.
J Craniofac Surg ; 28(6): 1589-1593, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28863111

RESUMO

PURPOSE: The authors studied the anatomic importance of the endoscopic prelacrimal recess approach (PLRA) to the pterygopalatine fossa (PPF) and infratemporal fossa (ITF). METHODS: Ten adult heads (20 sides) from cadavers fixed in formalin were dissected using the PLRA. Anatomic dissections were detailed and several crucial landmarks measured. RESULTS: Identification of the infraorbital neurovascular bundle is the crucial step for the detection of other branches of the maxillary artery. The distance from the base of columella to inferior orifice of the nasolacrimal duct, sphenopalatine foramen, pterygold canal, foramen rotundum, foramen ovale was (32.97 ±â€Š3.44), (63.93 ±â€Š4.52), (66.81 ±â€Š3.44), (68.13 ±â€Š4.43), and (85.23 ±â€Š6.25) mm, respectively. The PLRA can be used to expose the entire maxillary sinus and PPF, most parts of the ITF (lateral pterygoid muscle, foramen ovale, mandibular division of the trigeminal nerve, and its divisions), maxillary artery and its branches, and the superior part of the medial pterygoid muscle (upon the floor of the maxillary sinus). The lateral boundary can be reached to visualize the temporomandibular joint and vertically oriented temporalis muscle. CONCLUSION: Use of the PLRA to the PPF and ITF offers a clear visual field, wide range of exposure, as well as preservation of the integrity of nasal structures.


Assuntos
Endoscopia/métodos , Seio Maxilar/anatomia & histologia , Músculos Pterigoides/anatomia & histologia , Fossa Pterigopalatina , Osso Esfenoide/anatomia & histologia , Adulto , Humanos , Fossa Pterigopalatina/anatomia & histologia , Fossa Pterigopalatina/cirurgia
14.
Clinics ; 72(9): 554-561, Sept. 2017. tab, graf
Artigo em Inglês | LILACS | ID: biblio-890736

RESUMO

OBJECTIVES: Access to the pterygopalatine fossa is very difficult due to its complex anatomy. Therefore, an open approach is traditionally used, but morbidity is unavoidable. To overcome this problem, an endoscopic endonasal approach was developed as a minimally invasive procedure. The surgical aim of the present study was to evaluate the utility of the endoscopic endonasal approach for the management of both benign and malignant tumors of the pterygopalatine fossa. METHOD: We report our experience with the endoscopic endonasal approach for the management of both benign and malignant tumors and summarize recent recommendations. A total of 13 patients underwent surgery via the endoscopic endonasal approach for pterygopalatine fossa masses from 2014 to 2016. This case group consisted of 12 benign tumors (10 juvenile nasopharyngeal angiofibromas and two schwannomas) and one malignant tumor. RESULTS: No recurrent tumor developed during the follow-up period. One residual tumor (juvenile nasopharyngeal angiofibroma) that remained in the cavernous sinus was stable. There were no significant complications. Typical sequelae included hypesthesia of the maxillary nerve, trismus, and dry eye syndrome. CONCLUSION: The low frequency of complications together with the high efficacy of resection support the use of the endoscopic endonasal approach as a feasible, safe, and beneficial technique for the management of masses in the pterygopalatine fossa.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Neoplasias Nasofaríngeas/cirurgia , Angiofibroma/cirurgia , Fossa Pterigopalatina/cirurgia , Cirurgia Endoscópica Transanal/métodos , Neurilemoma/cirurgia , Imagem por Ressonância Magnética/métodos , Carcinoma/cirurgia , Carcinoma/patologia , Carcinoma/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Neoplasias Nasofaríngeas/patologia , Neoplasias Nasofaríngeas/diagnóstico por imagem , Neoplasias Nasais/cirurgia , Neoplasias Nasais/patologia , Neoplasias Nasais/diagnóstico por imagem , Reprodutibilidade dos Testes , Estudos Retrospectivos , Seguimentos , Resultado do Tratamento , Angiofibroma/patologia , Angiofibroma/diagnóstico por imagem , Embolização Terapêutica/métodos , Fossa Pterigopalatina/patologia , Fossa Pterigopalatina/diagnóstico por imagem , Gradação de Tumores , Neurilemoma/patologia , Neurilemoma/diagnóstico por imagem
15.
Neurol Med Chir (Tokyo) ; 57(10): 534-541, 2017 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-28845040

RESUMO

The authors describe the surgical anatomy for the endoscopic endonasal approach (EEA) to the ventrolateral skull base. The ventrolateral skull base can be divided into two segments: the upper lateral and lower lateral skull base. The upper lateral skull base includes the cavernous sinus and the orbit, while the lower lateral skull base includes the petrous apex, Meckel's cave, parapharyngeal space, infratemporal fossa, etc. To gain access to the upper lateral skull base, a simple opening of the ethmoid sinus provides sufficient exposure of this area. To reach the lower lateral skull base, a transpterygoid approach, following ethmoidectomy, is a key procedure providing wide exposure of this area. Understanding of surgical anatomy is mandatory for treating ventrolateral skull base lesions via EEA. An appropriate, less-invasive approach should be applied depending on the size, location, and type of lesion.


Assuntos
Endoscopia/métodos , Base do Crânio/cirurgia , Seio Cavernoso/cirurgia , Osso Etmoide/cirurgia , Humanos , Cavidade Nasal , Órbita/cirurgia , Fossa Pterigopalatina/cirurgia , Base do Crânio/anatomia & histologia , Neoplasias da Base do Crânio/cirurgia
16.
J Craniofac Surg ; 28(6): 1537-1540, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28749840

RESUMO

With the development of endoscopic technique, Caldwell-Luc approach has more wide applications and becomes a common method of pterygopalatine fossa (PPF) surgery. Few data can be used in this approach to avoid injuring the vessels and nerves within this area. In this study, the authors used computed tomography to get the coordinates of inferior orbital fissure, foramen rotundum, sphenopalatine foramen, internal opening of pterygoid canal, the strangulation of PPF, and the greater palatine foramen with canine fossa as the origin. Parameters of 60 patients (120 observations) between 35 and 55 years who have no experience of trauma or surgery before were involved in this study. The data were analyzed by SPSS, statistical software with the comparison between sexes and sides. After calculating the relative distances and angles between these points and canine fossa, the authors get the proportions of the upper part of PPF, and the pterygopalatine canal to PPF, respectively. The authors finally got the safety surgical range. The results are meaningful to safety in surgery and complication avoidance, which can be great references in clinical applications.


Assuntos
Endoscopia/métodos , Fossa Pterigopalatina , Tomografia Computadorizada por Raios X/métodos , Adulto , Feminino , Humanos , Masculino , Seio Maxilar/anatomia & histologia , Seio Maxilar/diagnóstico por imagem , Pessoa de Meia-Idade , Órbita/anatomia & histologia , Órbita/diagnóstico por imagem , Fossa Pterigopalatina/anatomia & histologia , Fossa Pterigopalatina/diagnóstico por imagem , Fossa Pterigopalatina/cirurgia , Osso Esfenoide/anatomia & histologia , Osso Esfenoide/diagnóstico por imagem
17.
J Stomatol Oral Maxillofac Surg ; 118(5): 279-282, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28642190

RESUMO

INTRODUCTION: The purpose of this retrospective clinical study was to evaluate the surgical complications associated with the surgically assisted rapid palatal expansion (SARPE) which does not involve pterygomaxillary separation (PMS). PATIENTS AND METHODS: A total of 40 (25 females, 15 males) skeletally mature patients, who had the diagnosis of maxillary transverse maxillary deficiency (TMD), were treated surgically under local or general anesthesia. The mean follow-up time was 6 months. RESULTS: Recorded perioperative and postoperative complications were discussed within the current literature. No serious complications were observed intraoperatively. Eight patients (20%) showed postoperative complications including neurosensory deficits, maxillary sinus infection, epistaxis, fistula formation and incisional dehiscence. DISCUSSION: Neurosensory deficits were the most common findings. The present findings suggest that minor complications were observed associated with SARPE without PMS. The technique may be performed safely also under local anesthesia.


Assuntos
Maxila/cirurgia , Osteogênese por Distração/efeitos adversos , Técnica de Expansão Palatina/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Fossa Pterigopalatina/cirurgia , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Masculino , Osteogênese por Distração/métodos , Osteogênese por Distração/estatística & dados numéricos , Técnica de Expansão Palatina/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Adulto Jovem
18.
World Neurosurg ; 103: 457-464, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28434957

RESUMO

BACKGROUND: The lateral extended transsphenoidal endoscopic approach (LETEA) is used to remove tumors located lateral to the cavernous segment of the internal carotid artery under direct visual control and provides access to Meckel cave, pterygopalatine fossa, medial part of the middle cranial fossa, and orbit. We describe an extended transsphenoidal approach to the amygdalohippocampectomy through the pterygopalatine fossa. METHODS: The LETEA to the middle cranial fossa through the pterygopalatine fossa was studied on 3 injected human cadavers at the Burdenko Neurosurgery Institute in Moscow, Russia. RESULTS: LETEA and trepanation of the greater wing of the sphenoid bone allow access to the medial part of the middle cranial fossa. Medial segments of the temporal lobe (hippocampus and amygdala) and the temporal pole were removed under guidance of the 45° angled endoscope. CONCLUSIONS: LETEA through the pterygopalatine fossa is minimally invasive and provides direct access to the temporal pole and medial part of the temporal lobe. This approach may reduce risk of neurologic deficit and help to avoid cosmetic defects in the frontotemporal region associated with injury to temporal muscle and facial nerve injury as can occur during transcranial approaches. Disadvantages that limit application of LETEA include risk of cerebrospinal fluid leak and skills needed for manipulation in a narrow and deep surgical field with angled 30° and 45° endoscopes.


Assuntos
Tonsila do Cerebelo/cirurgia , Endoscopia/métodos , Hipocampo/cirurgia , Fossa Pterigopalatina/cirurgia , Tonsila do Cerebelo/anatomia & histologia , Cadáver , Hipocampo/anatomia & histologia , Humanos , Imagem por Ressonância Magnética , Neoplasias dos Seios Paranasais/cirurgia , Fossa Pterigopalatina/anatomia & histologia , Osso Esfenoide/cirurgia , Tomografia Computadorizada por Raios X
19.
Int J Oral Maxillofac Surg ; 46(6): 798-804, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28254262

RESUMO

The aim of this study was to obtain computed tomography (CT) and physical measurements of the pterygomaxillary region to determine the anatomical and radiographic landmarks that clinicians need for pterygoid implant placement. Seventy-eight hemi-heads with an atrophic posterior maxilla from 46 cadaveric samples were measured using CT. Twenty-one hemi-heads were selected randomly for physical measurements. CT measurements showed that the mean and minimum distance between the maxillary tuberosity point (MT) and the most lateral lowest point of the pterygomaxillary fissure (PF) were 18.7mm and 10.0mm, respectively. The mean and minimum distance between the alveolar crest point passing the extended line of the infrazygomatic crest and the PF were 22.7mm and 14.7mm, respectively. The mean and minimum distance between the PF and the greater palatine canal were 2.9mm and 0.2mm, respectively. Physical measurements showed that the mean and minimum distances between the MT and the descending palatine artery (DPA) were 19.4mm and 12.7mm, respectively, and those between the PF and the DPA were 3.7mm and 0.0mm, respectively. The results confirmed considerable variation in the values of the pterygomaxillary region measured at the specific sites. Therefore, careful and sufficient consideration is required in each case of pterygoid implant placement.


Assuntos
Implantação Dentária Endo-Óssea/métodos , Maxila/diagnóstico por imagem , Maxila/cirurgia , Fossa Pterigopalatina/diagnóstico por imagem , Fossa Pterigopalatina/cirurgia , Tomografia Computadorizada por Raios X , Idoso , Idoso de 80 Anos ou mais , Processo Alveolar/diagnóstico por imagem , Processo Alveolar/cirurgia , Pontos de Referência Anatômicos , Cadáver , Feminino , Humanos , Japão , Masculino
20.
J Craniofac Surg ; 28(4): 1007-1009, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28230590

RESUMO

Oral cancer, especially that originates in the maxillary tuberosity, buccal mucosa, and maxillary alveolus, is apt to invade the pterygopalatine fossa, where an intraoral approach is nearly impossible. There are 2 main types of extraoral approach to the pterygopalatine fossa; the anterior approach and the lateral approach. Although the lateral approach has an advantage compared with the anterior approach in terms of cosmetics, after the operation numbness of the lower lip occurs due to the sacrifice of the mental nerve. In the conventional lateral approach, a vertical incision is made in the center of the lower lip; a lateral flap is then elevated with the sacrifice of the mental nerve. The authors introduce here a new lateral approach to the pterygopalatine fossa with preservation of the mental nerve. In the present technique, a vertical incision was made in the corner of the mouth, and a lateral flap was then elevated with preservation of the mental nerve. This technique could also preserve the marginal mandibular branch of facial nerve in patients without a large metastasis in the submandibular lymph nodes. Additionally, expedient mandibular osteotomy, which is applied in the conventional lateral approach, could be omitted in the present technique, thus helping to prevent postoperative infection. The present approach was applied to 5 patients with oral cancer invading the pterygopalatine fossa. The postoperative numbness of the lower lip was estimated using the current perception threshold. The lesions were successfully resected with little numbness of the lower lip, and no postoperative infection occurred in any of the patients. This technique is available as an approach to the pterygopalatine fossa that preserves the mental nerve and can prevent postoperative infection.


Assuntos
Neoplasias Bucais/cirurgia , Nervos Periféricos , Fossa Pterigopalatina/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Lábio/cirurgia , Masculino , Mandíbula/cirurgia , Pessoa de Meia-Idade , Neoplasias Bucais/patologia , Invasividade Neoplásica , Tratamentos com Preservação do Órgão/efeitos adversos , Tratamentos com Preservação do Órgão/métodos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Retalhos Cirúrgicos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA