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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.
J Craniofac Surg ; 30(3): 863-867, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30817530

RESUMO

This is a retrospective analytical cross-sectional study involving 131 cone-beam computed tomography (CBCT) scans of adult (18-99 years) that assessed greater palatine canal (GPC) attributes (length, curvature angle, diameter of curvature) and the type of the trajectory of GPC-pterygopalatine fossa (PPF) component. The GPC is an important landmark that connects the oral cavity and PPF. It contains greater and lesser palatine nerves, along-with descending palatine artery and vein by extending from the inferior part of the PPF to the hard palate. The GPC acts as a pathway for infiltration of local anesthesia. The inferior orbital fissure (IOF) is in close proximity to these vital anatomic structures and hence accurate identification of its location during regional block anesthesia is crucial. This is one of the very few studies investigating these important structures on CBCT scans highlighting the importance of preoperative scans for the anatomic determination. The images were analyzed for the lengths and anatomic paths of the right and left GPC-PPF in sagittal plane. The diameters of the upper (higher bony aspect of PPF) and lower openings (GPC opening) displayed statistically significant differences in the comparison between males and females (P < 0.05). Overestimation or underestimation of the GPC length can cause a lack of anesthesia and undesirable diffusion of the anesthetic solution into the orbit thorough the IOF causing diplopia, or into the cranial cavity. A thorough understanding of GPC length and pathway types is obligatory for proper anesthetic administration and performing any maxillofacial procedures.


Assuntos
Boca/anatomia & histologia , Órbita/anatomia & histologia , Fossa Pterigopalatina/anatomia & histologia , Fossa Pterigopalatina/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Pontos de Referência Anatômicos/diagnóstico por imagem , Anestesia Local , Tomografia Computadorizada de Feixe Cônico , Estudos Transversais , Feminino , Humanos , Masculino , Maxila , Pessoa de Meia-Idade , Boca/diagnóstico por imagem , Órbita/diagnóstico por imagem , Estudos Retrospectivos , Adulto Jovem
3.
Surg Radiol Anat ; 41(5): 513-522, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30725218

RESUMO

PURPOSE: The aim of this study was to investigate the detailed anatomy of the pterygomaxillary fissure (PMF) and pterygopalatine fossa (PPF) and variations therein using three-dimensional (3D) cone-beam computed tomography (CBCT) software. METHODS: This study was based on a retrospective evaluation of CBCT scans. A total of 825 CBCT images of patients (448 females, 377 males) who met the inclusion criteria were analyzed. PMF shapes were classified, and morphometric measurements (PMF area and PPF volume) were performed according to age, right/left side, and gender using 3D rendering programs. Maxillary and sphenoid sinus pathologies were also classified to reveal possible correlations between morphometric measurements. Analysis of variance was used for comparisons. Multiple comparisons were assessed using the Bonferroni test. Pearson's test was used to assess correlations between parameters. A p value < 0.05 was considered to indicate statistical significance. RESULTS: Six types of PMF shapes were defined. There were no significant differences in types according to gender, age or sinus pathology. Males had a significantly larger PMF area than females (p < 0.001). Left/right comparison of the PMF area revealed that the mean PMF coronal, axial, and sagittal area dimensions were significantly higher on the right side in all patients. Our results also indicated that the PMF area and PPF volume increased significantly after 40 years of age. CONCLUSION: Various PMF shapes were defined and classified. PMF and PPF dimensions increased with age. Knowledge of these anatomical variations will allow surgeons to avoid damage to the neurovascular structures passing through the area.


Assuntos
Tomografia Computadorizada de Feixe Cônico/métodos , Imagem Tridimensional , Maxila/anatomia & histologia , Maxila/diagnóstico por imagem , Fossa Pterigopalatina/anatomia & histologia , Fossa Pterigopalatina/diagnóstico por imagem , Interpretação de Imagem Radiográfica Assistida por Computador , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Software
4.
J Clin Ultrasound ; 47(7): 405-411, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30770569

RESUMO

PURPOSE: To investigate with Doppler ultrasonography the maxillary and middle meningeal arteries in the infratemporal fossa, and describe their hemodynamic characteristics. METHODS: We included 24 female and 11 male volunteers without vascular diseases, with a median age of 43 years. We used the acoustic window, enlarged by subjects half-opening their mouth, located below the zygomatic arch, in front of temporo-mandibular joint, to reach the maxillary and middle meningeal arteries. RESULTS: In the 35 subjects, 112 arteries were visualized successfully: 60 maxillary (85.7%), and 52 middle meningeal arteries (74.3%), at a depth of 2.40 and 2.50 cm, respectively. Their blood flow was directed anteriorly and away from the probe. While all the measured hemodynamic characteristics differed significantly between the maxillary and the middle meningeal artery (P < 0.001), there was no significant difference between male and female subjects, nor between the left or the right side. CONCLUSIONS: The maxillary and middle meningeal arteries can be insonated in the infratemporal fossa through the easily accessible acoustic window below the zygomatic arch, when the patient holds his mouth half open. They can be differentiated by their ultrasonographic characteristics and blood flow features.


Assuntos
Artéria Maxilar/diagnóstico por imagem , Artérias Meníngeas/diagnóstico por imagem , Ultrassonografia Doppler/métodos , Adulto , Feminino , Humanos , Masculino , Artéria Maxilar/anatomia & histologia , Artérias Meníngeas/anatomia & histologia , Pessoa de Meia-Idade , Fossa Pterigopalatina/anatomia & histologia , Fossa Pterigopalatina/diagnóstico por imagem
5.
Surg Radiol Anat ; 41(5): 551-567, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30617510

RESUMO

INTRODUCTION: The pterygopalatine fossa (PPF) infiltration is performed to reduce blood flow during endoscopic sinus surgery and septorhinoplasty, as well as to control posterior epistaxis and provide regional anesthesia in dental procedures. PPF infiltration performed with consideration of the morphometrics of greater palatine foramen (GPF), greater palatine canal (GPC) and PPF would increase the success of the procedure and reduce the risk of complications. The aim of this study is to investigate the GPF, GPC, lesser palatine foramen (LPF), lesser palatine canal (LPC) and PPF morphology via the images obtained by CBCT, to provide information for interventional procedures. MATERIALS AND METHODS: GPF, GPC, LPF, LPC and PPF were morphometrically evaluated retrospectively in CBCT images of 75 female and 75 male cases by Planmeca Romexis program. The 19 parameters were measured on these images. RESULTS: These parameters were evaluated statistically. The comparison of these parameters by genders revealed significant differences in distances between GPC-PC, PC-IOF, LPC-GPF, GPF-MS in the coronal and transverse planes, the distance between GPF and the occlusal plane of the teeth, GPF-PNS, GPF-IF and TD-GPF, and in the area of GPF. The number of LPF was found ranging from 1 to 5. CONCLUSION: Our results may help to insert to needle properly for application of maxillary nerve block with a high success rate and minimal complication. We recommend that the needle should be inserted 14-15 mm lateral to the midsagittal plane, 19-20 mm over the occlusal plane of the teeth and on the same line with the third molar teeth. For PPF infiltration through the GPF, the needle should be pushed forward 28 mm upward at 66° angle on the transverse plane and 14°-15° angle on the vertical plane.


Assuntos
Maxila/anatomia & histologia , Maxila/diagnóstico por imagem , Palato Duro/anatomia & histologia , Palato Duro/diagnóstico por imagem , Fossa Pterigopalatina/anatomia & histologia , Fossa Pterigopalatina/diagnóstico por imagem , Tomografia Computadorizada de Feixe Cônico Espiral , Adolescente , Adulto , Idoso , Variação Anatômica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Bloqueio Nervoso
7.
Surg Radiol Anat ; 41(5): 523-528, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30542926

RESUMO

PURPOSE: The pterygopalatine fossa is an important anatomical structure for several surgical and anaesthesiologic procedures; yet, very few data are available about its size. This study aims at providing a metrical assessment of pterygopalatine fossa through an innovative 3D segmentation procedure on head CT-scans. METHODS: CT-scans from 100 patients (50 males and 50 females) aged between 18 and 85 years were chosen for the study. Right and left pterygopalatine fossae were segmented through ITK-SNAP open source software. Height and volume were calculated on the acquired 3D models. In addition, anterior-posterior nasal spine distance, upper facial height (nasion-prosthion) and biorbital breadth (ectoconchion-ectoconchion) were measured as well. Statistically significant differences of height and volume according to sex and side were assessed through two-way ANOVA test: sexually dimorphic measurements were further assessed through one-way ANCOVA test using the three cranial measurements as covariates (p < 0.05). RESULTS: On average pterygopalatine fossa height was 24.1 ± 3.5 mm in males, and 22.8 ± 3.4 mm in females, whereas volume was 0.930 ± 0.181 cm3 in males and 0.817 ± 0.157 cm3 in females, with statistically significant differences according to sex (p < 0.05), but not to side (p > 0.05); interaction was negligible for both the measurements. ANCOVA test verified that sexual dimorphism of both measurements is independent from general cranial size (p < 0.05). CONCLUSIONS: The present study highlighted the sexual dimorphism of pterygopalatine fossa: results may improve the knowledge of this anatomical structure difficult to explore, but crucial in several fields of clinics and surgery.


Assuntos
Fossa Pterigopalatina/anatomia & histologia , Fossa Pterigopalatina/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Pontos de Referência Anatômicos , Feminino , Humanos , Imagem Tridimensional , Masculino , Pessoa de Meia-Idade , Caracteres Sexuais
8.
Surg Radiol Anat ; 41(2): 161-168, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30470877

RESUMO

PURPOSE: The pterygopalatine fossa is a deep viscerocranial space containing the maxillary artery and nerve, the pterygopalatine ganglion, and the nerve of the pterygoid canal (vidian nerve). The endoscopic approach to this area relies on adequate preoperative imaging, such as computed tomography (CT). The aim was to determine the morphometric characteristics of the pterygopalatine fossa and its communications, including several previously unpublished measurements. METHODS: 100 CT scans (56 male and 44 female patients) were analyzed. The axial, coronal, and sagittal slices, together with the three-dimensional reconstructions, were used in the study. RESULTS: The central diameter and the length of the foramen rotundum, the vertical diameter and the length of the pterygoid (vidian) canal, and the diameter of the sphenopalatine foramen were significantly larger in men. The central diameters of the foramen rotundum and the vidian canal were significantly smaller than their anterior and posterior transverse diameters. The vidian canal length of 12.1 mm indicates the presence of the type 3 VC with a sensitivity of 83% and a specificity of 85%. CONCLUSION: Several new descriptions of the pterygopalatine fossa are presented here (such as the angle between the sphenopalatine foramen and the vidian canal, a new aspect in the understanding of the FR, and the distance between the posterior wall of the maxillary sinus to the vidian canal and the foramen rotundum), which might prove useful in the comprehension of the anatomy of the pterygopalatine fossa.


Assuntos
Fossa Pterigopalatina/anatomia & histologia , Fossa Pterigopalatina/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Pontos de Referência Anatômicos , Feminino , Humanos , Imagem Tridimensional , Masculino , Pessoa de Meia-Idade , Interpretação de Imagem Radiográfica Assistida por Computador , Estudos Retrospectivos , Sensibilidade e Especificidade
9.
Braz J Otorhinolaryngol ; 85(2): 136-143, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29337014

RESUMO

INTRODUCTION: The type of endoscopic approach chosen for vidian neurectomy can be specified by evaluating the vidian canal and the surrounding sphenoid sinus structures. OBJECTIVE: The variations and morphometry of the vidian canal were investigated, focusing on the functional correlations between them which are crucial anatomical landmarks for preoperative planning. METHODS: This study was performed using paranasal multidetector computed tomography images that were obtained with a section thickening of 0.625mm of 250 adults. RESULTS: The distributions of 500 vidian canal variants were categorized as follows; Type 1, within the sphenoid corpus (55.6%); Type 2, partially protruding into the sphenoid sinus (34.8%); Type 3, within the sphenoid sinus (9.6%). The pneumatization of the pterygoid process is mostly seen in vidian canal Type 2 (72.4%) and Type 3 (95.8%) (p<0.001). The mean distances from the vidian canal to the foramen rotundum and the palatovaginal canal were greater in the vidian canal Type 2 and 3 with the pterygoid process pneumatization (p<0.001). The prevalence of the intrasphenoid septum between the vidian canal and the vomerine crest and lateral attachment which ending on carotid prominence were much higher in vidian canal Type 3 than other types (p<0.001). The mean angle between the posterior end of the middle turbinate and the lateral margin of the anterior opening of the vidian canal was measured as 33.05±7.71°. CONCLUSIONS: Preoperative radiologic analysis of the vidian canal and the surrounding structures will allow surgeons to choose an appropriate endoscopic approach to ensure predictable postoperative outcomes.


Assuntos
Denervação/métodos , Tomografia Computadorizada Multidetectores/métodos , Fossa Pterigopalatina/anatomia & histologia , Fossa Pterigopalatina/diagnóstico por imagem , Seio Esfenoidal/anatomia & histologia , Seio Esfenoidal/diagnóstico por imagem , Adulto , Pontos de Referência Anatômicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valores de Referência , Reprodutibilidade dos Testes , Estudos Retrospectivos , Adulto Jovem
10.
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
11.
Reg Anesth Pain Med ; 43(6): 625-630, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29677030

RESUMO

BACKGROUND AND OBJECTIVES: This study aimed to describe and assess the accuracy and feasibility of a novel technique for ultrasound-guided maxillary nerve block using the lateral pterygoid plate (LPP) approach via the pterygopalatine fossa (PPF) in a soft cadaveric model. METHODS: Ten soft cadavers were studied. The curved array ultrasound transducer probe was applied over 1 side of the face of the cadavers in the open-mouth posture. It was placed transversely below the zygomatic arch for identifying the border of the maxillary tuberosity and the LPP. We tilted the curve probe from the caudal to the cranial direction until the uppermost part of the PPF was identified. The in-plane needle approach was used from the anterior-to-posterior and lateral-to-medial directions through the fossa, and 3 mL of methylene blue dye was injected. RESULTS: The spread of injectate after ultrasound-guided maxillary nerve block using the LPP approach was successfully performed in all cadavers as demonstrated by visualized moderate to marked traces of methylene blue within the PPF. No accidental injections in the maxillary arteries or facial nerves were observed. CONCLUSIONS: This cadaveric study suggests that ultrasound-guided maxillary nerve block using the LPP approach via the PPF has a high degree of accuracy and feasibility. Further studies are required to confirm its efficacy and safety for clinical application.


Assuntos
Bloqueio Nervoso Autônomo/métodos , Nervo Maxilar/diagnóstico por imagem , Músculos Pterigoides/diagnóstico por imagem , Fossa Pterigopalatina/diagnóstico por imagem , Ultrassonografia de Intervenção/métodos , Cadáver , Feminino , Humanos , Masculino , Nervo Maxilar/efeitos dos fármacos , Nervo Maxilar/metabolismo , Azul de Metileno/administração & dosagem , Azul de Metileno/metabolismo , Músculos Pterigoides/efeitos dos fármacos , Músculos Pterigoides/metabolismo , Fossa Pterigopalatina/efeitos dos fármacos , Fossa Pterigopalatina/metabolismo
12.
J Headache Pain ; 19(1): 14, 2018 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-29442191

RESUMO

BACKGROUND: Historical reports describe the sphenopalatine ganglion (SPG) as positioned directly under the nasal mucosa. This is the basis for the topical intranasal administration of local anaesthetic (LA) towards the sphenopalatine foramen (SPF) which is hypothesized to diffuse a distance as short as 1 mm. Nonetheless, the SPG is located in the sphenopalatine fossa, encapsulated in connective tissue, surrounded by fat tissue and separated from the nasal cavity by a bony wall. The sphenopalatine fossa communicates with the nasal cavity through the SPF, which contains neurovascular structures packed with connective tissue and is covered by mucosa in the nasal cavity. Endoscopically the SPF does not appear open. It has hitherto not been demonstrated that LA reaches the SPG using this approach. METHODS: Our group has previously identified the SPG on 3 T-MRI images merged with CT. This enabled us to measure the distance from the SPG to the nasal mucosa covering the SPF in 20 Caucasian subjects on both sides (n = 40 ganglia). This distance was measured by two physicians. Interobserver variability was evaluated using the intraclass correlation coefficient (ICC). RESULTS: The mean distance from the SPG to the closest point of the nasal cavity directly over the mucosa covering the SPF was 6.77 mm (SD 1.75; range, 4.00-11.60). The interobserver variability was excellent (ICC 0.978; 95% CI: 0.939-0.990, p < 0.001). CONCLUSIONS: The distance between the SPG and nasal mucosa over the SPF is longer than previously assumed. These results challenge the assumption that the intranasal topical application of LA close to the SPF can passively diffuse to the SPG.


Assuntos
Anestésicos Locais/administração & dosagem , Transtornos da Cefaleia/tratamento farmacológico , Transtornos de Enxaqueca/tratamento farmacológico , Mucosa Nasal/anatomia & histologia , Neuroimagem , Fossa Pterigopalatina/anatomia & histologia , Bloqueio do Gânglio Esfenopalatino/métodos , Administração Intranasal , Adulto , Idoso , Análise de Variância , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mucosa Nasal/diagnóstico por imagem , Neuroimagem/métodos , Fossa Pterigopalatina/diagnóstico por imagem
13.
J Craniofac Surg ; 29(3): e298-e300, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29420383

RESUMO

Primitive tumors of pterygopalatine fossa (PPF) are often benign tumors or extension of a malignant sinonasal tract. Primitive tumors may rarely occur in PPF.The authors present a 71-year-old woman with a 6-month history of left cranial nerve palsy. Magnetic resonance imaging and positron emission tomography-computed tomography showed an enhancing isolated lesion at the PPF. A transmaxillary biopsy was performed, leading to diagnosis of primitive squamous cell carcinoma. The patient underwent radiotherapy treatment.Primitive tumors of PPF are rare and diagnosis may be difficult. Endoscopic access for diagnosis can be performed. Squamous cell carcinoma occurring in PPF is associated with poor prognosis.


Assuntos
Carcinoma de Células Escamosas , Fossa Pterigopalatina , Neoplasias Cranianas , Idoso , Biópsia , Feminino , Humanos , Imagem por Ressonância Magnética , Fossa Pterigopalatina/diagnóstico por imagem , Fossa Pterigopalatina/patologia
14.
Surg Radiol Anat ; 40(6): 689-695, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29274037

RESUMO

PURPOSE: The pterygopalatine ganglion has yet not been identified on medical images in living humans. The primary aim of this study was to evaluate whether the pterygopalatine ganglion could be identified on 3 T MR imaging. METHODS: This study was performed on medical images of 20 Caucasian subjects on both sides (n = 40 ganglia) with an exploratory design. 3 T MR images were assessed by two physicians for the presence and size of the pterygopalatine ganglion. The distance from the pterygopalatine ganglion to four bony landmarks was registered from fused MR and CT images. In an equivalence analysis, the distances were compared to those obtained in an anatomical cadaveric study serving as historical controls (n = 50). RESULTS: A structure assumed to be the pterygopalatine ganglion was identified on MR images in all patients on both sides by both physicians. The mean size was depth 2.1 ± 0.5 mm, width 4.2 ± 1.1 mm and height 5.1 ± 1.4 mm, which is in accordance with formerly published data. Equivalence of the measurements on MR images and the historical controls was established, suggesting that the structure identified on the MR images is the pterygopalatine ganglion. CONCLUSION: Our findings suggest that the pterygopalatine ganglion can be detected on 3 T MR images. Identification of the pterygopalatine ganglion may be important for image-guided interventions targeting the pterygopalatine ganglion, and has the potential to increase the efficacy, safety and reliability for these treatments.


Assuntos
Imagem por Ressonância Magnética/métodos , Fossa Pterigopalatina/diagnóstico por imagem , Fossa Pterigopalatina/inervação , Adulto , Idoso , Ensaios Clínicos como Assunto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes
15.
Prog Orthod ; 18(1): 34, 2017 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-29090368

RESUMO

BACKGROUND: Mini-implant-assisted rapid palatal expansion (MARPE) appliances have been developed with the aim to enhance the orthopedic effect induced by rapid maxillary expansion (RME). Maxillary Skeletal Expander (MSE) is a particular type of MARPE appliance characterized by the presence of four mini-implants positioned in the posterior part of the palate with bi-cortical engagement. The aim of the present study is to evaluate the MSE effects on the midpalatal and pterygopalatine sutures in late adolescents, using high-resolution CBCT. Specific aims are to define the magnitude and sagittal parallelism of midpalatal suture opening, to measure the extent of transverse asymmetry of split, and to illustrate the possibility of splitting the pterygopalatine suture. METHODS: Fifteen subjects (mean age of 17.2 years; range, 13.9-26.2 years) were treated with MSE. Pre- and post-treatment CBCT exams were taken and superimposed. A novel methodology based on three new reference planes was utilized to analyze the sutural changes. Parameters were compared from pre- to post-treatment and between genders non-parametrically using the Wilcoxon sign rank test. For the frequency of openings in the lower part of the pterygopalatine suture, the Fisher's exact test was used. RESULTS: Regarding the magnitude of midpalatal suture opening, the split at anterior nasal spine (ANS) and at posterior nasal spine (PNS) was 4.8 and 4.3 mm, respectively. The amount of split at PNS was 90% of that at ANS, showing that the opening of the midpalatal suture was almost perfectly parallel antero-posteriorly. On average, one half of the anterior nasal spine (ANS) moved more than the contralateral one by 1.1 mm. Openings between the lateral and medial plates of the pterygoid process were detectable in 53% of the sutures (P < 0.05). No significant differences were found in the magnitude and frequency of suture opening between males and females. Correlation between age and suture opening was negligible (R 2 range, 0.3-4.2%). CONCLUSIONS: Midpalatal suture was successfully split by MSE in late adolescents, and the opening was almost perfectly parallel in a sagittal direction. Regarding the extent of transverse asymmetry of the split, on average one half of ANS moved more than the contralateral one by 1.1 mm. Pterygopalatine suture was split in its lower region by MSE, as the pyramidal process was pulled out from the pterygoid process. Patient gender and age had a negligible influence on suture opening for the age group considered in the study.


Assuntos
Tomografia Computadorizada de Feixe Cônico/métodos , Imagem Tridimensional/métodos , Técnica de Expansão Palatina/instrumentação , Palato/diagnóstico por imagem , Fossa Pterigopalatina/diagnóstico por imagem , Adolescente , Adulto , Feminino , Humanos , Masculino , Mandíbula/anatomia & histologia , Mandíbula/diagnóstico por imagem , Maxila/anatomia & histologia , Maxila/diagnóstico por imagem , Desenho de Aparelho Ortodôntico , Palato/anatomia & histologia , Fossa Pterigopalatina/anatomia & histologia , Estudos Retrospectivos , Adulto Jovem
16.
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
17.
J Anat ; 231(6): 961-969, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28960297

RESUMO

The ganglion pterygopalatinum has become a therapeutic target to treat various pain syndromes in recent years. It is located in the fossa pterygopalatina, and the fissura pterygomaxillaris is the main access to surgically approach this structure. Recently, the neuromodulation of the ganglion pterygopalatinum by microstimulator implantation has become the first therapeutic line in refractory cluster headache treatment. This invasive technique is performed transorally through the fissura pterygomaxillaris, and is limited by the size of the implantation device, which requires an opening of at least 2 mm. Therefore, extensive knowledge about the anatomy of the fissura pterygomaxillaris prior to surgery is necessary to predict the success of both the approach and intervention. Likewise, establishing a morphological typology of the different fissura pterygomaxillaris variations would be a valuable predictive tool in the clinical practice. In this work, an anatomical analysis was performed of the morphological characteristics of the 242 fissurae pterygomaxillares, which corresponded to 121 adult patients, 58 males and 63 females, aged between 18 and 87 years. For each subject, right and left fissures were studied with radiological computed tomography images. Aperture fissura pterygomaxillaris measurements were taken in an upper (Measure A), middle (Measure B) and lower craneo-caudal third (Measure C). Intra-subject differences were studied between the measurements taken of each patient's right and left fissures, and the inter-subject measures in which fissures were compared according to patients' age and gender. The obtained results showed no significant differences between each patient's right and left fissures in any three measurements taken. Intra-subject differences were not significant for gender or age. No statistically significant differences were found for the inter-subject measures between the measures of fissures according to patients' age. However, our data revealed that males' fissurae pterygomaxillares were significantly larger than those of females in all three measures. Having analysed fissures, a typological classification was made according to the morphological patterns found. A 2-mm limiting measure was considered, and Measures A, B and C of each fissure were classified depending on whether they had a value above or equal to 2 mm, or below 2 mm. With this classification criterion, four fissurae pterygomaxillares types were obtained. Type I and II fissure values (with a higher prevalence) were equal to or were greater than 2 mm in all three measures, or in two measures. Type III fissure values were only greater than or equal to 2 mm in Measure A, whereas all the Type IV fissure values were below 2 mm. Future studies are necessary to correlate the fissure types successfully proposed in the surgical ganglion pterygopalatinum approach.


Assuntos
Fossa Pterigopalatina/anatomia & histologia , Fossa Pterigopalatina/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Gânglios Simpáticos/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Adulto Jovem
18.
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
19.
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
20.
J Stomatol Oral Maxillofac Surg ; 118(2): 90-94, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28345519

RESUMO

INTRODUCTION: The aim of this study was to describe the anatomical landmarks for maxillary nerve block in the pterygopalatine fossa. The risk of injury to the skull base and maxillary artery was assessed. METHODS: This retrospective study was based on the analysis of 61 consecutive computed tomography angiographies obtained from patients suffering from different pathologies. Anatomical relationships between optic canal (OC), foramen rotundum (FR), inferior orbital fissure (IOF) and puncture point (PP) were assessed. A "maxillary section" was virtually carried out on the CTs, following a plane passing through PP, IOF and FR in order to mimic the anaesthesia needle route. RESULTS: No gender difference was observed except for the PP-OC distance that was longer in men. The mean PP-IOF distance was of 31.9 (± 0.7mm). PP-OC (43.9±0.5) and PP-FR (44.2±0.7) distances increased significantly with the patients height (PP-FR=17.25+0.16×height (cm); PP-OC=20.54+0.13×height (cm)). The route to the skull base was curved, with an angle of 168±1.6° at the FR level. The angle to reach the OC was greater than 7°. DISCUSSION: With a 35-mm needle length, the probability to reach the IOF was high (79%), while the risk to injure the skull base (2%) and the optical nerve (0%) was low. Artery injuries were only found in 13% of cases. Therefore, a 35-mm needle length allows for the best efficacy/risk ratio in maxillary nerve block.


Assuntos
Pontos de Referência Anatômicos/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Nervo Maxilar/diagnóstico por imagem , Bloqueio Nervoso/métodos , Fossa Pterigopalatina/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Pontos de Referência Anatômicos/patologia , Anestesia por Condução , Feminino , França , Humanos , Injeções , Masculino , Maxila/diagnóstico por imagem , Maxila/patologia , Nervo Maxilar/efeitos dos fármacos , Nervo Maxilar/patologia , Pessoa de Meia-Idade , Órbita/diagnóstico por imagem , Órbita/patologia , Fossa Pterigopalatina/patologia , Estudos Retrospectivos , Base do Crânio/diagnóstico por imagem , Base do Crânio/patologia , Osso Esfenoide/diagnóstico por imagem , Osso Esfenoide/efeitos dos fármacos , Osso Esfenoide/patologia , Adulto Jovem
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