Anatomical Variations and Relationships of the Infratemporal Fossa: Foundation of a Novel Endonasal Approach to the Foramen Ovale

Lifeng Li; Nyall R. London Jr.; Daniel M. Prevedello; Ricardo L. Carrau

doi:10.1055/s-0040-1715815

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

J Neurol Surg B Skull Base 2021; 82(06): 668-674
DOI: 10.1055/s-0040-1715815

Original Article

Anatomical Variations and Relationships of the Infratemporal Fossa: Foundation of a Novel Endonasal Approach to the Foramen Ovale

Lifeng Li

¹Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China

²Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, Ohio, United States

,

Nyall R. London Jr.

²Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, Ohio, United States

³Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, United States

⁴Sinonasal and Skull Base Tumor Program, National Institute on Deafness and Other Communication Disorders, NIH, Bethesda, Maryland, United States

,

Daniel M. Prevedello

²Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, Ohio, United States

⁵Department of Neurological Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, Ohio, United States

,

Ricardo L. Carrau

²Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, Ohio, United States

⁵Department of Neurological Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, Ohio, United States

› Author Affiliations

Abstract

Objective Access to the infratemporal fossa (ITF) is complicated by its complex neurovascular relationships. In addition, copious bleeding from the pterygoid plexus adds to surgical challenge. This study aims to detail the anatomical relationships among the internal maxillary artery (IMA), pterygoid plexus, V_3, and pterygoid muscles in ITF. Furthermore, it introduces a novel approach that displaces the lateral pterygoid plate (LPP) to access the foramen ovale.

Design and Main Outcome Measures Six cadaveric specimens (12 sides) were dissected using an endonasal approach to the ITF modified by releasing and displacing the LPP and lateral pterygoid muscle (LPTM) as a unit. Subperiosteal elevation of the superior head of LPTM revealed the foramen ovale. The anatomic relationships among the V₃, pterygoid muscles, pterygoid plexus, and IMA were surveyed.

Results In 9/12 sides (75%), the proximal IMA ran between the temporalis and the LPTM, whereas in 3/12 sides (25%), the IMA pierced the LPTM. The deep temporal nerve was a consistent landmark to separate the superior and inferior heads of LPTM. An endonasal approach displacing the LPP in combination with a subperiosteal elevation of the superior head of LPTM provided access to the posterior trunk of V₃ and foramen ovale while sparing injury of the LPTM and exposing the pterygoid plexus. The anterior trunk of V₃ traveled anterolaterally along the greater wing of sphenoid in all specimens.

Conclusion Displacement of the LPP and LPTM provided direct exposure of foramen ovale and V₃ avoiding dissection of the muscle and pterygoid plexus; thus, this maneuver may prevent intraoperative bleeding and postoperative trismus.

Keywords

infratemporal fossa - lateral pterygoid plate - foramen ovale - V₃ - internal maxillary artery

Full Text

References

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