DOCSLIB.ORG

Surgical Approaches to the Nasopharynx

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Surgical Approaches to the Nasopharynx Surgical approaches to the nasopharynx An essay submitted for fulfillment of master degree in Otorhinolaryngology Presented by Moamen Mohammed Assem Mohammed Nawwar M.B.B.Ch. Cairo University Under supervision of Prof. Dr. Sherif Adly Raafat Professor of otorhinolaryngology Faculty of Medicine Cairo University Prof. Dr. Ashraf Bahaa El-Din Fayek Professor of otorhinolaryngology Faculty of Medicine Cairo University Dr. Ahmed Hussein Abd El-Gawad Lecturer of Otorhinolaryngology Faculty of Medicine Cairo University 2012 بسم هللا الرمحن الرحمي ﴿ يرفع ا﵀ الذين ءامنوا منكم والذين أوتوا العلم درجات وا﵀ بما تعملون خبير ﴾ صدق هللا العظمي سورة المجادلة اﻵية )١١( Abstract The nasopharynx lies deep and central in the skull. It is the region located behind the nasal cavities and above the soft palate. The undersurface of the body of the sphenoid bone forms the slanting roof that merges inferiorly with the posterior wall. The floor of the nasopharynx opens downward into the oropharynx at the level of the soft palate. Tumours arising from the nasopharynx could be benign or malignant. The most common benign tumour is angiofibroma, while the main malignant neoplasm is nasopharyngeal carcinoma. Surgical excision of JNA is considered the primary treatment modality. Surgery has a limited role in the treatment of nasopharyngeal carcinoma because of the tumor's high degree of radiosensitivity and the anatomic barriers to surgical access. Resection of lesion in the nasopharynx is a challenge due to this anatomical complexity and the surrounding vital structures. Preoperative radiologic evaluation of the tumor is important in planning the surgical approach. Although it is entirely accepted that surgery is the treatment of choice for the majority of JNAs, the surgical approach is still under discussion. Several open surgical approaches have been performed. Each approach has its advantages and disadvantages. Key Words : Epstein-Barr virus - Eustachian tube - EBV encoded early RNA . Acknowledgment Thanks to ALLAH for giving me the power and strength to carry out this work. Words stands short when they come to express my gratefulness to my supervisors. I wish to express my sincere gratitude and thanks to Prof. Dr. Sherif Adly Raafat, for his remarkable effort, considerable help and continuous guidance which were the major factors behind the completion of this work. My deep gratitude goes to his faithful supervision and great cooperation. I am deeply indebted to Prof. Dr. Ashraf Bahaa El-Din Fayek, for his patience and keen supervision. He generously offered me agreat help through his experience, support and encouragement. My deep gratitude goes to Dr. Ahmed Hussein Abd El-Gawad, for his constant support valuable advice and remarks that have been of utmost help. Lastly, I wish to express my sincere gratitude to my family, dear professors and colleagues for their help, encouragement and support. i Contents Title Page Acknowledgement ………………………………...…………………… i List of Figures ……………………………………………………… ii List of Tables ……………………………………………………… vi List of Abbreviations ……………………………………………………... vii Introduction ……..…………………….………………………… 1 Chapter (1) Anatomy of the nasopharynx ……………………. 3 Chapter (2) Lesions of the nasopharynx ……………………… 23 Chapter (3) Open surgical approaches ………………….…….. 47 Chapter (4) Endoscopic surgical approaches …………………. 72 Summary ……………………………………………………… 102 References ……………………………………………………… 104 Arabic summary List of Figures Figure title Page Figure (1) Sagittal section of the head showing the nasopharynx, nasal cavity and paranasal sinuses ………………………………….. 4 Figure (2) Axial view of pharyngobasilar fascia at two levels …………... 5 Figure (3) Axial view of the nasopharynx showing fascial spaces ……… 7 Figure (4) Axial view of the nasopharynx showing its relationship with the surrounding structures ……………………………………. 10 Figure (5) Inferior view of the skull base ………………………………... 13 Figure (6) Veins of the pterygoid plexus ………………………………… 15 Figure (7) Osteology of the infratemporal fossa …………………………. 17 Figure (8) Contents of the infratemporal fossa …………………………... 19 Figure (9) Osteology of the base of skull and the pterygomaxillary fossa 20 Figure (10) Osteology of the infratemporal fossa and the pterygomaxillary fossa …………………………………………………………... 22 Figure (11) Nasopharyngeal nonkeratinizing carcinoma …………………. 28 Figure (12) Nasopharyngeal nonkeratinizing carcinoma, undifferentiated subtype ………………………………………………………... 28 Figure (13) Nasopharyngeal nonkeratinizing carcinoma, differentiated subtype ………………………………………………………... 28 Figure (14) Nasopharyngeal keratinizing squamous cell carcinoma, well differentiated ………………………………………………….. 30 Figure (15) Basaloid squamous cell carcinoma of the nasopharynx ……… 30 Figure (16) Pure nasopharyngeal carcinoma-in-situ ………………………. 31 Figure (17) Nasopharyngeal papillary adenocarcinoma …………………... 32 Figure (18) Adenoid cystic carcinoma, the cribriform architecture ………. 34 Figure (19) Adenoid cystic carcinoma, the tubular form and solid form …. 34 ii Figure (20) Mucoepidermoid carcinoma of nasopharynx ………………… 35 Figure (21) Nasopharyngeal dermoid ……………………………………... 36 Figure (22) Inverted papilloma ……………………………………………. 37 Figure (23) Ectopic pituitary adenoma of the nasopharynx ………………. 38 Figure (24) Salivary gland anlage tumour ………………………………… 39 Figure (25) Nasopharyngeal angiofibroma ………………………………... 41 Figure (26) Extramedullary plasmacytoma ……………………………….. 43 Figure (27) Two catheters inserted through the nostrils to retract the soft palate to expose the nasopharynx (Transpalatal Approach) ….. 50 Figure (28) Vertical incision on the palate with a small anterior transverse limb to improve the exposure (Transpalatal Approach) ……… 50 Figure (29) Transmandibular-transcervical approach …………………….. 53 Figure (30) A. Lateral rhinotomy incision. B. Lateral rhinotomy incision appearance ……………………………………………………. 54 Figure (31) Intraoperative A. and postoperative B. views of lip-splitting extension of lateral rhinotomy incision ………………………. 55 Figure (32) Tumour removal via Lefort I approach ………………………. 56 Figure (33) Lefort I Closure ………………………………………………. 56 Figure (34) Gingival-buccal and gingival-labial incisions (Midfacial Degloving Approach) ………………………………………… 59 Figure (35) Transfixion incision (Midfacial Degloving Approach) ………. 59 Figure (36) Sharp dissection (Midfacial Degloving Approach) …………... 60 Figure (37) Complete degloving (Midfacial Degloving Approach) ………. 60 Figure (38) Bipedicle incisions (Midfacial Degloving Approach) ………... 61 Figure (39) Completed flap (Midfacial Degloving Approach) ……………. 61 Figure (40) 5-0 chromic suturing technique, reapproximating the anterior edge of the bipedicle flap (A) to the vestibular skin (Midfacial Degloving Approach) ………………………………………… 61 iii Figure (41) Schematic CT image, (Maxillary Swing Approach) …………. 62 Figure (42) The maxilla is swung laterally to expose the nasopharynx (Maxillary Swing Approach) …………………………………. 65 Figure (43) After removing the tumor in the nasopharynx and the lymph node in the paranasopharyngeal space (Maxillary Swing Approach) …………………………………………………….. 65 Figure (44) Intraoperative views of the infratemporal fossa approach ……. 69 Figure (45) Axial section sinus CT of a Radkowski stage IIB JNA ………. 77 Figure (46) MRI with gadolinium of a Radkowski stage IIB JNA ……….. 78 Figure (47) Angiogram illustrating vascularity of the JNA ……………….. 79 Figure (48) JNA has been mobilized medially to identify its origin ……… 81 Figure (49) Following ligation of the pedicle and detachment of the lesion (JNA) from surrounding structures …………………………… 82 Figure (50) The anatomy of the pterygopalatine fossa following removal of the posterior wall of the maxillary sinus …………………... 83 Figure (51) Extirpation of the tumor from the pterygopalatine and infratemporal fossae ………………………………………...... 84 Figure (52) Illustration of the binostril, two-surgeon transseptal approach.. 85 Figure (53) Axial and coronal T1-weighted MRIs with gadolinium obtained 6 months after endoscopic resection of the JNA …… 86 Figure (54) Schematic representation of the operation field before and after removal of the posterior half of the nasal septum ………. 88 Figure (55) The endoscopic nasopharyngectomy procedure for rT2b nasopharyngeal carcinoma ………………………………….... 91 Figure (56) The comparison of the presurgical and postsurgical magnetic resonance imaging (MRI) images …………………………….. 92 iv Figure (57) The endoscopic nasopharyngectomy procedure for rT3 nasopharyngeal carcinoma …………………………………… 93 Figure (58) A comparison of the presurgical and postsurgical magnetic resonance imaging (MRI) images …………………………….. 94 Figure (59) Nasopharyngeal endoscopic resection (NER) type 1 ………… 96 Figure (60) Nasopharyngeal endoscopic resection (NER) type 2 ………… 97 Figure (60) Nasopharyngeal endoscopic resection (NER) type 3 ……….... 98 Figure (62) Transoral adenoidectomy using a nasal endoscopic-guided curette ………………………………………………………… 99 v List of Tables Table title Page Table (1) TNM classification of carcinomas of the nasopharynx ………. 25 Table (2) Stage Grouping ……………………………………………….. 26 Table (3) Chandler’s classification ……………………………………… 74 Table (4) Andrew’s (modified Fisch) classification …………………….. 74 Table (5) Radkowski’s modification of Sessions’ classification ……….. 74 Table (6) Revised staging system for juvenile nasopharyngeal angiofibroma ………………………………………………….. 76 vi List of Abbreviations BSCC Basaloid squamous cell carcinoma CSF Cerebrospinal fluid CT Computed tomography EBER EBV encoded early RNA EBV Epstein-Barr virus ECA External carotid artery EMP
Load more

Recommended publications
  • Head & Neck Surgery Course
    Head & Neck Surgery Course Parapharyngeal space: surgical anatomy Dr Pierfrancesco PELLICCIA Pr Benjamin LALLEMANT Service ORL et CMF CHU de Nîmes CH de Arles Introduction • Potential deep neck space • Shaped as an inverted pyramid • Base of the pyramid: skull base • Apex of the pyramid: greater cornu of the hyoid bone Introduction • 2 compartments – Prestyloid – Poststyloid Anatomy: boundaries • Superior: small portion of temporal bone • Inferior: junction of the posterior belly of the digastric and the hyoid bone Anatomy: boundaries Anatomy: boundaries • Posterior: deep fascia and paravertebral muscle • Anterior: pterygomandibular raphe and medial pterygoid muscle fascia Anatomy: boundaries • Medial: pharynx (pharyngobasilar fascia, pharyngeal wall, buccopharyngeal fascia) • Lateral: superficial layer of deep fascia • Medial pterygoid muscle fascia • Mandibular ramus • Retromandibular portion of the deep lobe of the parotid gland • Posterior belly of digastric muscle • 2 ligaments – Sphenomandibular ligament – Stylomandibular ligament Aponeurosis and ligaments Aponeurosis and ligaments • Stylopharyngeal aponeurosis: separates parapharyngeal spaces to two compartments: – Prestyloid – Poststyloid • Cloison sagittale: separates parapharyngeal and retropharyngeal space Aponeurosis and ligaments Stylopharyngeal aponeurosis Muscles stylohyoidien Stylopharyngeal , And styloglossus muscles Prestyloid compartment Contents: – Retromandibular portion of the deep lobe of the parotid gland – Minor or ectopic salivary gland – CN V branch to tensor
    [Show full text]
  • Deep Neck Infections 55
    Deep Neck Infections 55 Behrad B. Aynehchi Gady Har-El Deep neck space infections (DNSIs) are a relatively penetrating trauma, surgical instrument trauma, spread infrequent entity in the postpenicillin era. Their occur- from superfi cial infections, necrotic malignant nodes, rence, however, poses considerable challenges in diagnosis mastoiditis with resultant Bezold abscess, and unknown and treatment and they may result in potentially serious causes (3–5). In inner cities, where intravenous drug or even fatal complications in the absence of timely rec- abuse (IVDA) is more common, there is a higher preva- ognition. The advent of antibiotics has led to a continu- lence of infections of the jugular vein and carotid sheath ing evolution in etiology, presentation, clinical course, and from contaminated needles (6–8). The emerging practice antimicrobial resistance patterns. These trends combined of “shotgunning” crack cocaine has been associated with with the complex anatomy of the head and neck under- retropharyngeal abscesses as well (9). These purulent col- score the importance of clinical suspicion and thorough lections from direct inoculation, however, seem to have a diagnostic evaluation. Proper management of a recog- more benign clinical course compared to those spreading nized DNSI begins with securing the airway. Despite recent from infl amed tissue (10). Congenital anomalies includ- advances in imaging and conservative medical manage- ing thyroglossal duct cysts and branchial cleft anomalies ment, surgical drainage remains a mainstay in the treat- must also be considered, particularly in cases where no ment in many cases. apparent source can be readily identifi ed. Regardless of the etiology, infection and infl ammation can spread through- Q1 ETIOLOGY out the various regions via arteries, veins, lymphatics, or direct extension along fascial planes.
    [Show full text]
  • 6. the Pharynx the Pharynx, Which Forms the Upper Part of the Digestive Tract, Consists of Three Parts: the Nasopharynx, the Oropharynx and the Laryngopharynx
    6. The Pharynx The pharynx, which forms the upper part of the digestive tract, consists of three parts: the nasopharynx, the oropharynx and the laryngopharynx. The principle object of this dissection is to observe the pharyngeal constrictors that form the back wall of the vocal tract. Because the cadaver is lying face down, we will consider these muscles from the back. Figure 6.1 shows their location. stylopharyngeus suuperior phayngeal constrictor mandible medial hyoid bone phayngeal constrictor inferior phayngeal constrictor Figure 6.1. Posterior view of the muscles of the pharynx. Each of the three pharyngeal constrictors has a left and right part that interdigitate (join in fingerlike branches) in the midline, forming a raphe, or union. This raphe forms the back wall of the pharynx. The superior pharyngeal constrictor is largely in the nasopharynx. It has several origins (some texts regard it as more than one muscle) one of which is the medial pterygoid plate. It assists in the constriction of the nasopharynx, but has little role in speech production other than helping form a site against which the velum may be pulled when forming a velic closure. The medial pharyngeal constrictor, which originates on the greater horn of the hyoid bone, also has little function in speech. To some extent it can be considered as an elevator of the hyoid bone, but its most important role for speech is simply as the back wall of the vocal tract. The inferior pharyngeal constrictor also performs this function, but plays a more important role constricting the pharynx in the formation of pharyngeal consonants.
    [Show full text]
  • SPLANCHNOLOGY Part I. Digestive System (Пищеварительная Система)
    КАЗАНСКИЙ ФЕДЕРАЛЬНЫЙ УНИВЕРСИТЕТ ИНСТИТУТ ФУНДАМЕНТАЛЬНОЙ МЕДИЦИНЫ И БИОЛОГИИ Кафедра морфологии и общей патологии А.А. Гумерова, С.Р. Абдулхаков, А.П. Киясов, Д.И. Андреева SPLANCHNOLOGY Part I. Digestive system (Пищеварительная система) Учебно-методическое пособие на английском языке Казань – 2015 УДК 611.71 ББК 28.706 Принято на заседании кафедры морфологии и общей патологии Протокол № 9 от 18 апреля 2015 года Рецензенты: кандидат медицинских наук, доцент каф. топографической анатомии и оперативной хирургии КГМУ С.А. Обыдённов; кандидат медицинских наук, доцент каф. топографической анатомии и оперативной хирургии КГМУ Ф.Г. Биккинеев Гумерова А.А., Абдулхаков С.Р., Киясов А.П., Андреева Д.И. SPLANCHNOLOGY. Part I. Digestive system / А.А. Гумерова, С.Р. Абдулхаков, А.П. Киясов, Д.И. Андреева. – Казань: Казан. ун-т, 2015. – 53 с. Учебно-методическое пособие адресовано студентам первого курса медицинских специальностей, проходящим обучение на английском языке, для самостоятельного изучения нормальной анатомии человека. Пособие посвящено Спланхнологии (науке о внутренних органах). В данной первой части пособия рассматривается анатомическое строение и функции системы в целом и отдельных органов, таких как полость рта, пищевод, желудок, тонкий и толстый кишечник, железы пищеварительной системы, а также расположение органов в брюшной полости и их взаимоотношения с брюшиной. Учебно-методическое пособие содержит в себе необходимые термины и объём информации, достаточный для сдачи модуля по данному разделу. © Гумерова А.А., Абдулхаков С.Р., Киясов А.П., Андреева Д.И., 2015 © Казанский университет, 2015 2 THE ALIMENTARY SYSTEM (systema alimentarium/digestorium) The alimentary system is a complex of organs with the function of mechanical and chemical treatment of food, absorption of the treated nutrients, and excretion of undigested remnants.
    [Show full text]
  • Ta2, Part Iii
    TERMINOLOGIA ANATOMICA Second Edition (2.06) International Anatomical Terminology FIPAT The Federative International Programme for Anatomical Terminology A programme of the International Federation of Associations of Anatomists (IFAA) TA2, PART III Contents: Systemata visceralia Visceral systems Caput V: Systema digestorium Chapter 5: Digestive system Caput VI: Systema respiratorium Chapter 6: Respiratory system Caput VII: Cavitas thoracis Chapter 7: Thoracic cavity Caput VIII: Systema urinarium Chapter 8: Urinary system Caput IX: Systemata genitalia Chapter 9: Genital systems Caput X: Cavitas abdominopelvica Chapter 10: Abdominopelvic cavity Bibliographic Reference Citation: FIPAT. Terminologia Anatomica. 2nd ed. FIPAT.library.dal.ca. Federative International Programme for Anatomical Terminology, 2019 Published pending approval by the General Assembly at the next Congress of IFAA (2019) Creative Commons License: The publication of Terminologia Anatomica is under a Creative Commons Attribution-NoDerivatives 4.0 International (CC BY-ND 4.0) license The individual terms in this terminology are within the public domain. Statements about terms being part of this international standard terminology should use the above bibliographic reference to cite this terminology. The unaltered PDF files of this terminology may be freely copied and distributed by users. IFAA member societies are authorized to publish translations of this terminology. Authors of other works that might be considered derivative should write to the Chair of FIPAT for permission to publish a derivative work. Caput V: SYSTEMA DIGESTORIUM Chapter 5: DIGESTIVE SYSTEM Latin term Latin synonym UK English US English English synonym Other 2772 Systemata visceralia Visceral systems Visceral systems Splanchnologia 2773 Systema digestorium Systema alimentarium Digestive system Digestive system Alimentary system Apparatus digestorius; Gastrointestinal system 2774 Stoma Ostium orale; Os Mouth Mouth 2775 Labia oris Lips Lips See Anatomia generalis (Ch.
    [Show full text]
  • Pitfalls in the Staging of Cancer of the Oropharyngeal Squamous Cell Carcinoma
    Pitfalls in the Staging of Cancer of the Oropharyngeal Squamous Cell Carcinoma Amanda Corey, MD KEYWORDS Oropharyngeal squamous cell carcinoma Oropharynx Human papilloma virus Transoral robotic surgery KEY POINTS Oropharyngeal squamous cell carcinoma (OPSCC) has a dichotomous nature with 1 subset of the disease associated with tobacco and alcohol use and the other having proven association with human papilloma virus infection. Imaging plays an important role in the staging and surveillance of OPSCC. A detailed knowledge of the anatomy and pitfalls is critical. This article reviews the detailed anatomy of the oropharynx and epidemiology of OPSCC, along with its staging, patterns of spread, and treatment. Anatomic extent of disease is central to deter- tissue, constrictor muscles, and fascia. The over- mining stage and prognosis, and optimizing treat- whelming tumor pathology is squamous cell carci- ment planning for head and neck squamous cell noma (SCC), arising from the mucosal surface. carcinoma (HNSCC). The anatomic boundaries of As the OP contents include lymphoid tissue and the oropharynx (OP) are the soft palate superiorly, minor salivary glands, lymphoma and nonsqua- hyoid bone, and vallecula inferiorly, and circumvel- mous cell tumors of salivary origin can occur.2 late papilla anteriorly. The OP communicates with In understanding spread of disease from the OP, the nasopharynx superiorly and the hypopharynx it is helpful to remember the fascial boundaries and supraglottic larynx inferiorly, and is continuous subtending the OP, to recall the relationship of with the oral cavity anteriorly. The palatoglossus the pharyngeal constrictor muscles with the ptery- muscle forms the anterior tonsillar pillar, and the gomandibular raphe and the deep cervical fascia, palatopharyngeus muscle forms the posterior and to be aware of the adjacent spaces and struc- tonsillar pillar.
    [Show full text]
  • A Syllabus of Core Surgical Anatomy
    A Syllabus of Core Surgical Anatomy Background In February 2010, it was agreed that the Anatomy Committee would undertake to develop a new generic examination for implementation in 2012 to assess anatomy for surgical trainees. Content Anatomical questions relate to: • clinical examination – surface anatomy, inspection, palpation, percussion, auscultation, pelvic examination, testing for peripheral nerve injuries, potential sites of spread of tumours (as determined by anatomy e.g. lymphatic drainage of the breast) • urethral catheterization • vascular access (arterial and venous, peripheral and central) • the airway: maintenance, access • chest drainage • imaging (plain radiographs, CT, MRI, US, contrast studies) • surgical access – open and minimally invasive • endoscopy (GI, arthroscopy etc) • peripheral nerve blocks • percutaneous liver biopsy • trauma (aligned to anatomy in EMST) • common anatomical complications of routine surgical procedures • principles of anatomy: terminology, anatomical position, planes, relationships in regional anatomy, movements, tissues, systems, and anatomical variation. Syllabus Essential (+++) • What an early SET 1 trainee (PGY 2-3 with general experience) should know. • Must recognise, understand and be able to explain. • These structures comprise core basic surgical anatomy and are essential in inter-specialty communication. • Lack of knowledge could jeapordise patient safety. • Includes all common and important anatomical characteristics of the structure: location, constituent parts, relations, blood supply and lymphatic drainage, innervation, course and distribution, when the structure is at risk, effects of injury, and common variants of clinical importance. Desirable (++) • Should be able to describe the basic anatomy/location of the structure, its function, major nerve and blood supply ± lymphatic drainage, and general relations. Non-core (+) • Not considered core knowledge but may be appropriate for specialty-specific anatomy.
    [Show full text]
  • Digestive System
    IN THE NAME OF GOD General anatomy For paramedicine student Dr. Saeednia Digestive system LIPS ORAL CAVITY TONGUE SALIVARY GLANDS PHARYNX ESOPHAGUS PERITONEUM STOMACH SMALL INTESTINE LARGE INTESTINE LIVER GALL BLADDER PANCREAS Skin Mucosa orbicularis oris Digestive system vessels Nerve frenulum lapi Lips : oral cavity tongue salivary glands pharynx esophagus peritoneum stomach small intestine large intestine liver gall bladder pancreas Vestibule Mouth proper Digestive system Lips oral cavity tongue salivary glands pharynx esophagus peritoneum stomach small intestine large intestine liver gall bladder pancreas Oral cavity Roof: Hard palate Soft palate Palato glossus fold Palato pharyngeous fold Tonsilar fossa Floor: Supra hyoid muscles Digestive system Lips oral cavity tongue salivary glands pharynx esophagus peritoneum 2/3Ant. stomach 1/3Post. small intestine Foramen cecum large intestine Lingual frenulum liver :Papilla gall bladder pancreas Filiform Vallate Fungiform Folliate Lingual tonsil Tongue: Sup. Surface Apex Base: attach to Hyoid / Mandible /Temporal Ext. Muscles: attach to Hyoid Mandible Temporal Artery : ext. carotid + facial Vein : int. jugular Nerve: Sensory: Ant. 2/3: 5-7 Post. 1/3: 9 Base : 10 Motor: 12 (palatoglossal / 11) :Parotid gland gr / pyramid shape 25 Digestive system Inf. Of ext. acoustic meatus Between SCM & masseter Apex= post. Belly of digastric Base= superficial temporal A / auriculotemporal N Lips NVA (surface to deep)= facial / retromandibular / ext. carotid oral cavity Stenons duct tongue salivary glands
    [Show full text]
  • Pocket Atlas of Human Anatomy © 2000 Thieme a a All Rights Reserved
    Bones 31 1 2 2 6 17.23 22 3 4 8 5 3 21 21 19 6 19 5 5 20 20 7 18 18 8 4 9 16 10 11 12 A Internal base of cranium. B Skull base Superior aspect of skull base. viewed from below 13 14 22.17 15 10a 9 16 11 10b 15 24.15 17 12 12.1 13 15 14 18 19 24 C D Skull from left Schematic 20 horizontal section through the 26(25) pterygopalatine fossa 21 27 22 22 17 23 23 24 E Hard palate viewed from below 25 Feneis, Pocket Atlas of Human Anatomy © 2000 Thieme a a All rights reserved. Usage subject to terms and conditions of license. A Bones 33 1 11 8 2 3 26 4 4 5 5 6 10 A Lateral wall of nasal cavity 9 with frontal and sphenoidal sinuses 3 7 6 8 15 22 21 9 17 23 10 10.20 22a B 20 Normal outline of skull viewed 11 10.33 22b from behind (norma occipitalis) 19 12 18 7 2 13 1 24 16 14 3 15 C Right bony orbital cavity 16 28 17 18 28 19 20 29 21 12 13 22 3 29 23 31 30 24 D Skull of newborn, E Skull of newborn, dextrolateral view superior view 25 Feneis, Pocket Atlas of Human Anatomy © 2000 Thieme a a All rights reserved. Usage subject to terms and conditions of license. A Muscles 79 76.24 1 2 2 1 3 4 76.26 1 76.25 4 5 3 6 A Deep suboccipital muscles, lateral view 7 8 82.1 9 11 8 10 10 19 11 24 12 9 18 12 19 B Neck, anterior view 23 13 28 25 14 15 22 21 16 13 20 17 C 18 Superficial muscles of head 15 27 16 19 28 20 28 21 22 D Deep mimic muscles 23 28 24 E Sagittal section through the lips 25 Feneis, Pocket Atlas of Humana Anatomy © 2000 Thieme All rights reserved.
    [Show full text]
  • Imaging of Parapharyngeal Space and Infratemporal Fossa Imaging of Parapharyngeal Space and Infratemporal Fossa
    AIJOC 10.5005/jp-journals-10003-1096 INVITED REVIEW ARTICLE Imaging of Parapharyngeal Space and Infratemporal Fossa Imaging of Parapharyngeal Space and Infratemporal Fossa Sanjay Jain, Aman Kumar, Harshal Dhongade, Ravi Varma ABSTRACT Cross-sectional imaging is an indispensable tool in the investigation of parapharyngeal space and infratemporal fossa pathologies. Computed tomography and magnetic resonance imaging exquisitely display the complex anatomy of this region and provides accurate spatial localization of pathology, differential diagnosis and vital information for treatment planning. Keywords: Parapharyngeal space, Infratemporal fossa, Imaging. How to cite this article: Jain S, Kumar A, Dhongade H, Varma R. Imaging of Parapharyngeal Space and Infratemporal Fossa. Int J Otorhinolaryngol Clin 2012;4(3):113-121. Source of support: Nil Conflict of interest: None declared INTRODUCTION The parapharyngeal space (PPS) is centrally located and surrounded by other neck spaces from all sides. Due to its critical location and anatomic relationships, it acts as a highway for spread of infection and tumors from any of the areas that surround it to any of the other bordering spaces. Clinical examination is limited by the inaccessible location; hence diagnosis of PPS pathologies is completely dependent on cross-sectional imaging. PPS ANATOMY PPS is an inverted pyramidal-shaped potential space extending down from the skull base on either side of the pharynx (Figs 1 and 2). It is divided into two compartments: Prestyloid and retrostyloid by tensor-vascular-styloid fascia.1 This fascia connects tensor veli palatini muscle with Figs 2A to D: Radiological anatomy of parapharyngeal space: An inverted pyramid-shaped space along the pharynx on either side (A and C: arrows) (B and D: ) extending from skull base up to the Fig.
    [Show full text]
  • United States National Museum Bulletin 273
    SMITHSONIAN INSTITUTION MUSEUM O F NATURAL HISTORY UNITED STATES NATIONAL MUSEUM BULLETIN 273 The Muscular System of the Red Howling Monkey MIGUEL A. SCHON The Johns Hopkins University School of Medicine SMITHSONIAN INSTITUTION PRESS WASHINGTON, D.C. 1968 Publications of the United States National Museum The scientific publications of the United States National Museum include two series, Proceedings of the United States National Museum and United States National Museum Bulletin. In these series are published original articles and monographs dealing with the collections and work of the Museum and setting forth newly acquired facts in the fields of anthropology, biology, geology, history, and technology. Copies of each publication are distributed to libraries and scientific organizations and to specialists and others interested in the various subjects. The Proceedings, begun in 1878, are intended for the publication, in separate form, of shorter papers. These are gathered in volumes, octavo in size, with the publication date of each paper recorded in the table of contents of the volume. In the Bulletin series, the first of which was issued in 1875, appear longer, separate publications consisting of monographs (occasionally in several parts) and volumes in which are collected works on related subjects. Bulletins are either octavo or quarto in size, depending on the needs of the presentation. Since 1902, papers relating to the botanical collections of the Museum have been published in the Bulletin series under the heading Contributions from the United States National Herbarium. This work forms number 273 of the Bulletin series. Frank A. Taylor Director, United States National Museum U.S.
    [Show full text]
  • Deep Cervical Fascia
    DEEP CERVICAL FASCIA BY DR.M.MD.MUSTAFA SHARIFF DEPT OF ANATOMY SENIOR LECTURER SRMDC&H DEEP CERVICAL FASCIA • It is also called FASCIA COLLI • The deep cervical fascia of neck is clinically very important for it forms various fascial spaces in the neck. • It also provides capsule to the glands and invests the muscles in the region. • It forms protective sheaths around neurovascular structures. • The layers of deep cervical fascia forms planes to direct the spread of infection or pus in the neck. INVESTING LAYER • It lies deep to the platysma and surrounds the neck like a collar. • It forms the roof of the posterior triangle of the neck. • It encloses the sternocleidomastoid and trapezius the two large superficial muscles of the neck on either side. ATTACHMENTS SUPERIORLY: o External occipital protuberance o Superior nuchal line o Mastoid process o Lower border of mandible ▪ Anterior and superiorly it is attached to the lower border of the mandible. ▪ Anteroinferiorly it is attached to the clavicle and manubrium sterni. Posteriorly: ▪ It is attached to the ligamentum nuchae , spine of the C7 vertebrae, spine of scapula , acromian process of the scapula. ▪ The investing layer encloses two salivary glands namely the parotid and submandibular gland. ▪ Tracing the fascia upwards from the clavicle to the lower border of the mandible , it divides into two layers. ▪ Superficial layer is attached to the lower border of mandible and deep layer attached to mylohyoid line. ▪ Between the two layers the submandibular salivary gland and the lymph glands are enclosed. • Near the angle of mandible the investing layer divides into two layers to enclose the parotid gland.
    [Show full text]