1
|
Agosti E, Rezende NC, Leonel LCPC, Alexander AY, Pinheiro-Neto CD, Peris-Celda M. Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Endoscopic Endonasal and Endoscopic-Assisted Transmaxillary Transpterygoid Approaches. J Neurol Surg B Skull Base 2024; 85:81-94. [PMID: 38274480 PMCID: PMC10807960 DOI: 10.1055/s-0042-1759874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 11/07/2022] [Indexed: 12/30/2022] Open
Abstract
Introduction The endoscopic endonasal transpterygoid approach (EETPA) with or without the addition of the endoscopic-assisted sublabial anterior transmaxillary approach (ESTA) has become increasingly utilized for lesions posterior to the pterygopalatine fossa (PPF), including infratemporal fossa (ITF), lateral recess of the sphenoid sinus, Meckel's cave, petrous apex, and parapharyngeal space. The main goal of this study is to develop an educational resource to learn the steps of the EETPA for trainees. Methods EETPA and ESTA were performed in 12 specimens by neurosurgery trainees, under supervision from the senior authors. One EETPA and one ESTA were performed on each specimen on opposite sides. Dissections were supplemented with representative cases. Results After a wide unilateral sphenoidotomy, ethmoidectomy, and partial medial maxillectomy, the anteromedial bone limits of the PPF were identified and drilled out. The pterygoid progress was modularly removed. By enlarging the opening of the posterior and lateral walls of the maxillary sinus through EETPA and ESTA, respectively, the neurovascular and muscular compartments of the PPF and ITF were better identified. The EETPA opens direct corridors to the PPF, medial ITF, middle cranial fossa, cavernous sinus, Meckel's cave, petrous apex, and internal carotid artery. If a more lateral exposure of the ITF is needed, the ESTA is an appropriate addition. Conclusion Despite the steep learning curve of the EETPA, granular knowledge of its surgical anatomy and basic surgical steps are vital for those advancing their learning in complex endoscopic approaches to the ventral skull base when expanding the approach laterally in the coronal plane.
Collapse
Affiliation(s)
- Edoardo Agosti
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
- Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Natália Cerqueira Rezende
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States
- Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Luciano C. P. C. Leonel
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - A. Yohan Alexander
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Carlos D. Pinheiro-Neto
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
- Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Maria Peris-Celda
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
- Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
| |
Collapse
|
2
|
Díaz-Olivares LA, Cortés-Bretón Brinkmann J, Martínez-Rodríguez N, Martínez-González JM, López-Quiles J, Leco-Berrocal I, Meniz-García C. Management of Schneiderian membrane perforations during maxillary sinus floor augmentation with lateral approach in relation to subsequent implant survival rates: a systematic review and meta-analysis. Int J Implant Dent 2021; 7:91. [PMID: 34250560 PMCID: PMC8273047 DOI: 10.1186/s40729-021-00346-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 04/22/2021] [Indexed: 12/22/2022] Open
Abstract
Background This systematic review aimed to propose a treatment protocol for repairing intraoperative perforation of the Schneiderian membrane during maxillary sinus floor augmentation (MSFA) procedures with lateral window technique. In turn, to assess subsequent implant survival rates placed below repaired membranes compared with intact membranes and therefore determine whether membrane perforation constitutes a risk factor for implant survival. Material and methods This review was conducted according to PRISMA guidelines. Two independent reviewers conducted an electronic search for articles published between 2008 and April 30, 2020, in four databases: (1) The National Library of Medicine (MEDLINE/PubMed) via Ovid; (2) Web of Science (WOS); (3) SCOPUS; and (4) Cochrane Central Register of Controlled Trials (CENTRAL); also, a complementary handsearch was carried out. The Newcastle-Ottawa Quality Assessment Scale was used to assess the quality of evidence in the studies reviewed. Results Seven articles fulfilled the inclusion criteria and were analyzed. A total of 1598 sinus lift surgeries were included, allowing the placement of 3604 implants. A total of 1115 implants were placed under previously perforated and repaired membranes, obtaining a survival rate of 97.68%, while 2495 implants were placed below sinus membranes that were not damaged during surgery, obtaining a survival rate of 98.88%. The rate of Schneiderian membrane perforation shown in the systematic review was 30.6%. In the articles reviewed, the most widely used technique for repairing perforated membranes was collagen membrane repair. Conclusions Schneiderian membrane perforation during MFSA procedures with lateral approach is not a risk factor for dental implant survival (p=0.229; RR 0.977; 95% CI 0.941-1.015). The knowledge of the exact size of the membrane perforation is essential for deciding on the right treatment plan. Supplementary Information The online version contains supplementary material available at 10.1186/s40729-021-00346-7.
Collapse
Affiliation(s)
- Luis Alfredo Díaz-Olivares
- Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University of Madrid, Pza Ramon y Cajal s/n, 28040, Madrid, Spain
| | - Jorge Cortés-Bretón Brinkmann
- Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University of Madrid, Pza Ramon y Cajal s/n, 28040, Madrid, Spain.
| | - Natalia Martínez-Rodríguez
- Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University of Madrid, Pza Ramon y Cajal s/n, 28040, Madrid, Spain
| | - José María Martínez-González
- Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University of Madrid, Pza Ramon y Cajal s/n, 28040, Madrid, Spain
| | - Juan López-Quiles
- Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University of Madrid, Pza Ramon y Cajal s/n, 28040, Madrid, Spain
| | - Isabel Leco-Berrocal
- Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University of Madrid, Pza Ramon y Cajal s/n, 28040, Madrid, Spain
| | - Cristina Meniz-García
- Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University of Madrid, Pza Ramon y Cajal s/n, 28040, Madrid, Spain
| |
Collapse
|
3
|
Abstract
BACKGROUND Improved understanding of the microanatomy of the paranasal sinuses, including its individual variations, makes a substantial contribution to current progress in endonasal endoscopic microsurgery. Microanatomy of the sinuses is an active field of present scientific investitations. MATERIALS AND METHODS A comprehensive review on microanatomy of the maxillary sinus is presented from the perspective of contemporary endonasal endoscopic microsurgery. RESULTS The range of variation of the individual microanatomy of all sections of the maxillary sinus is presented, in particular to minimize secondary sugical tissue trauma, to avoid complications (e.g. on orbital tissues) and as a basis for the prelacrimal access to the maxillary sinus. CONCLUSION Improved understanding of the range of microanatomical variations reduced the burden on the patient while opimizing the effectiveness of the necessary surgical manipulations.
Collapse
Affiliation(s)
- W Hosemann
- Klinik für Hals-Nasen-Ohrenkrankheiten, Kopf- und Hals-Chirurgie, Universitätsmedizin Greifswald, Sauerbruchstraße, 17475, Greifswald, Deutschland.
| | - A Grimm
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Semmelweis Universität, Budapest, Ungarn.,Anatomisches, Histologisches und Embryologisches Institut, Semmelweis Universität, Budapest, Ungarn
| |
Collapse
|
4
|
Barbu HM, Iancu SA, Jarjour Mirea I, Mignogna MD, Samet N, Calvo-Guirado JL. Management of Schneiderian Membrane Perforations during Sinus Augmentation Procedures: A Preliminary Comparison of Two Different Approaches. J Clin Med 2019; 8:jcm8091491. [PMID: 31546766 PMCID: PMC6780245 DOI: 10.3390/jcm8091491] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 09/09/2019] [Accepted: 09/12/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The aim of this study was to retrospectively analyze two different sealing techniques for sinus membrane perforations produced during sinus floor augmentation by a lateral approach. METHODS A total of 172 lateral-approach sinus floor augmentation surgeries were performed on 130 patients. Sixty-one membrane perforations (35%) were reported. Most of the perforations were caused by accidental membrane tearing and 16 (26%) were caused by deliberate incision for mucocele removal. In 31 perforation cases (51%), the Schneiderian membrane was sealed by suturing, while the remaining 30 cases (49%) were sealed using a low-resorption collagen membrane coverage. RESULTS Out of the 31 cases treated with a suture-sealing techniques, 26 (84%) were successful, presenting graft integration. Failure occurred in the other five (16%) cases. Out of the 30 perforations sealed with low-resorption collagen membranes, 28 (93%) presented successful graft integration, while two (7%) failed. CONCLUSIONS Both surgical techniques yielded therapeutic success.
Collapse
Affiliation(s)
- Horia Mihail Barbu
- Oral Implantology Department, Titu Maiorescu University, 031593 Bucharest, Romania.
| | | | | | - Michele Davide Mignogna
- Head & Neck Clinical Section, Department of Neuroscience, Reproductive and Odontostomatological Sciences, Federico II University of Naples, 80138 Naples, Italy.
| | - Nachum Samet
- Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, MA 02115, USA.
| | - José Luis Calvo-Guirado
- Department of Oral and Implant Surgery, Universidad Católica of Murcia, 30107 Murcia, Spain.
| |
Collapse
|
5
|
Assam JH, Quinn TH, Militsakh ON. The maxillary artery as a recipient vessel option for complex midface and anterior skull base microsurgical repair: A cadaveric study. Microsurgery 2016; 37:611-617. [PMID: 27571583 DOI: 10.1002/micr.30095] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 07/15/2016] [Accepted: 08/04/2016] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Variations in the operative situation for complex head and neck defect reconstructions resulting from mechanisms such as trauma, oncologic resection, and prior radiation exposure can result in situations of a vessel-depleted neck. This requires an awareness of alternate, innovative options for use in reconstructive repairs. The purpose of this study was to provide characterization of the third segment of the maxillary artery necessary to consider its use as a recipient vessel in free flap repair of complex midface defects. MATERIALS AND METHODS Seventeen cadaver hemifaces were used for anatomic demonstration of the maxillary artery third segment by a transmaxillary approach to obtain descriptive measures for statistical analysis. RESULTS The average artery intraluminal cross-section diameter was obtained for the sphenopalatine (1.39 ± 0.12 mm) descending palatine (0.94 ± 0.10 mm), and terminal maxillary (1.68 ± 0.17 mm) arterial vessels. The mean transmaxillary depth with was (43 ± 1.2 mm). Mean mobilizable lengths for sphenopalatine, descending palatine, and terminal maxillary arteries were (30 ± 2 mm), (29 ± 2 mm), and (20 ± 2 mm), accordingly. Vessel patterns were characterized using Morton and Kahn classification for sphenopalatine-descending palatine bifurcation as well as the Kwak classification for maxillary artery third segment morphology. CONCLUSIONS In situations where primary recipient vessel sites are unavailable, the maxillary artery represents an innovative option to be considered with suitable recipient artery characteristics.
Collapse
Affiliation(s)
- Jed H Assam
- Department of Biomedical Science, Creighton University, Omaha, NE.,University of South Dakota Sanford School of Medicine, Sioux Falls, SD
| | - Thomas H Quinn
- Department of Biomedical Science, Creighton University, Omaha, NE
| | - Oleg N Militsakh
- Head and Neck Surgical Oncology, Estabrook Cancer Center, Nebraska Methodist Health System, Omaha, NE
| |
Collapse
|