ePrints@TNMGRM (Tamil Nadu Dr. M.G.R. Medical University)
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A Comparative study of Neurological Soft Signs in Patients with Obsessive Compulsive Disorder, their First Degree Relatives and Normal Controls
No full textAnalysis of Functional and Radiological Outcome of Distal Femur Fractures Treated by Open Reduction and Internal Fixation with Locking Compression Plate: A Prospective study
No full textA Prospective study on Various Factors Which Influence the Perioperative Outcome during Laparoscopic Cholecystectomy
No full textNutritional Status of Children Aged 5-9 Years in Kaniyambadi Block of Vellore District, Tamil Nadu and The Risk Factors Associated with It A Community-Based, Cross-Sectional study
No full textCochlear Sparing Effects of Volumetric Modulated Arc Therapy (VMAT) in Head and Neck Cancer Patients
No full textA Descriptive study of Parapharyngeal Internal Carotid Artery Anatomy and Its Surgical Landmarks in Expanded Endoscopic Approaches
No full textBACKGROUND:
The parapharyngeal space (PPS) is a deep space in head and neck in relation to the internal carotid artery. Surgical approach for lesions confined to this space is challenging. The transition of open skull base surgeries to transnasal endoscopic surgeries for skull base and pituitary pathologies have revolutionized the management
by reducing the mortality and morbidity due to better visualization and patient outcomes, reduced hospital stay and postoperative pain. However any injury to the ICA can be
devasting. Therefore a good knowledge about the internal carotid artery anatomy within the PPS and its relation to the surrounding structures as observed through the endoscope
and an understanding of consistent anatomical landmarks is crucial for a surgeon to proceed confidently when operating on a lesions near the ICA within the PPS. The objective of this study was to describe new intraoperative surgical landmarks for ppICA and their relevance and to develop a strategy to use these landmarks and various other
landmarks used in literature to determine the position of ppICA.
AIM & OBJECTIVES
AIM OF THE STUDY:
To study the anatomy and describe the surgical landmarks for the parapharyngeal internal carotid artery (ppICA).
OBJECTIVES:
1. To describe the relevance of new intraoperative surgical landmarks to the parapharyngeal internal carotid artery (ppICA).
2. To develop a strategy to determine the position of ppICA using these land marks and other various landmarks described in literature.
MATERIAL AND METHODS:
A retrospective single centre study of patients above 18 yrs with a normal parapharyngeal space anatomy on a CT neck or PNS were included in the study. These scans were reviewed and the course of ppICA and its relationship to the
bony landmarks were analysed by two investigators independently. Four surgical landmarks were chosen for this study on the axial sections, the position of the ppICA was
determined in relation to the pharyngeal tubercle, the point on the clivus at the level of the hard palate, the lower clival mid axial point and the medial pterygoid plate. The
distance of the ppICA from junction of lower clivus mid axial line and medial pterygoid plate line was also measured. The relation of ppICA with regards to eustachian tube isthmus and foramen ovale was also determined.
RESULTS:
A total of 63 CT scans were included in the study. Patients aged from 18 years to 78 years with a male female ratio of 69:31. 85.9% of ppICA were found to be anteriorly placed in in relation to the coronal line passing through the lower clival mid axial point (LCMAL) with weighted kappa of 0.79 for the right side and 0.91 on the left side. More than 65% of the ppICA were anteriorly placed with respect to skull base at the level of hard palate with kappa = 0.7 on both sides. All ppICA were placed lateral to the sagittal
line along the medial pterygoid plate and all of them were found to be placed posterior to the coronal line along the eustachian tube isthmus and the foramen ovale. The minimum
distance of a laterally placed ppICA from the junction of sagittal line along medial pterygoid plate and axial line along lower clival mid axial point is 0.005 cm.
CONCLUSION:
Anatomical landmarks such as floor of hard palate, pharyngeal tubercle and lower clival mid axial point help determine the craniocaudal trajectory of the artery
during an expanded endoscopic approach. A small percentage of patients can have their ppICA placed anterior to the coronal plane along ET isthmus. Therefore, determining the position of ppICA preoperatively is crucial to avoid ppICA bleed. Medial pterygoid plate is a bony structure easily visualised during endoscopic approach and all ppICA are placed lateral to the sagittal plane along MPP, hence it is safe to dissect soft tissue medial to it without posing a risk to the vessel
Outcomes of Enhanced Recovery After Surgery (ERAS) in Major Incisional Hernia Repair: An (Ambidirectional) Retrospective and Prospective Observational study
No full textThe Identification of Vasculo-Biliary Anatomy and Its Variations using Real-Time Indocyanine Green Near Infrared Fluorescence during Laparoscopic Cholecystectomy: The Iva Green study
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