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Preauricular retromandibular trans tympanic plate and styloid process keyhole approach to parapharyngeal lesions: a laboratory study

  • Original Article - Neurosurgical Anatomy
  • Published:
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Abstract

Background

The surgical removal of the infratemporal parapharyngeal lesions (IPL) is challenging due to its anatomical complexity. Previous surgical approaches have often been too invasive and necessitated sacrifice of normal function and anatomical structures, particularly in the retromandibular nerve region. Therefore, we sought to identify an approach corridor to this area that requires less sacrifice and report an innovative approach through a retromandibular fossa route to the IPL.

Methods

Five cadaveric specimens were dissected bilaterally with a trans-tympanic plate and styloid process approach. These specimens were investigated microanatomically and morphometrically to examine the extent of the approach in the parapharyngeal space. The clinical application of this approach was compared to previous approaches to the IPL used in our clinical series of 20 cases.

Results

Using this novel approach, the inferior alveolar nerve was identified in all specimens, while the chorda tympani and lingual nerve were identified in 6 (60%) and 4 (40%) dissections, respectively. In all specimens, the petrous portion of the internal carotid artery and the exit of the lower cranial nerve were identified. The average length of the exposed lower cranial nerves was 16.6 ± 3.8 mm (range: 11–25 mm).

Conclusions

The described approach is feasible for accessing the IPL at the retromandibular nerve and is less invasive than conventionally used approaches.

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Abbreviations

EAC:

External auditory canal

FN:

Facial nerve

ICA:

Internal carotid artery

IPL:

Infratemporal parapharyngeal lesions

ITF:

Infratemporal fossa

ITR:

Inferior tympanic ring

PS:

Parapharyngeal space

SP:

Styloid process

TMJ:

Temporomandibular joint

TP:

Tympanic plate

TTSA:

Trans-tympanic plate and styloid process approach

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Acknowledgments

The authors thank Mrs. Lori Radcliffe for managing our investigation and Prof. Allan H. Friedman and Prof. John H. Sampson for providing the research opportunity. We would like to thank Mr. Shawn Mullin and Editage (www.editage.com) for English language editing.

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Authors and Affiliations

  1. Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA

    Hikari Sato, Udom Bawornvaraporn & Takanori Fukushima

  2. Moriyama Memorial Hospital, 4-3-1 Kitakasai, Edogawa, Tokyo, 134-0081, Japan

    Hikari Sato

  3. Department of Neurosurgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan

    Yoichi Nonaka

  4. Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand

    Udom Bawornvaraporn

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  1. Hikari Sato
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Correspondence to Hikari Sato.

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Video 1

Illustration of the steps involved in the cadaveric dissection. CN IX = glossopharyngeal nerve; CN X = vagus nerve; XI = accessory nerve; EAC = external auditory canal; FN = facial nerve; PS = parapharyngeal space (MOV 282491 kb)

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Sato, H., Nonaka, Y., Bawornvaraporn, U. et al. Preauricular retromandibular trans tympanic plate and styloid process keyhole approach to parapharyngeal lesions: a laboratory study. Acta Neurochir 162, 661–669 (2020). https://doi.org/10.1007/s00701-020-04217-9

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  • DOI: https://doi.org/10.1007/s00701-020-04217-9

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