Anatomy, anatomy, anatomy

This end of year issue is the usual blend of basic science and medical or surgical treatments, but with a strong anatomical flavour. It would seem there is little new to say about topographical anatomy and yet from a surgical perspective there is still much to be learnt, as evidenced by the in-depth investigation by Liu et al. (1) of the Vidian canal. Although vidian neurectomy is clearly still fashionable in Taiwan, the canal itself has assumed greater importance with the demonstration that this is the principle route for sphenoid invasion by juvenile angiofibroma (JAF) and thus the site of ‘recurrence’ if not adequately explored (2). Drilling out the canal and the surrounding basi-sphenoid is now recognised as a key determinant in the complete removal of JAF whatever surgical approach is employed. 3-D imaging reconstruction elegantly demonstrates the range of anatomical variation related principally to increased sphenoid pneumatisation and consequent prominence of adjacent structures such as the vidian canal itself and the foramen rotundum (3,4). A better appreciation of this anatomy might even lead to a resurgence of international interest in vidian neurectomy for the treatment of excessive watery rhinorrhoea if the associated complications from the procedure could be minimised (5,6).