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Published on: February 22, 2013
ICA Window: A Reliable Landmark for Locating Parapharyngeal ICA via Endoscopic Transoral Medial Pterygomandibular
Lei Wang1,2, Huan-Kang Zhang1, Quan Liu1
1ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China.
Objective:
One of the primary challenges in surgical procedures involving parapharyngeal space (PPS) lesions is accurately localizing the internal carotid artery (ICA) within the parapharyngeal space. This study aims to investigate the anatomical landmarks of the parapharyngeal internal carotid artery (ppICA) in endoscopic transoral approach surgery.
Methods:
A total of seven fresh frozen cadaveric heads (14 sides) were dissected using the endoscopic transoral medial pterygomandibular fold approach in the anatomical laboratory of the Surgical Treatment Technology Innovation Unit at Nasal Skull Base Tumor in Eye and ENT Hospital, Fudan University. Additionally, a comparative anatomical study was conducted on three cadaveric head specimens using the microscopic preauricular infratemporal approach. Photographic documentation and measurements were taken for adjacent structures of the ppICA, along with specific anatomical structures neighboring the ppICA. To illustrate the method for locating and protecting the ppICA, three cases involving the prestyloid, poststyloid, and retropharyngeal spaces were selected.
Results:
The stylopharyngeal muscle was located anterolaterally to the ppICA, while the levator veli palatini and longus capitis muscles were situated anterosuperiorly and posteromedially to the ppICA, respectively. The area enclosed by these three muscles was named the "ICA window" in this study. The ppICA was posterior to this window, sealed by the stylopharyngeal fascia. This ICA window was considered a reliable landmark for identification of the ppICA via endoscopic transoral medial pterygomandibular fold approach for PPS surgery.
Conclusion:
The ICA window, delineated by the stylopharyngeal muscle, tensor veli palatini muscle, longus capitis muscle, vaginal process of the tympanic bone, and the intervening fascial structures, emerges as a reliable anatomical landmark for orienting the ppICA during endoscopic transoral surgery for parapharyngeal space procedures.
Level Of Evidence:
N/A.
