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The Styloid-Pterygoid Line: A Reproducible Anatomic Landmark for V3 Perineural Spread Biopsy
Ivy T Vo1, Victor Sai1, Brian Dahlin1
1From the Department of Radiology (I.T.V., N.F., N.P.), Pathology (M.R.), Stanford University School of Medicine, Stanford, CA; Department of Radiology (V.S.), University of California, Los Angeles David Geffen School of Medicine, CA and Department of Radiology (B.D.), Kaiser Permanente, Sacramento, CA.
A new CT-guided transcondylar approach safely diagnoses perineural spread (PNS) of head and neck cancers along the mandibular nerve (V3). This technique offers a less invasive alternative for accurate tissue diagnosis, guiding treatment intensification.
Area of Science:
- Radiology
- Oncology
- Head and Neck Surgery
Background:
- Perineural spread (PNS) along the mandibular division (V3) of the trigeminal nerve is a critical prognostic factor in head and neck cancers.
- Traditional diagnostic methods like open biopsy or foramen ovale access carry significant risks, including hemorrhage and infection.
Purpose of the Study:
- To describe and evaluate a novel CT-guided transcondylar approach for diagnosing V3 PNS.
- To establish a safe and effective alternative to existing invasive diagnostic procedures.
Main Methods:
- A CT-guided transcondylar needle biopsy technique was employed, utilizing the styloid-pterygoid line as a landmark.
- The approach targeted the mandibular nerve within the infratemporal fossa in six patients with suspected V3 PNS.
- Procedures were performed between 2015 and 2024.
Main Results:
- Technical success was achieved in 100% of cases.
- Histologic confirmation of malignant PNS was obtained in 83% of patients, leading to treatment escalation.
- One patient had a benign biopsy result, confirmed by subsequent imaging improvement. No complications were reported.
Conclusions:
- The CT-guided transcondylar approach is a safe, effective, and reproducible method for diagnosing suspected V3 PNS.
- This technique offers a minimally invasive alternative, mitigating risks associated with traditional methods.
- It should be considered for histologic confirmation of mandibular nerve involvement to optimize clinical management.
