Head and Neck

Carotid artery and lower cranial nerve exposure with increasing surgical complexity to the parapharyngeal space

Ana M. Lemos-Rodriguez MD

Department of Otolaryngology–Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A

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Satyan B. Sreenath MD,

Satyan B. Sreenath MD

Department of Otolaryngology–Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A

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Rounak B. Rawal MD,

Rounak B. Rawal MD

Department of Otolaryngology–Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A

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Lewis J. Overton MD,

Lewis J. Overton MD

Department of Otolaryngology–Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A

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Zainab Farzal BS,

Zainab Farzal BS

Department of Otolaryngology–Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A

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Adam M. Zanation MD, FACS,

Corresponding Author

Adam M. Zanation MD, FACS

[email protected]

Department of Otolaryngology–Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A

Department of Neurosurgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A

Send correspondence to Adam M. Zanation, MD, Department of Otolaryngology–Head & Neck Surgery, University of North Carolina at Chapel Hill, 170 Manning Drive, CB #7070, Physician's Office Building Room G-190, Chapel Hill, NC, 27599. E-mail: [email protected]Search for more papers by this author

Ana M. Lemos-Rodriguez MD,

Ana M. Lemos-Rodriguez MD

Department of Otolaryngology–Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A

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Satyan B. Sreenath MD,

Satyan B. Sreenath MD

Department of Otolaryngology–Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A

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Rounak B. Rawal MD,

Rounak B. Rawal MD

Department of Otolaryngology–Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A

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Lewis J. Overton MD,

Lewis J. Overton MD

Department of Otolaryngology–Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A

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Zainab Farzal BS,

Zainab Farzal BS

Department of Otolaryngology–Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A

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Adam M. Zanation MD, FACS,

Corresponding Author

Adam M. Zanation MD, FACS

[email protected]

Department of Otolaryngology–Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A

Department of Neurosurgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A

First published: 26 November 2016

https://doi.org/10.1002/lary.25781

Citations: 17

Part of the content of this article (Abstract number: 493) was a poster presentation at the Triological Society Annual Meeting at Combined Otolaryngology Spring Meeting, Boston, Massachusetts, U.S.A., April 24–25 2015.

The authors have no funding, financial relationships, or conflicts of interest to disclose.

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Abstract

Objectives/Hypothesis

To investigate the extent of carotid artery exposure attained, including the identification of the external carotid branches and lower cranial nerves in five sequential external approaches to the parapharyngeal space, and to provide an anatomical algorithm.

Study Design

Anatomical study.

Methods

Six latex-injected adult cadaver heads were dissected in five consecutive approaches: transcervical approach with submandibular gland removal, posterior extension of the transcervical approach, transcervical approach with parotidectomy, parotidectomy with lateral mandibulotomy, and parotidectomy with mandibulectomy. The degree of carotid artery exposure attained, external carotid branches, and lower cranial nerves visualized was documented.

Results

The transcervical approach exposed 1.5 cm (Standard Deviation (SD) 0.5) of internal carotid artery (ICA) and 1.25 cm (SD 0.25) of external carotid artery (ECA). The superior thyroid and facial arteries and cranial nerve XII and XI were identified. The posterior extension exposed 2.9 cm (SD 0.7) of ICA and 2.7 cm (SD 1.0) of ECA. Occipital and ascending pharyngeal arteries were visualized. The transparotid approach exposed 4.0 cm (SD 1.1) of ICA and 3.98 cm (SD 1.8) of ECA. Lateral mandibulotomy exposed the internal maxillary artery, cranial nerve X, the sympathetic trunk, and 4.6 cm (SD 2.4) of ICA. Mandibulectomy allowed for complete ECA exposure, cranial nerve IX, lingual nerve, and 6.9 cm (SD 1.3) of ICA.

Conclusion

Approaches for the parapharyngeal space must be based on anatomic and biological patient factors. This study provides a guide for the skull base surgeon for an extended approach based on the desired anatomic exposure.

Level of Evidence

N/A. Laryngoscope, 127:585–591, 2017

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Citing Literature

Volume127, Issue3

March 2017

Pages 585-591

Carotid artery and lower cranial nerve exposure with increasing surgical complexity to the parapharyngeal space

Abstract

Objectives/Hypothesis

Study Design

Methods

Results

Conclusion

Level of Evidence

BIBLIOGRAPHY

Citing Literature

References

Information

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Carotid artery and lower cranial nerve exposure with increasing surgical complexity to the parapharyngeal space

Abstract

Objectives/Hypothesis

Study Design

Methods

Results

Conclusion

Level of Evidence

BIBLIOGRAPHY

Citing Literature

References

Related

Information