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Anatomy of the head and neck
Published in Helen Whitwell, Christopher Milroy, Daniel du Plessis, Forensic Neuropathology, 2021
The falx cerebri is located within the longitudinal fissure separating the left and right cerebral hemispheres. Inferiorly, it is attached to the crista galli and the internal occipital crest of the inner surface of the occipital bone. Both the superior and inferior sagittal venous sinuses lie within the falx cerebri. Its posterior margin is continuous with the tentorium cerebelli, which separates the cerebellar hemispheres from the cerebrum, but is at right angles to the falx cerebri. The transverse sinus is located within the tentorium cerebelli. Finally, the falx cerebelli separates the two cerebellar hemispheres in the midline but inferior to the tentorium cerebelli (Figure 1.3).
Abnormal Skull
Published in Swati Goyal, Neuroradiology, 2020
Lesions involving ACF include sincipital encephalocele, benign sinonasal masses, such as polyps, hemangiomas, inverted papillomas, inflammatory mucosal disease, juvenile nasopharyngeal angiofibromas, and malignant masses, including sinonasal malignancy and olfactory neuroblastoma. Frontal bone osteomyelitis extends outward, forming a subgaleal abscess (Pott’s puffy tumor), and is an infective lesion of the region. Traumatic fracture of the cribriform plate and the crista galli can result in CSF rhinorrhea.
Extended Anterior Skull Base Approaches
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
Carl H. Snyderman, Paul A. Gardner, Juan C. Fernandez-Miranda, Eric W. Wang
A Draf 3 frontal sinusotomy is the foundation for the transfrontal approach (Figure 116.5). The nasofrontal recess is identified bilaterally by following the uncinate process and opening the anterior ethmoid air cells. The anterior ethmoid artery is identified at the posterior limit of the nasofrontal recess. The anterior tip of the middle turbinate is resected to the first olfactory fibre. The mucosa and periosteum of the olfactory sulcus can be elevated to assist in identification of the anterior margin of the cribriform plate and olfactory fibres. A superior septal window is created between the nasofrontal recesses to provide binarial access and improved angles for instrumentation. With visualization of the frontal sinuses on both sides, the floor of the frontal sinuses is then drilled in a curvilinear fashion anterior to the crista galli. Additional bone is drilled anteriorly in the midline (frontal beak) to increase access superiorly. Intersinus septations are drilled as necessary to provide a wide drainage pathway.
High-resolution computed tomography assessment of bony nasolacrimal parameters: variations due to age, sex, and facial features
Published in Orbit, 2021
Zhiheng Lin, Namita Kamath, Adeela Malik
For measurements of the face, standardisation was achieved by aligning the axial plane with the superior surface of the hard palate (Figure 4) as a landmark to account for variable flexion of the neck. We also aligned the sagittal plane to a midsagittal line running between the crista galli and the protuberantia internus occipitalis (Figure 5) to account for a face turn. Reconstructed images were then used. For nasal height and width, the most inferior axial image where the tip of the nasal bone (rhinion) was visible was used, measuring width from between the nasolacrimal grooves (Figure 6). For upper facial width, the most anterior coronal image displaying the zygomatico-frontal sutures was analysed, measuring from the outer aspects (Figure 7).
A superficial nasal dermoid cyst excised through a novel horizontal zig-zag incision in a 49-year-old man
Published in Acta Oto-Laryngologica Case Reports, 2020
Jeremy Wales, Babak Alinasab, Ola Fridman-Bengtsson
The classical presentation of a dermoid cyst can often give a hint to its diagnosis and is considered to be pathognomonic. However, clinical examination of NDCs alone cannot rule out intracranial extension. The majority of NDCs are classified as simple and do not involve underlying structures. However, more complex NDCs can involve the nasal bones, skull base or include an intracranial component [9]. Therefore, good surgical planning is essential. Moses et al. [2] recommends an initial CT and if the diagnosis is unclear to proceed to MR, however, Herrington et al. [6] recommends MR as the first investigation so as to reduce radiation exposure in children. CT can be used to assess the bony anatomy associated with the NDC. One often sees a wide foramen caecum (>3 mm) and a bifid crista galli. However, these findings do not necessarily indicate intracranial extension [10]. MR should be used to follow the course of the fistula or cyst and conclusively rule out/in intracranial extension [7]. We, as well as others [4], would recommend that the initial investigation in adults should be a CT to define the bony anatomy and then an MR to determine intracranial extension and operative planning. Hartley et al. [11] proposed a radiological classification of NDCs divided in to four groups: superficial, intraosseus, intracranial extradural and intracranial intradural, to allow better surgical planning.
Intracranial complications of midline nasal dermoid cysts
Published in Acta Chirurgica Belgica, 2019
Dries Opsomer, Toon Allaeys, Ann-Sofie Alderweireldt, Edward Baert, Nathalie Roche
When diagnosing a child with a midline nasal dermoid cyst, preoperative evaluation of possible intracranial involvement is imperative. An ultrasound is usually performed first. When this raises suspicion further work-up should be done by CT and/or MRI imaging, but this requires general anaesthesia in a small child. Computed tomography is superior in showing the indirect bony deformities such as deformed or bifid crista galli, patent foramen caecum or a defect of the cribriform plate. Magnetic resonance imaging is more useful for clearly visualising the direct soft tissue involvement [2–7].