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Juvenile Angiofibroma
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
The tumour usually arises from the lateral wall of the posterior nasal cavity close to the sphenopalatine foramen and the pterygoid base (Figure 113.1a). Due to its early submucosal expansion towards the nasopharynx, it has frequently been termed ‘nasopharyngeal angiofibroma’. Due to this location nasal obstruction and nasal bleeding may be symptoms presented by the adolescents. Although the tumour is histopathologically classified as a benign lesion, bony erosions of the pterygoid, the clivus and the sphenoid sinus floor are common hallmarks of JAs. Bony destruction of the sphenoid sinus floor is followed by tumour extension into the sphenoid sinus. Here the tumour may fill the sinus space almost completely without infiltrating the mucosa. Furthermore, the tumour may grow along the central skull base towards the foramen lacerum. In such cases, assessment should be made of the presence, or not, of tumour tissue posterior to the pterygoid plates.
Central nervous system
Published in Dave Maudgil, Anthony Watkinson, The Essential Guide to the New FRCR Part 2A and Radiology Boards, 2017
Dave Maudgil, Anthony Watkinson
These three foramina are orientated in an oblique line, from anteromedially behind the superior orbital fissure to posterolaterally: rotundum, ovale, spinosum. The foramen rotundum transmits the maxillary nerve, the foramen ovale the mandibular nerve and the foramen spinosum the middle meningeal artery. The foramen lacerum is located at the base of the medial pterygoid plate.
Head and Neck
Published in Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno, Understanding Human Anatomy and Pathology, 2018
Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno
The centrally-located ethmoid bone is a light, spongy bone (ethmos = “sieve,” and thus ethmoid means “sieve-like”) that acts rather like a keystone anchoring the cranial bone with the facial bones. The intricate and vaguely rectangular ethmoid bone includes the crista galli and cribriform plate—with foramina for bundles of the olfactory nerve (CN I) (Plate 3.2). From the same superior view of the cranial base that shows the ethmoid, one can see that the sphenoid bone includes the lesser wing, anterior clinoid process, greater wing, carotid groove (for the internal carotid artery), and the sphenoid body, which comprises the jugum, chiasmatic (optic) groove, and the sella turcica (tuberculum sellae, hypophyseal fossa, dorsum sellae, and posterior clinoid process) (Plates 3.11 and 3.12). The sphenoid bone also encloses the optic canal—for optic nerve (CN II) and ophthalmic artery; the superior orbital fissure—for oculomotor nerve (CN III), trochlear nerve (CN III), ophthalmic nerve (CN V1), abducens nerve (CN VI), and superior ophthalmic vein; the foramen rotundum—for maxillary nerve (CN V2); foramen ovale—for mandibular nerve (CN V3); and the foramen spinosum—for middle meningeal artery and vein (Plate 3.2). Note that the foramen lacerum lies between the sphenoid and temporal bones, the anterior cranial fossa is separated from the middle cranial fossa by the sphenoidal crests and limbus, and the posterior cranial fossa is also separated from the middle cranial fossa by the superior border of the petrous part of the temporal bone and by the dorsum sellae. On the medial wall of the orbit between the sphenoid and the frontal bones lie the anterior ethmoidal foramen and the posterior ethmoidal foramen through which pass the anterior and posterior ethmoidal arteries, veins, and nerves, respectively. The part of the ethmoid bone that forms the medial aspect of the orbit is so thin that is called the lamina papyracea (“papyrus,” the thin plant-derived paper; “lamina” means layer).
Treatment of intractable epistaxis in patients with nasopharyngeal cancer
Published in Annals of Medicine, 2023
Xiaojing Yang, Hanru Ren, Minghua Li, Yueqi Zhu, Weitian Zhang, Jie Fu
Based on the anatomy of the nasopharynx, it can be concluded that the main arterial blood supply comes from the internal maxillary arteries. When the lesion in the pharyngeal recess is deep, it can invade the foramen lacerum and the ICA, resulting in uncontrolled carotid blowout, which can be harmful to patients. During DSA examination, internal maxillary angiography can reveal small blood vessels and a few bleeding points [39]. This may be due to the existence of the pharyngeal recess that is adjacent to the cervical segment of the ICA. Since the ICA extends to the skull via the foramen lacerum, rupture of its walls can lead to fatal bleeding. The pharyngeal recess and the areas outside the sphenoid sinus are considered the apical regions of the ICA. High-dose radiotherapy can cause blood vessels to become hard and fibrotic, with stage IV patients often experiencing skull-base bone destruction. Regeneration of tumor tissues and nasopharyngeal ulcers compresses the bone and surrounding tissues in the apical region of the ICA, which can cause the formation of a pseudoaneurysm (PSA) if the invaded ICA ruptures initially [40]. The rupture of PSA can cause nasopharyngeal hemorrhage due to increased blood pressure. In case of a major hemorrhage, temporary hemostasis may be observed clinically after the blood pressure drops. However, when the blood pressure returns to normal, blood volume recovery can lead to fatal hemorrhage. The apical vessels of the ICA are considered nasopharyngeal hemorrhage-prone areas after radiotherapy in patients with NPC [41]. Lesions in the pharyngeal recess area that invade the foramen lacerum and ICA often result in uncontrolled major bleeding. In addition, bleeding caused by PSA in the neck vessels after NPC radiotherapy can be fatal if left untreated or mistreated, accounting for approximately 1% of patients with significant bleeding.