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Paediatrics
Published in Adnan Darr, Karan Jolly, Jameel Muzaffar, ENT Vivas, 2023
Paula Coyle, Eishaan Bhargava, Adnan Darr, Karan Jolly, Kate Stephenson, Michael Kuo
Investigations: Cross-sectional imaging: Digital subtraction angiography for embolisationCT with contrast paranasal sinuses/head: Anterior bowing of posterior maxillary wall (Holman-Miller sign)Widening of sphenopalatine foramenMRI: Salt and pepper appearance on T2 (due to flow voids)Soft-tissue evaluation/extension: Intracranial, orbit, pterygopalatine fossa
Endoscopic management of CSF rhinorrhea
Published in Jyotirmay S. Hegde, Hemanth Vamanshankar, CSF Rhinorrhea, 2020
Jyotirmay S Hegde, Hemanth Vamanshankar
Sphenoid defects can be approached through the medial, intermediate, and lateral approaches. Posterior septectomy may be done for additional exposure of the midline perisellar or clival regions. Defects located in the lateral recess of the sphenoid sinus may require an endoscopic transpterygoid approach.22A wide middle meatal antrostomy, anterior and posterior ethmoidectomy and wide sphenoidotomy are performed. Then the pterygopalatine fossa is entered after the posterior wall of the maxillary sinus is removed. The internal maxillary artery and its branches are identified, moved inferiorly, or clipped and divided to expose the deeper areas of the pterygopalatine fossa. The sphenopalatine ganglion, vidian nerve and V2 are dissected free, and preserved if possible. The pterygoid plate is drilled or curetted away to gain access to the lateral recess of the sphenoid sinus20 (Video 5).
Anatomy of the Skull Base and Infratemporal Fossa
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
A cone-shaped depression deep to the infratemporal fossa, posterior to the maxilla near the orbital apex, the small pterygopalatine fossa contains the terminal third of the maxillary artery, the maxillary nerve (V2), the pterygopalatine ganglion just in front of the pterygoid canal (itself containing the Vivian nerve, a union of the greater and deep petrosal nerves, which then runs anteriorly to the sphenopalatine ganglion) and fat. Its roof is the body of the sphenoid and medially it abuts the perpendicular plate of the palatine bone in the lateral nasal wall. It has several communications to other parts of the skull base, principally laterally via the pterygomaxillary fissure to the infratemporal fossa, medially via the sphenopalatine foramen to the nasal cavity and anteriorly via the inferior orbital fissure to the orbit; posteriorly, the pterygoid (Vidian) canal has been described, with the foramens rotundum and lacerum communicating to the middle cranial fossa.
Specific imaging findings in the course of sinus fungus ball progression to chronic invasive fungal rhinosinusitis
Published in Acta Oto-Laryngologica Case Reports, 2023
Tomotaka Hemmi, Kazuhiro Nomura, Mika Watanabe, Yuki Numano, Risako Kakuta, Mitsuru Sugawara
All MRI findings in the present case indicated CIFRS invasion to the pterygopalatine fossa, except for the ADC. The signal of the posterior wall of the maxillary sinus and the pterygopalatine fossa were identical on T1WI, T2WI, and Gd-enhanced contrast imaging. Interestingly, the ADC indicated an intact pterygopalatine fossa. Unfortunately, we did not take samples from the pterygopalatine fossa in order to avoid injuring the maxillary artery, and we were sure that radical surgery was not needed for CIFRS. These discrepancies between standard settings and the ADC might help distinguish CIFRS from malignant tumors. Further studies are required to confirm these inconsistencies. We believe that, in elderly patients with SFB, surgical treatment should be recommended in order to prevent conversion to IFRS.
Effect of neuropathic pain on sphenopalatine ganglion block responses in persistent idiopathic facial pain
Published in Neurological Research, 2023
Samet Sancar Kaya, Şeref Çelik, Erkan Yavuz Akçaboy, Hamit Göksu, Gökhan Yıldız, Şaziye Şahin
The injections were performed in an operating room. The patient was placed in the supine position and hemodynamic monitoring was performed (blood pressure, heart rate, SpO2). After the area was prepared with sterile aseptic precautions, a mandibular rami was superimposed in the lateral position under C-arm fluoroscopy to obtain an inverted goblet or triangular view of the pterygopalatine fossa. The area was infiltrated with 2 mL of 1% lidocaine using a 25 G needle. A 22 G spinal needle was inserted infrazygomatically in the direction of the sphenopalatine foramen via a mandibular notch and directed medially, cephalad, and slightly posteriorly. After bone contact was established in the pterygopalatine fossa under lateral fluoroscopic view, the needle tip was positioned just laterally to the lateral wall of the nose under an anteroposterior view. After confirming the appropriate contrast spread with anterior-posterior and lateral fluoroscopic (bi-planar) views, a mixture of 40 mg of lidocaine 2% and 8 mg of dexamethasone was injected (Figure 1). The injections were performed only once.
Transcutaneous retrobulbar injection of amphotericin B in rhino-orbital-cerebral mucormycosis: a review
Published in Orbit, 2022
Akshay Gopinathan Nair, Tarjani Vivek Dave
Mucormycosis spreads predominantly by direct tissue invasion. Typically, infection occurs due to inhalation of the spores into the nasal and oral passages, from where the fungal infection spreads into the neighboring paranasal sinuses.1 Direct extension into the anatomically adjacent structures such as the orbit and the pterygopalatine fossa soon follow. Orbital involvement may occur due to extension across contiguous anatomic spaces by bone destruction, by spread across natural bony defects (fissures and foramina). or along natural pathways such as the nasolacrimal ducts.37 Thus, in the initial orbital involvement phase, the infection is localized to one or more of the above-mentioned entry points to the orbital space. Recognizing this early with appropriate imaging would allow for aggressive targeted treatment of the involved region of the orbit, thus salvaging the orbit and avoiding exenteration.