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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 external surface of the temporal bone includes the zygomatic process, mastoid process (mastoid means “breast-like” in Latin, in reference to the rounded shape of this process), styloid process (“stick-like” or “pointed”), mandibular fossa, external acoustic meatus, articular tubercle, carotid canal (for internal carotid artery), the bony portion of the pharyngotympanic tube, the jugular fossa, and the stylomastoid foramen (Plates 3.8a and c and 3.10). The temporal fossa is a depression formed by the parietal, frontal, squamous part of the temporal bone, and greater wing of the sphenoid. It serves to expand the area for attachment of jaw closing muscles. The zygomatic arch (colloquially known as the “cheekbone”) is formed by the zygomatic process of the temporal bone and the temporal process of the zygomatic bone. The infratemporal fossa lies inferior to the zygomatic arch and includes or adjoins the following structures: The pterygomaxillary fissure lies between the lateral plate of the pterygoid process of the sphenoid bone and the infratemporal surface of the maxilla; the pterygopalatine fossa lies at the superior end of the pterygomaxillary fissure, and the sphenopalatine foramen is an opening into the nasal cavity (Plates 3.8 and 3.9); the inferior orbital fissure lies between the maxilla and the greater wing of the sphenoid bone, which contains the foramen ovale and foramen spinosum.
Temporomandibular Joint Disorders
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
The masseter muscles lie over the vertical ramus of the mandible up to the base of the zygomatic arch. The temporalis lies above the zygomatic arch, extending behind and above the ear and onto the forehead below the hairline. Tenderness in a muscle during clenching or the palpation of tight bands of muscle indicates myofascial spasm and pain.
Approaches to the Nasopharynx and Eustachian Tube
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 postauricular C-shaped incision is made that extends superiorly into the temporal region and inferiorly into the neck (Figure 109.5a). The temporalis muscle, mastoid and zygoma are exposed. A periosteal flap is elevated and the external auditory canal is transsected and closed as a blind sac. The pinna and skin flap are reflected anteriorly. As a precaution, the neck is dissected so that control of the carotid and jugular vessels can be achieved. The main trunk of the facial nerve is identified together with its frontal branch so that the zygomatic arch can be exposed and divided anterior to the temporomandibular joint and again just behind the orbital rim without damaging the frontal branch. The zygomatic arch is reflected inferiorly attached to masseter muscle (Figure 109.5b). The temporalis muscle and fascia is elevated from the temporal fossa and reflected inferiorly to expose the superolateral quadrant of the infra-temporal fossa.
Internal maxillary artery to middle cerebral artery bypass for a complex recurrent middle cerebral artery aneurysm: case report and technical considerations
Published in British Journal of Neurosurgery, 2022
Ronan J. Doherty, Daragh Moneley, Paul Brennan, Mohsen Javadpour
Preoperatively the patient underwent computed tomographic angiography (CTA) of the head which was used for intraoperative navigation and localisation of the IMAX (Figure 2). Under general anaesthesia, the patient was positioned supine, with the head in the Mayfield head holder and rotated approximately 45 degrees towards the contralateral side. The previous left frontotemporal incision and pterional craniotomy were reopened. The temporalis muscle was reflected inferiorly and a zygomatic arch osteotomy was performed. Under the operating microscope, a temporal fossa craniectomy was performed consisting of removal of bone of the lateral part of middle cranial fossa floor extending medially as far as a line connecting the foramen rotundum and foramen ovale (Figures 3 and 4). The left IMAX was localised in the infratemporal fossa using a combination of CTA-based neuronavigation and micro-Doppler probe (Mizuho Inc. Tokyo, Japan) (Figure 5). In addition, the deep temporal arteries in the deep aspect of the temporalis muscle were followed proximally to lead to the location of the IMAX.
Immediate reconstruction of segmental mandibular defects via tissue engineering
Published in Baylor University Medical Center Proceedings, 2022
Robert O. Weiss, Patrick E. Wong, Likith V. Reddy
Reconstruction was performed based on a tissue engineering protocol. Both patients were taken to the operative room for surgical resection and immediate reconstruction. A combined intraoral and extraoral approach was used to allow access in both cases. For Patient 1, the zygomatic arch was osteotomized to allow for unfettered access to the expansive lesion. Following anterior osteotomy in the parasymphysis region, disarticulation of the condyle easily aided in completing the hemimandibulectomy. A costochondral autograft was obtained from the patient’s right sixth rib to reconstruct the temporomandibular joint aspect. For Patient 2, the resection did not require disarticulation of the joint, and an osteotomy was performed at the anterior parasymphysis region and mid-ramus. A cadaveric rib allograft was secured to the inferior aspect of the reconstruction plate to provide for an inferior stop for bone grafting material. Nerve allografts were secured to the inferior alveolar nerve stumps and a multilayered water-tight closure concluded the procedure.
A comparative analysis of piezosurgery and oscillating saw for balanced orbital decompression
Published in Orbit, 2019
Kerstin Stähr, Anja Eckstein, Laura Holtmann, Anke Schlüter, Meaghan Dendy, Stephan Lang, Stefan Mattheis
Surgery was performed under general anesthesia and a local anaesthetic mixture of xylocaine and adrenalin 2%. A 10 mm incision was made 5 mm lateral to the lateral canthus. The periosteum was incised from the zygomatic arch to the frontozygomatic suture and dissected from the lateral wall. The lateral wall was removed either by piezosurgery or an oscillating saw. When using the saw, the temporalis muscle and periorbita were retracted and protected by a hook as well as an orbital spatula. The retraction and protection of soft tissue was not necessary when performing piezo surgery. Tissue cooling was maintained in both cases by an integrated irrigation. Remaining bone rims of the deep lateral wall were trimmed using a high-speed burr to generate a smooth surface thus avoiding a bony edge possibly affecting the eye muscles' movement. After having resected the lateral periorbita, 1.5–3 ml orbital fat were removed. The resected lateral wall was reduced to 2–3 mm width via piezosurgery or an oscillating saw to restore the orbit's contour followed by a fixation with microplates in 171 patients. The replantation was performed in patients with thin tissue layers above the lateral orbital wall, to preserve the shape of the lateral face. The medial wall was decompressed via endonasal endoscopy. All orbital decompressions were performed by the same surgeon (SM).