Central nervous system
Dave Maudgil, Anthony Watkinson in The Essential Guide to the New FRCR Part 2A and Radiology Boards, 2017
Are the following statements regarding cerebral anatomy true or false? The foramen rotundum transmits the mandibular nerve.The foramen spinosum is anteromedial to the foramen ovale.The foramen ovale transmits the middle meningeal artery.The foramen ovale is posterolateral to the foramen rotundum.The foramen lacerum is located at the base of the lateral pterygoid plate.
Imaging of the Neck
John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford in Head & Neck Surgery Plastic Surgery, 2018
An understanding of the pathology of nasopharyngeal cancer is essential in order to correctly interpret imaging at the time of staging and subsequent follow-up.40 Most nasopharyngeal tumours originate in the fossa of Rosenmuller and tend to spread submucosally with early infiltration of the palatal muscles and obstruction of the Eustachian tube (Figure 37.5). The most common spread is laterally with infiltration of the parapharyngeal and masticator spaces with potential involvement of the mandibular nerve and intracranial spread. Anterior spread of tumour into the nasal fossa can result in erosion of the maxillary sinus and infiltration of the pterygopalatine fossa and thence along the maxillary nerve onto the foramen rotundum (Figure 37.6). NPC can spread superiorly to erode the clivus (Figure 36.7), petrous apex, sphenoid sinus and foramen lacerum. Inferiorly it can extend along the pharyngeal wall to the oropharynx while posteriorly it infiltrates the retropharyngeal space and prevertebral muscles. Nodal metastases (Figure 37.8) to all cervical levels including the retropharyngeal group are extremely common and may be the presenting feature but level 2B nodes rather than retropharyngeal nodes appear to be the first echelon nodes in NPC.41, 42 Tomita et al. showed that primary tumour existence beyond the midline of the nasopharynx was associated with a higher incidence of bilateral lymph node metastases than primary tumour presence within the midline, with incidences of 66% and 18% respectively.43 Distant metastases to the lung and liver are common.
Facial anatomy
Michael Parker, Charlie James in Fundamentals for Cosmetic Practice, 2022
The mandibular (V3) division of the trigeminal nerve is unique compared to the other branches in that it has both motor and sensory functions. It is the most inferior division and arises from the lower portion of the trigeminal root ganglion. Once it has branched from the ganglion, it travels anteriorly along the floor of Meckel’s cave and through the foramen ovale of the sphenoid bone (posterolateral to the foramen rotundum). The nerve is then sandwiched between the medial tensor muscle of the velum palatinium and lateral pterygoid muscle as it continues to head anteriorly before dividing into a thin anterior and thick posterior trunk.
Perineural spread of basosquamous carcinoma to the orbit, cavernous sinus, and infratemporal fossa
Published in Orbit, 2018
Alec L. Amram, William J. Hertzing, Stacy V. Smith, Patricia Chévez-Barrios, Andrew G. Lee
The pterygopalatine or sphenopalatine fossa is a passageway between many major compartments of the skull and is thus a critical location for tumor spread. This fossa is a located in the basilar region of the skull and is bounded medially by the palatine bone, posteriorly by the pterygoid process of the sphenoidal bone, and anteriorly by the posterior wall of the maxillary sinus. It has six communications to major compartments of the skull, communicating medially to the nasal cavity via the sphenopalatine foramen, laterally to the infratemporal fossa via the pterygomaxillary fissure, anteriorly to the orbit through the inferior orbital fissure, posteriorly and superiorly to Meckel’s cave and the cavernous sinus via the foramen rotundum, posteriorly and inferiorly to the middle cranial fossa via the vidian canal, and inferiorly to the palate through the greater and lesser palatine canals. As this fossa has direct access to the nasal cavity, intracranial space, orbit, and cavernous sinus, it is a common site for direct invasion and perineural spread of disease and can present with involvement of any combination of the aforementioned compartments.15 In our patient, the carcinoma most likely spread from the nasal cavity to the sphenopalatine fossa, and then extended to the infratemporal fossa, cavernous sinus, and orbit.
Evaluating the perioperative analgesic effect of ultrasound-guided trigeminal nerve block in adult patients undergoing maxillofacial surgery under general anesthesia: A randomized controlled study
Published in Egyptian Journal of Anaesthesia, 2023
Maha Misk, Abdelrhman Alshawadfy, Medhat Lamei, Fatma Khames, Mohamed Abd Elgawad, Hamdy A. Hendawy
Following intubation, the blocks were performed in an aseptic setting with the patients being observed with a fitted oxygen face mask. The block was performed on the same side of the surgery. The side of the patient’s face that needed to be blocked was on the upper side while they lay supine. The high-frequency, linear array transducer (Sonosite M-Turbo ® US machine, 7–12 MHz) was positioned longitudinally on the side of the face slightly below the zygomatic bone, above the mandibular notch, and in front of the mandibular condyle. The probe’s angle was cephalad, pointing in the direction of the pterygopalatine fossa. To reach the foramen rotundum, the local anesthetic could be injected deeply into the superior head of the lateral pterygoid muscle along the pterygomaxillary fissure. The zygomatic bone, lateral pterygoid muscle, lateral pterygoid plate, maxillary bone, and maxillary artery were identified in the pterygopalatine fossa using US and color power Doppler US. A 22-G, 5 cm insulated echogenic needle was inserted out of plane above the zygomatic bone (suprazygomatic approach) and introduced in a lateral to medial and posterior to anterior direction in the pterygopalatine fossa. The patient’s mouth was kept open with an oral airway to prevent the coronoid process from creating an auditory shadow. The probe was slightly elevated in a superior direction. A negative aspiration was followed by the administration of 5 mL of 0.25% bupivacaine.
Radiotherapy for Melanoma with Perineural Invasion: University of Florida Experience
Published in Cancer Investigation, 2018
Simeng Zhu, William M. Mendenhall
All seven patients were white and included five males and two females. The median age at the time of treatment was 60 years (range, 35–81 years). Five patients (patients 1 through 5) presented with cutaneous lesions which were found to have PNI after excision. Of note, none of them displayed any neurologic symptoms at presentation. In contrast, patients 6 and 7, both had a history of skin cancer resection and presented with neurologic symptoms due to a local recurrence with perineural tumor spread to the skull base and were deemed to be incompletely resectable. Patient 6 presented with a 7-month history of right-sided facial pain, which was initially misdiagnosed as trigeminal neuralgia until imaging revealed enlargement of the second division of the right trigeminal nerve. Biopsy of the nerve revealed melanoma. The patient recalled that he had over 50 resections of “skin cancers,” but he could not remember whether any one of them was thought to be melanoma. Patient 7 presented with a 2.5-year history of left facial numbness, hyperesthesia, dysesthesia, and sharp pain in the left hemi-face. He also had a history of stinging and tearing of the left eye as well as trismus and difficulty chewing and eating. Imaging showed a mass in the left pterygopalatine fossa that also involved the inferior orbital fissure, foramen rotundum, and trigeminal ganglion. An endoscopic biopsy of the mass revealed melanoma. This patient also reported a history of multiple “skin cancer” resections without knowledge of a prior diagnosis of melanoma.
Related Knowledge Centers
- Birth
- Foramen Spinosum
- Maxillary Nerve
- Middle Cranial Fossa
- Pterygopalatine Fossa
- Sphenoid Bone
- Trigeminal Nerve
- Base of Skull
- Foramen Ovale