Paediatrics
Adnan Darr, Karan Jolly, Jameel Muzaffar in ENT Vivas, 2023
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
Head and neck
Aida Lai in Essential Concepts in Anatomy and Pathology for Undergraduate Revision, 2018
Pterygopalatine fossa– contents: CNV2 + maxillary a.– communicates laterally with infratemporal fossa through pterygomaxillary fissure– communicates medially with nasal cavity through sphenopalatine foramen– communicates superiorly with skull through foramen rotundum– communicates anteriorly with orbit through inferior orbital fissure
Endoscopic management of CSF rhinorrhea
Jyotirmay S. Hegde, Hemanth Vamanshankar in CSF Rhinorrhea, 2020
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).
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.
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.
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.
Related Knowledge Centers
- Foramen
- Infratemporal Fossa
- Maxilla
- Maxillary Tuberosity
- Skull
- Sphenoid Bone
- Sphenopalatine Foramen
- Pterygoid Processes of The Sphenoid
- Pterygomaxillary Fissure
- Greater Wing of Sphenoid Bone