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J Neurol Surg B Skull Base 2022; 83(S 02): e83-e88
DOI: 10.1055/s-0040-1722714
Original Article

Anatomical Variants of Post-ganglionic Fibers within the Pterygopalatine Fossa: Implications for Endonasal Skull Base Surgery

Lifeng Li 
1   Department of Otolaryngology-Head & Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
2   Department of Otolaryngology-Head & Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, Ohio, United States
,
Nyall R. London Jr.
2   Department of Otolaryngology-Head & Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, Ohio, United States
3   Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, United States
,
Daniel M. Prevedello 
2   Department of Otolaryngology-Head & Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, Ohio, United States
4   Department of Neurological Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, Ohio, United States
,
Ricardo L. Carrau
2   Department of Otolaryngology-Head & Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, Ohio, United States
4   Department of Neurological Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, Ohio, United States
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Abstract

Objectives The vidian nerve provides parasympathetic innervation to the nasal cavity and the lacrimal gland. Previous anatomic studies have primarily focused on preservation or severance of the vidian nerve proximal to the pterygopalatine ganglion (PPG). This study aimed to assess its neural fibers within the pterygopalatine fossa after synapsing at the PPG, and to explore potential clinical implications for endoscopic endonasal skull base surgery.

Methods An endonasal transpterygoid approach was performed on eight cadaveric specimens (16 sides). The PPG and maxillary nerve within the pterygopalatine fossa were divided. The vidian nerve was traced retrograde into the foramen lacerum, and postganglionic fibers distal to the PPG were dissected following the zygomatic nerve into the orbit. Potential communicating branches between the ophthalmic nerve (V1) and the PPG were also explored.

Results All sides showed a plexus of neural communications between the PPG and the maxillary nerve. The zygomatic nerve exits the maxillary nerve close to the foramen rotundum, piercing the orbitalis muscle to enter the orbit in all sides. The zygomatic nerve was identified running beneath the inferior rectus muscle toward a lateral direction. In 7/16 sides (43.75%), a connecting branch between V1 and the pterygopalatine ganglion was observed.

Conclusion Neural communications between the PPG and the maxillary nerve were present in all specimens. A neural branch from V1 to the PPG potentially contributes additional postganglionic parasympathetic function to the lacrimal gland.

Keywords

vidian nerve - pterygopalatine ganglion - postganglionic fiber - foramen lacerum - orbit


Publication History

Received: 30 July 2020

Accepted: 15 November 2020

Article published online:
22 February 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Al-Nashar IS, Carrau RL, Herrera A, Snyderman CH. Endoscopic transnasal transpterygopalatine fossa approach to the lateral recess of the sphenoid sinus. Laryngoscope 2004; 114 (03) 528-532
    CrossrefPubMedSearch in Google Scholar
  • 2 Kasemsiri P, Solares CA, Carrau RL. et al. Endoscopic endonasal transpterygoid approaches: anatomical landmarks for planning the surgical corridor. Laryngoscope 2013; 123 (04) 811-815
    CrossrefPubMedSearch in Google Scholar
  • 3 Li L, London Jr NR, Prevedello DM, Carrau RL. Endoscopic prelacrimal approach to lateral recess of sphenoid sinus: feasibility study. Int Forum Allergy Rhinol 2020; 10 (01) 103-109
    CrossrefPubMedSearch in Google Scholar
  • 4 Li L, London Jr NR, Prevedello DM, Carrau RL. Anatomy based corridors to the infratemporal fossa: implications for endoscopic approaches. Head Neck 2020; 42 (05) 846-853
    CrossrefPubMedSearch in Google Scholar
  • 5 Kassam AB, Vescan AD, Carrau RL. et al. Expanded endonasal approach: vidian canal as a landmark to the petrous internal carotid artery. J Neurosurg 2008; 108 (01) 177-183
    CrossrefPubMedSearch in Google Scholar
  • 6 Vescan AD, Snyderman CH, Carrau RL. et al. Vidian canal: analysis and relationship to the internal carotid artery. Laryngoscope 2007; 117 (08) 1338-1342
    CrossrefPubMedSearch in Google Scholar
  • 7 Wang WH, Lieber S, Mathias RN. et al. The foramen lacerum: surgical anatomy and relevance for endoscopic endonasal approaches. J Neurosurg 2018; 131 (05) 1-12
    CrossrefPubMedSearch in Google Scholar
  • 8 Mason EC, Hudgins PA, Pradilla G, Oyesiku NM, Solares CA. Radiographic analysis of the vidian canal and its utility in petrous internal carotid artery localization. Oper Neurosurg (Hagerstown) 2018; 15 (05) 577-583
    CrossrefPubMedSearch in Google Scholar
  • 9 Oakley GM, Ebenezer J, Hamizan A. et al. Finding the petroclival carotid artery: the vidian-eustachian junction as a reliable landmark. J Neurol Surg B Skull Base 2018; 79 (04) 361-366
    Thieme ConnectPubMedSearch in Google Scholar
  • 10 Servian DA, Beer-Furlan A, Lima LR. et al. Pharyngobasilar fascia as a landmark in endoscopic skull base surgery: the triangulation technique. Laryngoscope 2019; 129 (07) 1539-1544
    CrossrefPubMedSearch in Google Scholar
  • 11 Prevedello DM, Pinheiro-Neto CD, Fernandez-Miranda JC. et al. Vidian nerve transposition for endoscopic endonasal middle fossa approaches. Neurosurgery 2010; 67 (2, Suppl Operative): 478-484
    PubMedSearch in Google Scholar
  • 12 Alves-Belo JT, Mangussi-Gomes J, Truong HQ. et al. Lateral transorbital versus endonasal transpterygoid approach to the lateral recess of the sphenoid sinus: a comparative anatomic study. Oper Neurosurg (Hagerstown) 2019; 16 (05) 600-606
    CrossrefPubMedSearch in Google Scholar
  • 13 Osawa S, Rhoton Jr AL, Seker A, Shimizu S, Fujii K, Kassam AB. Microsurgical and endoscopic anatomy of the vidian canal. Neurosurgery 2009; 64 (5, Suppl 2): discussion 411–412 385-411
    PubMedSearch in Google Scholar
  • 14 Su WF, Liu SC, Hsu WC, Chen YC. Randomized, double-blind, controlled study to evaluate the effect of vidian nerve cauterization on lacrimation. Am J Rhinol Allergy 2014; 28 (03) 255-259
    CrossrefPubMedSearch in Google Scholar
  • 15 Hosseini SM, Razfar A, Carrau RL. et al. Endonasal transpterygoid approach to the infratemporal fossa: correlation of endoscopic and multiplanar CT anatomy. Head Neck 2012; 34 (03) 313-320
    CrossrefPubMedSearch in Google Scholar
  • 16 Abuzayed B, Tanriover N, Gazioglu N, Cetin G, Akar Z. Extended endoscopic endonasal approach to the pterygopalatine fossa: anatomic study. J Neurosurg Sci 2009; 53 (02) 37-44
    PubMedSearch in Google Scholar
  • 17 Rusu MC, Pop F, Curcă GC, Podoleanu L, Voinea LM. The pterygopalatine ganglion in humans: a morphological study. Ann Anat 2009; 191 (02) 196-202
    CrossrefPubMedSearch in Google Scholar
  • 18 Karci B, Midilli R, Erdogan U, Turhal G, Gode S. Endoscopic endonasal approach to the vidian nerve and its relation to the surrounding structures: an anatomic cadaver study. Eur Arch Otorhinolaryngol 2018; 275 (10) 2473-2479
    CrossrefPubMedSearch in Google Scholar
  • 19 Kaen A, Cárdenas Ruiz-Valdepeñas E, Di Somma A, Esteban F, Márquez Rivas J, Ambrosiani Fernandez J. Refining the anatomic boundaries of the endoscopic endonasal transpterygoid approach: the “VELPPHA area” concept. J Neurosurg 2018; 131 (03) 911-919
    CrossrefPubMedSearch in Google Scholar
  • 20 Kassam AB, Prevedello DM, Carrau RL. et al. The front door to meckel's cave: an anteromedial corridor via expanded endoscopic endonasal approach- technical considerations and clinical series. Neurosurgery 2009; 64 (3, Suppl): discussion ons82–ons83 ons71-ons82
    PubMedSearch in Google Scholar
  • 21 Ruskell GL. Distribution of pterygopalatine ganglion efferents to the lacrimal gland in man. Exp Eye Res 2004; 78 (03) 329-335
    CrossrefPubMedSearch in Google Scholar
  • 22 Robinson SR, Wormald PJ. Endoscopic vidian neurectomy. Am J Rhinol 2006; 20 (02) 197-202
    CrossrefPubMedSearch in Google Scholar
  • 23 Lee JC, Kao CH, Hsu CH, Lin YS. Endoscopic transsphenoidal vidian neurectomy. Eur Arch Otorhinolaryngol 2011; 268 (06) 851-856
    CrossrefPubMedSearch in Google Scholar
  • 24 Bleier BS, Schlosser RJ. Endoscopic anatomy of the postganglionic pterygopalatine innervation of the posterolateral nasal mucosa. Int Forum Allergy Rhinol 2011; 1 (02) 113-117
    CrossrefPubMedSearch in Google Scholar
  • 25 Marshak T, Yun WK, Hazout C, Sacks R, Harvey RJ. A systematic review of the evidence base for vidian neurectomy in managing rhinitis. J Laryngol Otol 2016; 130 (Suppl. 04) S7-S28
    CrossrefPubMedSearch in Google Scholar
  • 26 Li L, London Jr NR, Prevedello DM, Carrau RL. Endonasal endoscopic transpterygoid approach to the upper parapharyngeal space. Head Neck 2020; 42 (09) 2734-2740
    CrossrefPubMedSearch in Google Scholar
  • 27 Goosmann MM, Dalvin M. Anatomy, Head and Neck, Deep Petrosal Nerve. StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2020
    Search in Google Scholar
  • 28 Standring S. Gray's Anatomy: The Anatomical Basis of Clinical Practice. 41st ed.. London: Elsevier; 2016: 554-555
    Search in Google Scholar
  • 29 Rusu MC, Pop F. The anatomy of the sympathetic pathway through the pterygopalatine fossa in humans. Ann Anat 2010; 192 (01) 17-22
    CrossrefPubMedSearch in Google Scholar