Endoscopic transoral ⁃ medial pterygomandibular fold approach anatomic study for jugular foramen

Abstract

Objective To investigate the endoscopic transoral ⁃ medial pterygomandibular fold approach anatomic procedures for jugular foramen, and to analyze the clinical feasibility of this approach. Methods and Results In the anatomical laboratory of the Surgical Treatment Technology Innovation Unit of Nasal Skull Base Tumor in Eye & ENT Hospital of Fudan University, a total of 5 specimens of necroheads (10 sides) were taken as research objects to simulate the anatomical steps of entering the jugular foramina and its adjacent structures through the oral pterygomandibular fold medial approach, and observe and describe important anatomical markers. 1) Anatomical procedures of the jugular foramen: firstly, the soft palate mucosa and suprapharyngeal retractive muscle were cut through the medial incision of pterygomandibular fold to enter anterior parapharyngeal space, the adipose tissue in the space was removed, and the stylopharyngeal fascia and stylopharyngeal muscle group were exposed. After the stylopharyngeal fascia was removed, the internal carotid artery (ICA) was further exposed and the jugular foramen was exposed. 2) The jugular foramen and its adjacent anatomical structures: the upper boundary of the jugular foramen was jugular bulbous fossa, the anterior was ICA, the anterolateral lateral was styloid process, the posterolateral boundary was the lateral rectus of head and transverse process of atlas, the medial boundary was the hypoglossal nerve and medial of occipital condyle, and the lateral boundary was the mastoid, digastric and facial nerves. Conclusions Endoscopic transoral⁃medial pterygomandibular fold approach for jugular foramen has better visual field, wider exposure range and shorter path.

Keywords

• jugular foramina
• parapharyngeal space
• endoscopy
• autopsy