Endoscopic endonasal anatomy of pterygopalatine fossa and infratemporal fossa: comparison of endoscopic and radiological landmarks

Abstract

To investigate the feasibility and reliability of the measurement of critical anatomic landmarks of endoscopic endonasal anatomy of pterygopalatine fossa and infratemporal fossa using multislice spiral computed tomography (MSCT), and to illustrate the spatial relationship of the surgical landmarks in pterygopalatine fossa and infratemporal fossa through an endoscopic endonasal view and radiological images. Included in this study were eleven fixed cadaver heads (22 pterygopalatine fossa and infratemporal fossa), which were prepared from MSCT scans for establishing a spatial coordinates system to calculate the radiological anatomic data and attaining 3D reconstruction image, and also were anatomically dissected to get anatomic data. The anatomic data in two groups were compared, the endoscopic and radiological images of the same regions acquired during the endoscopic endonasal approaches observed. The distance (x(-) ± s) from nasal columella to sphenopalatine foramen, pterygoid canal, foramen rotundum, foramen ovale, foramen spinosum, carotid canal, foramen lacerum in radiological group were: (68.83 ± 3.00), (72.49 ± 2.88), (75.26 ± 3.14), (88.55 ± 5.00), (95.19 ± 4.31), (106.76 ± 3.77), (88.16 ± 2.87) mm and in anatomic group were: (68.90 ± 3.04), (72.73 ± 3.08), (75.44 ± 3.07), (89.75 ± 4.13), (96.22 ± 3.37), (106.68 ± 3.75), (88.47 ± 2.64) mm. There was no statistical difference between two groups (t value were -0.856, -1.134, -0.920, -1.923, -1.903, 2.820 and 1.209, respectively, all P > 0.05). Sphenopalatine foramen, pterygoid canal, foramen rotundum, foramen ovale, foramen spinosum, foramen lacerum, carotid canal were the corresponding anatomic structures in endoscope and radiology, which provided the surgeons with anatomic landmarks to identify the spatial relationship of the surgical structures in pterygopalatine fossa and infratemporal fossa. MSCT measurements of anatomic landmarks are feasible and reliable, can be used in clinical individualized surgery. The corresponding anatomic structures of endoscopic and radiological landmarks provide useful reference to surgeons when operating in these areas through an endoscopic endonasal approach.