Abstract
IntroductionThe type of endoscopic approach chosen for vidian neurectomy can be specified by evaluating the vidian canal and the surrounding sphenoid sinus structures. ObjectiveThe variations and morphometry of the vidian canal were investigated, focusing on the functional correlations between them which are crucial anatomical landmarks for preoperative planning. MethodsThis study was performed using paranasal multidetector computed tomography images that were obtained with a section thickening of 0.625mm of 250 adults. ResultsThe distributions of 500 vidian canal variants were categorized as follows; Type 1, within the sphenoid corpus (55.6%); Type 2, partially protruding into the sphenoid sinus (34.8%); Type 3, within the sphenoid sinus (9.6%). The pneumatization of the pterygoid process is mostly seen in vidian canal Type 2 (72.4%) and Type 3 (95.8%) (p<0.001). The mean distances from the vidian canal to the foramen rotundum and the palatovaginal canal were greater in the vidian canal Type 2 and 3 with the pterygoid process pneumatization (p<0.001). The prevalence of the intrasphenoid septum between the vidian canal and the vomerine crest and lateral attachment which ending on carotid prominence were much higher in vidian canal Type 3 than other types (p<0.001). The mean angle between the posterior end of the middle turbinate and the lateral margin of the anterior opening of the vidian canal was measured as 33.05±7.71°. ConclusionsPreoperative radiologic analysis of the vidian canal and the surrounding structures will allow surgeons to choose an appropriate endoscopic approach to ensure predictable postoperative outcomes.
Highlights
The type of endoscopic approach chosen for vidian neurectomy can be specified by evaluating the vidian canal and the surrounding sphenoid sinus structures
From lateral to medial the foramen rotundum (FR), the vidian canal (VC) which is located inferomedial to FR and the palatovaginal canal (PVC) are clinically important openings including critical neurovascular structures in the posterior wall of the PPF
Three variations of VC corpus anatomy according to the relationship with the sphenoid sinus were found as follows: Type 1 which was located within sphenoid bony roof (55.6%, 278/500), Type 2 which was partially protruded into sphenoid sinus (34.8%, 174/500), Type 3 which was totally protruded into sphenoid sinus with a stalk (9.6%, 48/500)
Summary
The type of endoscopic approach chosen for vidian neurectomy can be specified by evaluating the vidian canal and the surrounding sphenoid sinus structures. The pterygopalatine fossa (PPF) looks like an inverse pyramid in a relatively deep inaccessible anatomical location that is formed by the perpendicular lamina of palatine bone medially, greater wing of sphenoid bone superiorly, the pterygoid process of sphenoid bone posteriorly and maxillary sinus anteriorly.[1] The various osseous communications of the PPF forms recognizable anatomical landmarks on Multidetector Computed Tomography (MDCT) scans that describe the margins and openings of the PPF.[2] From lateral to medial the foramen rotundum (FR), the vidian canal (VC) which is located inferomedial to FR and the palatovaginal canal (PVC) are clinically important openings including critical neurovascular structures in the posterior wall of the PPF These foramina are in close association with the surrounding sphenoid sinus structures.[1]. Preoperative radiological evaluation of the VC corpus types and surrounding sphenoid structures guides the surgeon in choosing an appropriate surgical approach, decreasing complications during endoscopic surgery.[5]
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