Pterygopalatine Fossa Research Articles

Normative data for dimensions of the frontal and infraorbital nerves.

To present a series of normative measurements for the width of the frontal and infraorbital nerve branches of V1 and V2, respectively. Cadaveric dissection study of 15 embalmed cadaver heads (30 orbits). The frontal nerve was excised en bloc from the superior orbital rim to the superior orbital fissure. Similarly, the infraorbital nerve was excised en bloc from the inferior orbital rim to the orbital apex. Measurements were recorded of the maximal width of the frontal nerve, infraorbital nerve within the orbital floor, and pterygopalatine segment of the maxillary nerve. Any value greater than 2 standard deviations (SD) above the mean value, was defined as nerve enlargement. The mean transverse diameter of the frontal nerve was 2.27 ± 0.66 mm (1 SD). The mean transverse diameter of the infraorbital nerve branch, and the maxillary nerve within the pterygopalatine fossa, was 3.31 ± 0.68 mm (1 SD) and 3.59 ± 0.76 mm (1 SD), respectively. The upper limit of normal, defined as 2 SD above the mean value, for the widths of the frontal nerve, infraorbital nerve, and pterygopalatine segment of V2 widths were 3.59 mm, 4.67 mm, and 5.10 mm, respectively. The frontal and infraorbital nerves are implicated in various inflammatory and neoplastic orbital pathologies. Defining the normative data for width is important to compare with pathological states.

Anatomy of the infraorbital artery and its orbital branch.

To characterise the infraorbital artery (IOA) and its orbital branch, which are key structures encountered during inferior orbital explorations, with potential for orbital haemorrhage and vision loss if inappropriately handled. Thirteen embalmed heads (26 orbits) were dissected. The following parameters were measured: orientation of the IOA in relation to the infraorbital nerve (ION); presence or absence of the orbital branch of the IOA; and the distance between the orbital branch of the IOA to the inferior orbital rim. In the pterygopalatine fossa, the orientation of the IOA relative to V2 was medial (n = 9, 34.6%), inferior (n = 4, 15.4%), lateral (n = 4, 15.4%), inferolateral (n = 3, 11.5%), superolateral (n = 3, 11.5%), inferomedial (n = 2, 7.7%) and superior (n = 1, 3.8%). In the infraorbital canal, the IOA in relation to the ION was as follows: superomedial (n = 12, 46.2%), medial (n = 9, 34.6%), superior (n = 2, 7.7%), inferomedial (n = 2, 7.7%) and superolateral (n = 1, 3.8%). An orbital branch of the IOA was identified in 21/26 orbits (80.8%). The mean distance of the orbital branch to the inferior orbital rim was 13.0 ± 4.8 mm (range 2.0-23.0 mm). The IOA is an important vascular structure to recognise during inferior orbitotomies. The most common configuration is an IOA that runs medially to V2 in the pterygopalatine fossa, then superomedially to the ION within the infraorbital canal. The orbital branch of the IOA emerges 13 mm posterior to the inferior orbital rim. Recognition of these arterial branches and appropriate cauterization are paramount for avoiding significant operative complications.

A non-powder weapon projectile uneventfully removed from the pterygopalatine fossa: A case report

A non-powder weapon projectile uneventfully removed from the pterygopalatine fossa: A case report

Individual Differences in the Structure of the Pterygopalatine Fossa of the Adult Skull

The use of endoscopic microsurgical techniques in a number of surgical interventions on deep anatomical structures of the face requires detailed knowledge on the shape and individual variability of the size of the pterygopalatine fossa, containing vascular and nerve structures that provide blood supply and innervation of the upper face, including the pterygopalatine ganglion. The aim was to study individual differences in the shape and size of the pterygopalatine fossa of the adult human skull. Material and methods. The study included 62 archival series of anonymous CT scans (37 men and 25 women), performed with slice thickness of 0.5 mm. On axial and frontal scans, the X and Y coordinates were determined relative to the upper left corner of the scan of the opening of the greater palatine canal, which later serves as the zero point. On subsequent sections, a point with the coordinates of the opening of the greater palatine canal and the distance from this point to another point of interest along the X and Y axes were determined. The difference between the slice numbers multiplied by the thickness of the slice is the distance between two points along the Z axis. Based on the obtained coordinates, a 3- D image of the pterygopalatine fossa was constructed in the isometry system. On axial, frontal and sagittal scans, the width of the medial, anterior and posterior walls of the pterygopalatine fossa, its depth, height and other dimensions characterizing the relative location of the openings passing nerves were measured. The right and left sides of the scans, which had no pathology in this area, were examined. Results. It was stated that in the cavity of the pterygopalatine fossa, one should distinguish between the most bulk main (central) region, adjacent on the lateral side to the sphenopalatine foramen, and narrower regions which are directed downwards (vestibule of the greater palatine canal); backward (vestibule of the pterygoid canal); and laterally (vestibule of the pterygomaxillary fissure). New information has also been obtained characterizing the variability of the size of the pterygopalatine fossa. Conclusion. This study has been shown that the pterygopalatine fossa has a more complex shape than a narrow slit or pyramid, and the presence of the vestibule of the pterygoid canal in its cavity suggests a different position of the pterygoid ganglion in the pterygopalatine fossa and its external structure.

Endoscopic Sphenopalatine Artery Cauterization Under Local Anesthesia for Posterior Epistaxis: A Prospective Cohort Study of its Tolerability and Efficacy.

To assess the tolerability and efficacy of endoscopic sphenopalatine artery cauterization (ESPAC) under local anesthesia (LA) in managing posterior epistaxis. It was a prospective, cohort study, conducted in the Otorhinolaryngology Department of a tertiary-level hospital. Patients aged 18 years or above with posterior epistaxis who underwent ESPAC under LA were included. The tolerability of the procedure was reflected by the intraoperative pain measured using an 11-point numerical rating scale while the rebleed rate up to three months postoperatively denoted its efficacy. A total of 35 patients, 23 males and 12 females, aged 31 to 86 years (mean 57.42 ± 12.94) were included. Five out of 35 (14.2%) patients needed additional procedures besides ESPAC; 82.8% (29/35) had pterygopalatine fossa (PPF) block before ESPAC. The numerical rating scale reflecting the intraoperative pain ranged from 1 to 7 with a mean of 3.6 (± 1.7). The mean score was slightly higher in females than in males. Similarly, those who did not receive PPF block had a higher mean score than those who received it; however, the differences were not statistically significant. Meanwhile, the mean score was the same (3.6) irrespective of any additional procedure besides ESPAC. Amongst the 30 patients who completed the three-month follow-up, two patients rebled, so the overall success rate amounted to 93.3% in three months. Based on the outcome of this study, ESPAC under LA for posterior epistaxis is well tolerated and is as efficacious as under general anesthesia.

Blind spots in brain imaging: a pictorial essay.

Currently, radiologists must interpret large quantities of images and identify diseases on a daily basis. The minimization of errors is crucial for high-quality diagnostic imaging and optimal patient care. Brain imaging is frequently used in clinical practice; however, radiologists are prone to overlook some regions in brain imaging and make perceptual errors, thus leading to missed diagnoses. These regions, also known as "blind spots", comprise a number of intricate areas, including the posterior fossa, cerebral sulci and pia mater, cranial nerves (CNs), intracranial arteries, dural sinuses, sella and parasellar region, Meckel's cave, skull base, scalp, orbit, and pterygopalatine fossa (PPF). Therefore, the knowledge of normal computed tomography (CT) and magnetic resonance imaging (MRI) manifestations and common lesions in these blind spots is imperative to avoid false-negative results. This article graphically discusses and analyzes these common blind spots of brain imaging using real representative cases. It also provides comprehensive strategies to address missed diagnostic errors in radiology, including enhancing the selection of imaging protocols, implementing a multi-reviewer reporting system, adopting structured reporting templates, employing error measurement or detection strategies, and promoting the use, development, and refinement of artificial intelligence (AI) to improve diagnostic accuracy and efficiency. This article may also increase junior doctors' awareness of these blind spots and assist them in their daily work, and thus has continuing education implications.

Visualization of the infratemporal fossa: enhancing anatomical learning through three-dimensional modeling.

The infratemporal fossa and pterygopalatine fossa are critical pathways for blood vessels and nerves leading to the orbit, nasal cavity, and oral cavity. Anatomical observation of these areas is challenging for learners due to their complex connections with surrounding structures and their deep location within the body. Since it is not easy to understand this area in three dimensions with only textbook images, there is a need to produce three-dimensional (3D) content. Most existing 3D data have reconstructed the digital imaging and communication in medicine files from computed tomography images with high accuracy; however, the surrounding structures often obstruct the view. For this reason, this project utilized Cinema4D (R18) software to refine the modeled bones and to create 3D models of muscles, blood vessels, and nerves that accurately represent their anatomical shapes and pathways. To facilitate easier access for learners via PC, the content was converted into PDF format. This enables the educational materials to be more easily viewed and the main structures more clearly observed using a computer-based viewer.

Pterygopalatine Catecholamine-Secreting Paraganglioma: A Diagnostic and Therapeutic Challenge.

Paragangliomas are rare neuroendocrine tumors originating from the paraganglia. They are mostly benign, slow-growing, and non-secretory. This report describes a rare case of a catecholamine-secreting paraganglioma located in the pterygopalatine fossa. A 45-year-old man presented with severe hypertension, occipital headache, and facial pain. Imaging revealed a large pterygopalatine mass, initially misdiagnosed as chondrosarcoma. Gamma knife stereotactic radiosurgery was performed, followed by surgical resection via a maxillary swing approach. Histological examination confirmed the zellballen pattern typical of paraganglioma. Post-surgery, the patient's blood pressure normalized immediately and subsequently. This case highlights the diagnostic challenges of head and neck paragangliomas in atypical locations and underscores the importance of surgical intervention for catecholamine-secreting tumors. Future studies should focus on refining diagnostic protocols and comparing the efficacy of radiosurgery versus surgical resection for these tumors.

Modified Lateral Surgical Approach to the Pterygopalatine Fossa for Safe Preservation of the Peripheral Branch of the Marginal Mandibular Nerve.

In cases where oral cancer spreads toward the maxillary tubercle, surgery may extend to the pterygopalatine fossa. There are 2 main extraoral approaches: anterior and lateral. Previously, we introduced a modified lateral approach with a mouth corner incision from the lower lip, that preserves the mental and marginal mandibular nerves. Now, we present a further modification that allows safer preservation of the peripheral branches of the marginal mandibular nerve around the mouth. The procedure has 2 key points. The first is to follow the course of the marginal mandibular nerve from the submandibular incision. The second is to begin the mouth corner incision from the upper lip. Deploying the cheek flap ensured the marginal mandibular nerve was contained within a preserved platysma band. The postoperative contours and unremarkable scar on the face were acceptable to the patient. Paralysis of the facial and mental nerves was almost nonexistent. In conclusion, this newly modified lateral approach is useful in fully exposing the pterygopalatine fossa while preserving the mental nerve and not only the main trunks of the marginal mandibular nerves but also the peripheral branches around the mouth.

Resection of the Hemangioma Derived From Pterygopalatine Fossa via Anterior Nasolacrimal Recess: A Case Report and Literature Review.

Hemangiomas are rare and benign tumors originating from the pterygopalatine fossa (PPF). In this study, we report a rare case of PPF hemangioma in a 66-year-old male, for which he underwent surgical resection via the anterior nasolacrimal recess after preoperative arteria maxillaris embolization. To enhance our understanding on this rare condition, we conducted a comprehensive review of existing literature on this disease to discuss its clinical characteristics, differential diagnoses, and potential treatment approaches.

Assessment of Vidian canal morphology in axial section and its associated structures using cone beam computed tomography: A descriptive study

The Vidian Nerve (VN), a branch of the trigeminal nerve, passes by the Vidian Canal (VC), located at the base of the skull. The VC branches into the greater petrosal nerve and the VN in the pterygopalatine fossa, where the greater petrosal nerve carries parasympathetic fibers to the lacrimal glands and nasal mucosa, and the VN carries sensory fibers from the nasopharynx, nasal cavity, and palate. In this study, 60 subjects of both sexes who underwent cone beam computed tomography (CBCT) were selected by a convenient sampling technique. The data were subjected to statistical analysis following the examination of the various parameters in the axial sections. Among the various morphological characteristics appraised in the axial section, there was no significant sexual dimorphism, except for the angle between the VC and the medial wall of the maxillary sinus, which shows statistical significance. The present study aims to investigate morphometric analysis and its associated structures, offering insightful information about the complex structure of the Vidian canal (VC), which provides adequate knowledge for surgeons to plan with more caution complex skull base procedures, and eventually to lower the therapeutical risks associated with it.

The Diagnosis and Management of a Ewing’s Sarcoma of the Pterygopalatine fossa in a 5-year-old girl

The Diagnosis and Management of a Ewing’s Sarcoma of the Pterygopalatine fossa in a 5-year-old girl

Size and shape of the pterygopalatine fossa of the skull of a child aged 3–5 years based on the analysis of computed tomography scans

BACKGROUND: Endoscopic microsurgical techniques are used for sparing operations to remove foreign bodies of the pterygopalatine fossa, as well as neoplasms invading into it or growing out of it. These surgeries are performed not only in adults, but also in children as young as one month. For these surgeries, understanding the detailed structure and morphometric characteristics of the pterygopalatine fossa is crucial. However, detailed descriptions specific to children are lacking in the literature. AIM: This study aimed to examine the size and shape of the pterygopalatine fossa and the relative location of nerve foramina in children aged 3 to 5 years (the period of primary dentition) using computed tomography data. MATERIALS AND METHODS: To study the size and shape of pterygopalatine fossa, we analyzed anonymous archival frontal and axial computed tomograms of 12 children (24 pterygopalatine fossae) aged 3 to 5 years, obtained for examination of the underlying disease (brain pathology). All computed tomography scans were obtained using a helical computed tomograph (Somatom Sensation 64; Siemens, Germany) with an effective current of 63, 120 kV, a slice thickness of 0.5 mm, a reconstruction step of 0.7 mm, a collimation of 12×0.6 mm, Kernel U 70, a window width of 450 HU and a window center of 50 HU in University Clinic of Russian University of Medicine. The measurements were performed in the Cdviewer software after the preliminary measurements had determined sufficiently constant points on the contours of the pterygopalatine fossa of scans. On axial sections passing through the pterygoid canal, where the measurements had the greatest values, the following were studied: the largest width of the pterygoid canal (the distance between the anterior opening of the pterygoid canal and the orbital process of the palatine bone), the width of the medial wall and separately the width of the sphenopalatine foramen and the sphenoidal process of palate bone, the angle of deviation the medial wall from the sagittal plane, the width of the anterior wall (the distance between the most posteriorly protruding point of the anterior wall of the pterygopalatine fossa to the orbital process of the palatine bone), the greatest depth of the pterygopalatine fossa (posterior wall width) and the width of the pterygomaxillary fissure. The distance from the level of the orifice of the greater palatine canal to the anterior opening of the pterygoid canal and to the round foramen were measured on the frontal sections. According to axial tomograms, the spatial ratios between the orifice of the greater palatine canal and the round foramen and the anterior opening of the pterygoid canal, between these openings and the sphenopalatine foramen, between the round foramen and the anterior opening of the pterygoid canal were assessed. RESULTS: The study found that the shape of the pterygopalatine fossa differs from the pyramid-like structure, featuring four distinct parts: the main one adjacent to the sphenopalatine foramen, and funnel-shaped constrictions at the vestibule of the pterygoid canal, greater palatine canal, and pterygomaxillary fissure. The data indicated minor individual differences in the size of the pterygopalatine fossa and the uniformity of its shape in children aged 3 to 5 years. The spatial relationships of the orifice of the greater palatine canal, the anterior opening of the pterygoid canal, the round foramen, and the sphenopalatine foramen openings determining the position of the nerves in the pterygopalatine fossa were clarified. CONCLUSIONS: Pterygopalatine fossa in children aged 3 to 5 years (period of formed primary dentition) is characterized by a complex cavity structure, suggesting a different position of the pterygopalatine ganglion in it than is commonly believed. This circumstance, as well as for the first time the sizes of the pterygopalatine fossa determined by us, should be considered when developing surgical access to the pterygopalatine fossa and the pterygopalatine ganglion.

The Occipital Recess of the Sphenoidal Sinus-A Novel Anatomical Possibility.

There are reported here multiple rare anatomical variants of the sphenoidal sinus found in a 53-year-old male. The sinus exhibited uncommon features, including a prominent occipital recess extending bilaterally into the basilar part of the occipital bone. A narrow posterior isthmus connected the main chamber to 2 recesses: a superior postsellar recess pneumatising the dorsum sellae, and a postero-inferior occipital recess. The latter extended into the right basilar occipital bone, closely associated with the right hypoglossal canal and coursing alongside the right internal carotid artery. In addition, the sphenoidal sinus had a maxillary recess projecting above the pterygopalatine fossa and joining the right maxillary sinus and bilateral pterygoid recesses. Notably, the left vidian canal was situated superior to the pterygoid recess with no pneumatic space between it and the foramen rotundum, unlike the right side. These anatomical variants are clinically significant due to their proximity to vital neurovascular structures, increasing surgical risks. Partial ossification of the falx cerebri was also identified, potentially complicating neurosurgical procedures.

Malignant epithelioid neoplasm with GLI1 gene rearrangement (PANX3::GLI1 transcript) and MDM2 gene amplification.

We hereby report the case of an epithelioid neoplasm arising from pterygopalatine fossa in a 13-year-old child harboring PANX3::GLI1 fusion and MDM2 amplification. Identified chimeric gene can explain observed signs of osteogenic differentiation. We discuss the challenges in differential diagnosis from osteogenic tumors and soft tissue neoplasms with epithelioid morphology. Our case is the first report of a tumor with such genetic abnormalities and it is about to replenish the spectrum of rare GLI1-rearranged tumors.

9375 Acth-Producing Pituitary Carcinoma in the Falx Cerebri and Other Unusual Locations

Abstract Disclosure: J.E. Esquivel Vargas: None. A. Cob Guillén: None. A.B. Santos Rojo: None. A. Hong Lo: None. ACTH-producing Pituitary Carcinoma in the Falx Cerebri and other unusual locations Background: Pituitary carcinoma is a condition defined by metastasis of a pituitary tumor to a distant location. Pituitary carcinomas are very rare and account for approximately 0.12% of adenohypophyseal tumors (1). Clinical case: We present a case of a 29-year-old female who was followed up in our Endocrinology Department. Past medical history included the diagnosis of Cushing Disease and transsphenoidal tumor resection at 12 years of age, followed by transcranial resection two years later because of persistently elevated adrenocorticotropic hormone (ACTH). Despite the surgical management, the patient persisted with increased ACTH and hypercortisolism, so bilateral adrenalectomy was performed a year later. Two years after the procedure, the patient presented with a newly diagnosed pituitary macroadenoma, so the diagnosis of Nelson Syndrome was made. Linear accelerator radiotherapy was given, which reduced the size of the tumor. Later, multiple imaging studies showed multiple lesions on the falx cerebri, posterior clinoid process, retroclival region, cerebellopontine angle, pterygopalatine fossa, infratentorial region, and posterior ethmoidal cells. Biopsy and immunohistochemistry of the falx cerebri lesions described ACTH-producing pituitary adenocarcinoma. Treatment was given with intramuscular octreotide, dabrafenib, and trametinib. Despite persistently elevated ACTH levels, the patient has since remained clinically stable, without new development or worsening of symptoms. Conclusion: There are 3 unique aspects of our case. First, we reported an unusual presentation of this disease, because the patient in our case was a female with an early age of onset, in contrast with the reported literature. Second, this is the first reported case demonstrating pituitary carcinoma in the falx cerebri. Third, the prognosis of pituitary carcinoma is very poor, and mortality is extremely high, however, the patient in our case has been followed up for 7 years since the diagnosis of the metastatic lesions and has remained clinically stable.

Exploring Anatomical Variations in the Bony Architecture of the Greater Palatine Canal in Dry Bones.

Introduction The greater palatine canal (GPC) holds significant clinical importance due to its role in providing access to the branches of the maxillary division of the trigeminal nerve. Anatomical variations within this posterior maxillary region can complicate the surgical anatomy, making the identification of vital structures challenging. Therefore, a thorough understanding of both normal anatomy and common anatomical variations of the GPC is essential to minimize perioperative complications during surgical procedures.This study aims to investigate the bony architecture of the GPC in dry bones to identify anatomical variations and address significant lacunae in our current understanding of this structure. Despite its impact on the management of various dental and surgical procedures, there remains a limited and sometimes inconsistent knowledge of the normal and variant anatomy of the GPC.Existing literature often lacks comprehensive detail regarding the range of anatomical variations and their implications for surgical approaches. By systematically documenting these variations, this study aims to bridge these gaps in knowledge, justify the need for continued research in this area, and highlight its potential clinical implications. Materials and methods In total, 30 dried and intact adult skull specimens were selected, consisting of 19 males (63.3%) and 11 females (36.7%). The selection criteria included an intact hard palate with fully erupted third molars and an intact lateral nasal wall on both sides. The presence of erupted third molars was used to assess the degree of bone resorption, ensuring that only specimens with minimal bone loss were included. The exclusion criteria ruled out specimens with major craniofacial deformities, excessive bone resorption, and signs of advanced age. The bony walls of the GPC were observed by passing a black wire made of rubber material with a consistent diameter (approximately 5 mm), allowing us to qualitatively assess the bore of the canal. Results In four out of 30 specimens (13.3%), significant variations were noted in the bony medial wall of the GPC. Of these, three specimens were male (75%) and one was female (25%). These variations have been categorized into four distinct types for clarity and analysis. Type 1, in a male specimen, showed a deficiency in the lower segment of the bony medial wall of the left GPC above the greater palatine foramen. Type 2, in a male specimen, had a small bar of bone in the left GPC midway between the foramen and the pterygopalatine fossa. Type 3, in a female specimen, exhibited a small bar of bone above the greater palatine foramen on the right side, with no wall above it. Type 4, in a male specimen, displayed a bar of bone above the greater palatine foramen on the right side, with the medial wall completely absent on the left side. Conclusion The study identified anatomical variations in the bony architecture of the GPCbased on dry bone specimens. While these findings offer insights into potential variations that could affect surgical procedures, their clinical implications need validation through patient-based studies. Understanding these variations is crucial for improving preoperative planning and reducing surgical risks, but recommendations should be cautious given the limited sample size. Further research with larger samples and clinical validation is needed to fully understand the embryological basis and potential impact on surgical practice.

Utility of intraoperative scoring system in rhino-orbital mucormycosis as a prognostic tool.

To assess the utility of an intraoperative scoring system for mucormycosis and to predict prognosis by comparing the score with postoperative outcomes. This study was conducted among 80 patients with mucormycosis who underwent surgical management with mandatory pterygopalatine fossa and infratemporal fossa exploration. All cases were scored using our intraoperative scoring assessment tool. Postoperative outcomes in terms of favourable prognosis and mortality were evaluated and compared with demographics, clinical history and intraoperative findings. An intraoperative score of more than 25 was statistically significant in predicting mortality (p < 0.0001). In all, 86.7% of patients with a score above 25 succumbed to the disease. Statistical significance of mortality (p < 0.05) was observed in those with involvement of pterygopalatine fossa (78.9%), orbit (73.7%), infratemporal fossa (57.9%), cribriform plate (36.8%) and those with history of intake of antiviral drugs (47.4%), use of supplemental oxygen (31.6%) and renal failure (26.3%). This study enabled better prediction of postoperative prognosis in mucormycosis and reiterated the importance of exploration of pterygopalatine fossa and infratemporal fossa in management and prognostication of invasive fungal sinusitis.

University of Washington Quality of Life subdomain outcomes after treatment of sinonasal malignancy: A prospective, multicenter study.

Sinonasal malignancies (SNMs) adversely impact patients' quality of life (QOL) and are frequently identified at an advanced stage. Because these tumors are rare, there are few studies that examine the specific QOL areas that are impacted. This knowledge would help improve the care of these patients. In this prospective, multi-institutional study, 273 patients with SNMs who underwent definitive treatment with curative intent were evaluated. We used the University of Washington Quality of Life (UWQOL) instrument over 5 years from diagnosis to identify demographic, treatment, and disease-related factors that influence each of the 12 UWQOL subdomains from baseline to 5 -years post-treatment. Multivariate models found endoscopic resection predicted improved pain (vs. nonsurgical treatment CI 2.4, 19.4, p=0.01) and appearance versus open (CI 27.0, 35.0, p<0.001) or combined (CI 10.4, 17.1, p<0.001). Pterygopalatine fossa involvement predicted worse swallow (CI -10.8, -2.4, p=0.01) and pain (CI -17.0, -4.0, p<0.001). Neck dissection predicted worse swallow (CI -14.8, -2.8, p<0.001), taste (CI -31.7, -1.5, p=0.02), and salivary symptoms (CI -28.4, -8.6, p<0.001). Maxillary involvement predicted worse chewing (CI 9.8, 33.2; p<0.001) and speech (CI -21.8, -5.4, p<0.001) relative to other sites. Advanced T stage predicted worse anxiety (CI -13.0, -2.0, p=0.03). Surgical approach, management of cervical disease, tumor extent, and site of involvement impacted variable UWQOL symptom areas. Endoscopic resection predicted better pain, appearance, and chewing compared with open. These results may aid in counseling patients regarding potential QOL expectations in their SNM treatment and recovery course.

Retro-maxillary nasal recess: a case report with a new finding

BackgroundRetro-maxillary recess of the nasal cavity is an area that has not yet described in the literature.ObjectiveTo report, present, and describe a previously non-reported case which has bilateral retro-maxillary nasal recess by multi-slices computed tomography (MSCT).Case presentationA CT of a 22-year-old male showed bilateral retro-maxillary nasal recess extends beyond the posterior maxillary sinus wall and anterior to the pterygopalatine fossa as an extension of the middle meatus laterally and bounded by the maxillary sinus anterior, the orbital floor superior, the inferior turbinates lateral attachment inferior, and the pterygopalatine fossa anterior. The retro-maxillary nasal recess anteroposterior, lateral, and vertical dimensions were 11.53, 8.24, and 11.6 mm respectively at the left side and 5.6, 4.61, and 6.16 mm respectively at the right side.ConclusionThis study reports and describes a new retro-maxillary nasal recess that could represent a new hidden challenging area for ESS.