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A description of arterial variants in the transoral approach to the parapharyngeal space
Authors:Chengyuan Wang  Summit Kundaria  Juan Fernandez‐Miranda  Umamaheswar Duvvuri
Affiliation:1. Department of Otolaryngology Head and Neck Surgery, China‐Japan Friendship Hospital, Chaoyang District, Beijing, China;2. Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;3. Veterans Affairs Pittsburgh Health System, UPMC Department of Otolaryngology/Head and Neck Surgery, University of Pittsburgh Medical Center, Eye and Ear Institute, Suite 500, Pittsburgh, Pennsylvania
Abstract:This study demonstrates variations in the vascular anatomy of the parapharyngeal space (PPS) as seen from the transoral approach compared with the transcervical approach. The PPS was dissected in injected cadaveric specimens. Anatomical measurements, including those of branches of the external and internal carotid arteries (ECA and ICA) and the styloglossus and stylopharyngeus muscles, were recorded and analyzed. In 67% (8/12) of cases, the ascending palatine artery (APA) originated from the facial artery and crossed the styloglossus muscle. The diameter of the APA at its origin was 1.4 ± 0.3mm. In 75% (9/12) of cases, the ascending pharyngeal artery (aPA) arose from the medial surface of the ECA near its origin. In 58% (7/12) of cases, the aPA ascended vertically between the ICA and the lateral pharynx to the skull base, along the longus capitus muscle. The aPA crossed the styloglossus muscle 12.6 ± 3.9mm from the insertion into the tongue. In 92% (11/12) of cases, the ECA and ICA were separated by the styloid diaphragm and pharyngeal venous plexus. In 8% (1/12), the ECA bulged into the parapharyngeal fat between the styloglossus and stylopharyngeus muscles adjacent to the pharyngeal constrictors. Knowledge of the precise anatomy of the PPS is important for transoral robotic surgery (TORS). Control of the vessels that supply and traverse the PPS can help the TORS surgeon avoid those critical structures and reduce surgical morbidity and potential hemorrhage. Clin. Anat. 27:1016–1022, 2014. © 2014 Wiley Periodicals, Inc.
Keywords:robotic surgery  TORS  parapharyngeal space  arterial variants
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