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Surgical and Radiologic Anatomy

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Open Access 26-03-2024 | Original Article

Endoscopic trans-eustachian tube approach: identifying the precise landmarks, a novel radiological and anatomical evaluation

Authors: Ali Karadag, Mustafa Eren Yuncu, Erik H. Middlebrooks, Necmettin Tanriover

Published in: Surgical and Radiologic Anatomy | Issue 5/2024

Abstract

Purpose

The endoscopic trans-eustachian approach (ETETA) is a less invasive approach to the infratemporal fossa (ITF), providing superior exposure compared to traditional transcranial approaches. The anatomy of the pharyngotympanic (eustachian) tube and adjacent neurovascular structures is complex and requires in-depth knowledge to safely perform this approach. We present a cadaveric and radiological assessment of critical anatomic considerations for ETETA.

Methods

Six adult cadaveric heads were dissected alongside examination of 50 paranasal sinus CT scans. Key anatomic relationships of the pharyngotympanic tube and adjacent structures were qualitatively and quantitatively evaluated. Descriptive statistics were performed for quantitative data.

Results

Anatomical and radiological measurements showed lateralization of the pharyngotympanic tube allows access to the ITF. The pharyngotympanic tube has bony and cartilaginous parts with the junction formed by the sphenoid spine and foramen spinosum. The bony part and tendon of the tensor tympani muscle were located at the posterior genu of the internal carotid artery. The anterior and inferior wall of the carotid canal was located between the horizontal segment of the internal carotid artery and petrous segment of the cartilaginous pharyngotympanic tube.

Conclusion

The combination of preoperative radiographic assessment and anatomical correlation demonstrates a safe and effective approach to ETETA, which allowed satisfactory visualization of ITF. The morphological evaluation showed that the lateralization of the pharyngotympanic tube and related structures allowed a surgical corridor to reach the ITF. Endoscopic surgery through the pharyngotympanic tube is challenging, and in-depth understanding of the key anatomic relationships is critical for performing this approach.

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Title: Endoscopic trans-eustachian tube approach: identifying the precise landmarks, a novel radiological and anatomical evaluation
Authors: Ali Karadag
Mustafa Eren Yuncu
Erik H. Middlebrooks
Necmettin Tanriover
Publication date: 26-03-2024
Publisher: Springer Paris
Published in: Surgical and Radiologic Anatomy / Issue 5/2024
Print ISSN: 0930-1038
Electronic ISSN: 1279-8517
DOI: https://doi.org/10.1007/s00276-024-03344-7

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Endoscopic trans-eustachian tube approach: identifying the precise landmarks, a novel radiological and anatomical evaluation

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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