Operative Techniques in Otolaryngology - Head and Neck Surgery最新文献

英文中文

The lateral neck in 3 dimensions: A digital model derived from radiology, peer-reviewed literature, and medical illustration 三维侧颈：基于放射学、同行评议文献和医学插图的数字模型

Q3 Medicine

Operative Techniques in Otolaryngology - Head and Neck Surgery

Pub Date : 2025-03-01 DOI: 10.1016/j.otot.2024.08.006

Gabriel A. Hernandez-Herrera BS , Lazaro R. Peraza MD , Tissiana G. Vallecillo MS , Gabriela A. Calcano BS , Emilyn Frohn MS , Caitlin J. Vander Wert MA , David M. Routman MD , Jonathan M. Morris MD , Kathryn M. Van Abel MD

To develop an anatomically accurate 3-dimensional (3D) digital model of the lateral neck anatomy, including musculature, neurovasculature, and other associated structures such as lymphatics. Lateral neck anatomy, emphasizing level 1-4 structures, were segmented from a CT angiogram of a healthy 29-year-old female which was later transferred into a 3D illustration software after removal of imaging artifacts. To enhance anatomical accuracy, details not captured by imaging or unclear from the study were refined with relevant peer-reviewed literature. These structures were incorporated into the head and neck model. Following segmentation, the 3D models was refined in 3D CAD software. Structures not identified by segmentation, including vagus and phrenic nerves and lymphatics beyond the scan resolution, were designed by a medical illustrator and all structures were refined from peer-reviewed anatomic literature. Where discrepancies were found in the literature, the sample size, source, and methodology of the studies were considered to determine the most common variant of each structure. Finally, the 3D model was uploaded to MedReality for online viewing. This study demonstrates the critical anatomic structures, landmarks, and surgical relationships relevant to the lateral neck. The associated 3D model and manuscript will serve as a helpful tool for a broad range of clinicians and trainees in search of a detailed 3D anatomic description of the lateral neck. This literature-based model of the central neck combined with 3D anatomic modeling from real patient data should aid in surgical anatomy education.

建立解剖学上精确的三维（3D）侧颈解剖数字模型，包括肌肉组织、神经血管和其他相关结构，如淋巴管。从一名29岁健康女性的CT血管造影中分割出侧侧颈部解剖，强调1-4级结构，随后在去除成像伪影后将其转移到3D插图软件中。为了提高解剖学的准确性，未被成像捕获或研究中不清楚的细节通过相关的同行评审文献进行了完善。这些结构被纳入头颈部模型。分割后，在三维CAD软件中对三维模型进行细化。未通过分割识别的结构，包括迷走神经、膈神经和扫描分辨率之外的淋巴管，由医学插图画家设计，所有结构都是从同行评审的解剖文献中精炼出来的。如果在文献中发现差异，则考虑样本量，来源和研究方法，以确定每种结构的最常见变体。最后，3D模型被上传到MedReality供在线观看。本研究展示了与侧颈相关的关键解剖结构、标志和手术关系。相关的3D模型和手稿将作为一个有用的工具，广泛的临床医生和学员在寻找一个详细的三维解剖描述的侧颈。这种基于文献的中心颈部模型与来自真实患者数据的三维解剖模型相结合，应有助于外科解剖教育。

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引用次数: 0

Three-dimensional surgical anatomy of the parapharyngeal space: a digital anatomical model derived from radiographic images, peer-reviewed literature, and a medical illustration 咽旁间隙的三维外科解剖：基于放射影像、同行评议文献和医学插图的数字解剖模型

Q3 Medicine

Operative Techniques in Otolaryngology - Head and Neck Surgery

Pub Date : 2025-03-01 DOI: 10.1016/j.otot.2025.01.004

Gabriela A. Calcano BS , Kelly L. Staricha MD , Kathryn K. Xu BA , Gabriel A. Hernandez-Herrera BS , Caitlin J. Vander Wert MA , Emilyn P. Frohn MS , Kathryn M. Van Abel MD , Jonathan M. Morris MD , Eric J. Moore MD

The parapharyngeal space is a potential space below the skull base and lateral to the upper portion of the oropharynx. While tumors in this space are uncommon, neoplasms in this region are often treated surgically. Both clinical diagnosis, imaging and complete surgical excision require excellent 3-dimensional (3D) visualization to successfully plan treatment course and avoid surgical complications. Using combined radiographic images, peer reviewed literature on gross and microscopic anatomy, an anatomically accurate digital 3D model of the parapharyngeal space was developed by an experienced medical illustrator. Surgical techniques for head and neck tumors within the parapharyngeal space are further detailed. The final 3D model was rendered and uploaded to a 3D model repository. Here, we develop a 3D anatomically accurate model for the parapharyngeal space to aid clinicians, radiologists, surgeons, and learners in understanding and visualizing the complex relationships within the parapharyngeal space. This model can serve as a tool for understanding the complex anatomy of the parapharyngeal space and improving diagnostic imaging and surgical approaches to tumors in this region.

咽旁间隙是颅底以下和口咽上部外侧的一个潜在间隙。虽然该区域的肿瘤并不常见，但该区域的肿瘤通常采用手术治疗。无论是临床诊断、影像学还是完全的手术切除，都需要出色的三维可视化来成功规划疗程并避免手术并发症。结合放射图像，同行评审的大体和显微解剖文献，由经验丰富的医学插图画家开发了咽旁间隙的解剖学精确数字3D模型。进一步详细介绍了咽旁间隙头颈部肿瘤的手术技术。最终的3D模型被渲染并上传到3D模型存储库。在这里，我们开发了咽旁空间的三维解剖精确模型，以帮助临床医生，放射科医生，外科医生和学习者理解和可视化咽旁空间内的复杂关系。该模型可作为了解咽旁间隙复杂解剖结构的工具，改善该区域肿瘤的诊断成像和手术入路。

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引用次数: 0

Head and neck fascial layers and the spaces they create in 3-dimensions: an anatomic model created using peer-reviewed literature, radiographic imaging, and an experienced medical illustrator 头颈筋膜层及其在三维空间中创建的空间：使用同行评审文献，放射成像和经验丰富的医学插画师创建的解剖模型

Q3 Medicine

Operative Techniques in Otolaryngology - Head and Neck Surgery

Pub Date : 2025-03-01 DOI: 10.1016/j.otot.2025.01.002

Gabriela A. Calcano BS , Chelsia N. Melendez BA , Maani M. Archang MD-PhD , Gabriel A. Hernandez-Herrera BS , Emilyn P. Frohn MS , Caitlin J. Vander Wert MA , Kathryn M. Van Abel MD , Jonathan M. Morris MD , Linda X. Yin MD

Cervical fascias are critically important in compartmentalizing spaces of the head and neck with significant clinical and surgical implications. Knowledge and deep understanding of the cervical fascias serves to facilitate radiologic and clinical diagnostics, safe surgical practices, and advancements in surgical interventions. Precise anatomical knowledge, standardized terminology in clinical practice and a profound understanding of the 3-dimensional relationships created by cervical fascias is therefore important in the identification and management of head and neck pathologies. Standard 2-dimensional representations of the cervical fascia undermine the importance of these anatomical relationships which require a deep understanding of depth perception. We therefore develop a 3D virtual anatomic model of the cervical fascias of the head and neck and the spaces created. Using the segmented computerized tomography (CT) angiogram of a healthy 29-year-old female supplemented with detailed review of present literature, an anatomically accurate 3D model was developed by an experienced medical illustrator. Surgical and clinical importance of these structures are further detailed. The final 3D model was rendered and uploaded to a 3D model repository where it can be utilized for visualization of these complex relationships. This accurate 3D anatomical model serves as a tool in clinical and surgical education and practice.

颈筋膜在分隔头颈部的空间方面是至关重要的，具有重要的临床和外科意义。对颈筋膜的知识和深入理解有助于促进放射学和临床诊断、安全的手术实践和外科干预的进步。因此，精确的解剖学知识、临床实践中标准化的术语以及对颈筋膜所产生的三维关系的深刻理解对于头颈部病理的识别和管理非常重要。颈筋膜的标准二维表示破坏了这些解剖关系的重要性，这需要深度感知的深刻理解。因此，我们开发了头部和颈部颈筋膜及其空间的三维虚拟解剖模型。利用一名29岁健康女性的分段计算机断层扫描（CT）血管造影，辅以对现有文献的详细回顾，由一位经验丰富的医学插图画家建立了解剖学上准确的3D模型。这些结构的外科和临床重要性进一步详细说明。最终的3D模型被渲染并上传到3D模型存储库，在那里它可以用于这些复杂关系的可视化。这种精确的3D解剖模型可作为临床和外科教育和实践的工具。

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引用次数: 0

The posterior triangle and posterior muscles of the neck in 3-dimensions: creating a digital anatomic model using peer-reviewed literature, radiographic imaging, and an experienced medical illustrator 三维后三角和颈部后肌：使用同行评审文献、放射成像和经验丰富的医学插画师创建数字解剖模型

Q3 Medicine

Operative Techniques in Otolaryngology - Head and Neck Surgery

Pub Date : 2025-03-01 DOI: 10.1016/j.otot.2025.01.003

Gabriela A. Calcano BS , Dan C. Schmidtman MD , Mason J. Blue BA , Gabriel A. Hernandez-Herrera BS , Emilyn P. Frohn MS , Caitlin J. Vander Wert MA , Kathryn M. Van Abel MD , Jonathan M. Morris MD , Linda X. Yin MD

The posterior cervical triangle houses an important nodal basin in the spread of several cancers in the head and neck, particularly cutaneous malignancies of the scalp. A safe and effective Level V neck dissection necessitates thorough understanding of the neurovascular structures housed within the region. Conventional 2D anatomical representations offer insights into the named structures but fall short in illustrating the spatial relationships crucial in surgery. Here, we aim to develop an anatomically precise 3D virtual model of the posterior cervical triangle and its constituent structures. Musculature and neurovasculature were segmented from the computerized tomography (CT) angiogram of a healthy 29-year-old female. Literature review of cadaveric studies was performed to identify the most common variants, relevant surgical relationships, and usual dimensions of structures contained in the model. Both radiographic and anatomic data were used to inform the creation of a 3D model. This accurate 3D anatomical model will serve to supplement the education of practicing and aspiring head and neck surgeons.

颈后三角是头颈部肿瘤，尤其是头皮皮肤恶性肿瘤扩散的重要淋巴结区。安全有效的V级颈部解剖需要彻底了解该区域内的神经血管结构。传统的二维解剖表示提供了对命名结构的见解，但在说明外科手术中至关重要的空间关系方面存在不足。在这里，我们的目标是开发一个解剖精确的三维虚拟模型的后颈三角和它的组成结构。本文对一位29岁健康女性的CT血管造影进行了肌肉组织和神经血管的分割。对尸体研究的文献进行了回顾，以确定最常见的变异，相关的手术关系，以及模型中包含的结构的通常尺寸。x线摄影和解剖数据被用于创建三维模型。这种精确的3D解剖模型将有助于补充实践和有抱负的头颈外科医生的教育。

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引用次数: 0

The pterygopalatine fossa in three dimensions: A digital anatomical model derived from radiographic imaging, refined with peer-reviewed literature, and optimized with medical illustration 翼腭窝三维图像：一个基于放射影像的数字解剖模型，通过同行评议的文献进行完善，并通过医学插图进行优化

Q3 Medicine

Operative Techniques in Otolaryngology - Head and Neck Surgery

Pub Date : 2025-03-01 DOI: 10.1016/j.otot.2024.08.003

Gabriela A. Calcano BS , Heather L. Johns MD , Tucker M. Diamond-Ames BS , Gabriel A. Hernandez-Herrera BS , Caitlin J. Vander Wert MA , Emilyn P. Frohn MS , Kathryn M. Van Abel MD , Jonathan M. Morris MD , Carlos D. Pinheiro-Neto MD

The pterygopalatine fossa (PPF) is a small fat-filled space deep within the head on the lateral skull base. It serves as a site of communication between the infratemporal fossa, nasal cavity, nasopharynx, middle cranial fossa and the orbit, creating a pathway for infection and malignant spread. Its complex anatomy often makes diagnosis and treatment of pathologies in this region difficult. Moreso, the vital structures within this region makes comprehension of this region key for safe surgical resections. Here we develop an anatomically accurate 3D model for the PPF and the integral structures contained within. Neurovasculature, musculature, and openings of the PPF were segmented and measured from the Computerized Tomography (CT) angiogram of a healthy 29-year-old woman. Data related to variations, relationships, and dimensions of structures from anatomical studies were also used to deduce accurate relationships and identify known common anatomical variants of structures within the PPF. Finally, a medical illustrator used these data to develop a 3D anatomical model. The PPF is a clinically important area that transmits structures necessary for many functions in the head, including tear production, sensation over the maxilla, and supply of inner facial and nasopharyngeal structures. The final 3D model created in this project may serve to improve education and training for clinical applications. This includes identifying pathways of disease transmission and learning best surgical practices, such as approaches, nerve blocks, endoscopic techniques, and surgical landmark identification.

翼腭窝（PPF）是位于侧颅底的头部深处的一个充满脂肪的小空间。它是颞下窝、鼻腔、鼻咽、颅中窝和眼眶之间的交通枢纽，为感染和恶性扩散提供了途径。其复杂的解剖结构往往使该地区的病理诊断和治疗困难。此外，该区域内的重要结构使得对该区域的理解成为安全手术切除的关键。在这里，我们为PPF和包含在其中的整体结构开发了解剖学上准确的3D模型。对一名29岁健康女性的神经血管系统、肌肉组织和PPF开口进行了分割和测量。解剖学研究中有关结构变异、关系和尺寸的数据也被用于推断准确的关系，并确定PPF内已知的常见结构解剖变异。最后，一位医学插画师使用这些数据开发了一个3D解剖模型。PPF在临床上是一个重要的区域，它传递了头部许多功能所必需的结构，包括泪液的产生、上颌骨的感觉、面部和鼻咽内部结构的供应。在这个项目中创建的最终3D模型可以用于改善临床应用的教育和培训。这包括识别疾病传播途径和学习最佳外科实践，如入路、神经阻滞、内窥镜技术和外科标志识别。

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引用次数: 0

Retropharygneal node dissection 咽后淋巴结清扫

Q3 Medicine

Operative Techniques in Otolaryngology - Head and Neck Surgery

Pub Date : 2024-12-01 DOI: 10.1016/j.otot.2024.08.014

Warren C. Swegal MD

Metastasis to the retropharyngeal lymph nodes is not common for malignancies of the upper aerodigestive tract, salivary glands or thyroid. However, retropharyngeal metastasis is not a rare occurrence either and lymph node dissection may be required for therapeutic purposes. Prompt identification and management is paramount for disease control. Evidence of nodal involvement is the main indication for surgical dissection if radiotherapy is not available or effective. Significant extranodal extension with carotid or prevertebral involvement are considered contraindications to dissection. Surgical approach selection is vital as access can be limited. Both transcervical and transoral routes are available for appropriately experienced surgeons. Each approach has its advantages and disadvantages in set up, safety, and postoperative complications. These factors, along with need for concurrent tumor treatment should be considered when dissecting these lymph nodes.

转移到咽后淋巴结是不常见的恶性肿瘤上呼吸道消化道，唾液腺或甲状腺。然而，咽后转移也不是罕见的发生，淋巴结清扫可能需要治疗目的。及时识别和管理对疾病控制至关重要。如果放疗不可用或无效，淋巴结受累的证据是手术切除的主要指征。结外明显伸展伴颈动脉或椎前受累被认为是解剖的禁忌。手术入路的选择是至关重要的，因为进入可能是有限的。经颈和经口两种途径均可用于经验丰富的外科医生。每种入路在设置、安全性和术后并发症方面都有其优点和缺点。在解剖这些淋巴结时，应考虑到这些因素以及同时进行肿瘤治疗的需要。

引用次数: 0

Evolution of the Neck Dissection 颈部解剖的演变

Q3 Medicine

Operative Techniques in Otolaryngology - Head and Neck Surgery

Pub Date : 2024-12-01 DOI: 10.1016/j.otot.2024.08.008

Alyssa K. Givens MD, Neerav Goyal MD, MPH, FACS, David Goldenberg MD, FACS

Cervical lymph nodes are the most common site of metastasis from head and neck cancer and are the single most important prognostic factor in treating head and neck cancer. Neck dissection is the standard treatment for clinical and occult metastasis of head and neck cancer to the cervical nodal basins. This review will discuss the evolution of neck dissection over the past 2 centuries, highlighting the surgeons and articles credited with the major advancements of the procedure.

颈部淋巴结是头颈癌最常见的转移部位，也是治疗头颈癌最重要的预后因素。颈部清扫术是临床及隐匿性头颈部肿瘤转移至宫颈结盆的标准治疗方法。这篇综述将讨论过去两个世纪以来颈部解剖的发展，重点介绍在该手术中取得重大进展的外科医生和文章。

引用次数: 0

Radical neck dissection 根治性颈部清扫术

Q3 Medicine

Operative Techniques in Otolaryngology - Head and Neck Surgery

Pub Date : 2024-12-01 DOI: 10.1016/j.otot.2024.08.015

Madelyn N. Stevens MD , Alexandra E. Kejner MD FACS

Radical neck dissection was originally developed as an “en bloc” lymphadenectomy technique for malignancies of the head and neck and is sometimes utilized in current management for bulky disease not otherwise amenable to preservation therapy and for salvage disease. Although the majority of neck dissections are no longer radical, optimal technique is important as is the understanding of postoperative care. Historic and current literature was reviewed in order to provide the most up-to-date descriptions and considerations when performing this operating. Surgical technique is described as well as modern indications and contraindications. Common complication and options for minimizing postoperative morbidities are discussed. While the paradigm for en bloc resection of head and neck malignancy has changed, radical neck dissection remains a useful tool in the armamentarium of the contemporary head and neck surgeon for select cases.

根治性颈部清扫最初是作为头颈部恶性肿瘤的“整体”淋巴结切除术技术发展起来的，有时用于目前无法进行保留治疗的大体积疾病和挽救性疾病的治疗。虽然大多数颈部解剖不再是根治性的，但最佳的技术和对术后护理的理解是重要的。回顾了历史和当前的文献，以便在执行此操作时提供最新的描述和考虑因素。手术技术以及现代适应症和禁忌症的描述。讨论了常见的并发症和减少术后发病率的选择。虽然整体切除头颈部恶性肿瘤的范例已经改变，根治性颈部清扫仍然是当代头颈部外科医生在某些病例中使用的有用工具。

引用次数: 0

Robotic-assisted neck dissection 机器人辅助颈部解剖

Q3 Medicine

Operative Techniques in Otolaryngology - Head and Neck Surgery

Pub Date : 2024-12-01 DOI: 10.1016/j.otot.2024.08.016

Eric H. Abello MD, Yarah Haidar MD, Tjoson Tjoa MD

The neck dissection has had several evolutions in the last decades, most recently with the addition of the robotic neck dissection to the head and neck surgeon's arsenal. The robotic neck dissection has emerged as a viable option for patients and offers a minimally invasive approach to the cervical lymphatic system. The major advantage includes the avoidance of a visible neck scar, while its limitations include increased operative time and cost. After several iterations, the retro-auricular/modified facelift incision has developed into the surgical approach of choice, offering excellent cosmesis while securing oncologic effectiveness. In this chapter we describe this approach in detail.

在过去的几十年里，颈部解剖有了几次发展，最近，头颈部外科医生的军火库中增加了机器人颈部解剖。对于患者来说，机器人颈部解剖已经成为一种可行的选择，并为颈部淋巴系统提供了一种微创方法。其主要优点是避免了明显的颈部疤痕，但其局限性是增加了手术时间和费用。经过几次迭代，耳后/改良的整容切口已经发展成为手术的选择，在保证肿瘤疗效的同时提供良好的美容效果。在本章中，我们将详细描述这种方法。

引用次数: 0

Selective neck dissection-the supraomohyoid, lateral, and anterolateral dissection techniques 选择性颈部清扫-肩胛舌骨上、外侧和前外侧清扫技术

Q3 Medicine

Operative Techniques in Otolaryngology - Head and Neck Surgery

Pub Date : 2024-12-01 DOI: 10.1016/j.otot.2024.08.011

Mac Kenzie Reece DO , Milena D. Fabry DO , Estelle M. Viaud-Murat MS , Sameep P. Kadakia MD FACS

In this article, the indications for performing the supraomohyoid, lateral, and anterolateral selective neck dissections will be discussed. Super selective neck dissections, though not included with a specific technique section, will also be briefly examined. An emphasis of the authors’ techniques will be illustrated with pertinent anatomy as well as postoperative care and complications to consider. Photographs will accompany the write-up in order to provide the reader with an anatomic operative reference.

在这篇文章中，我们将讨论肩胛舌骨上、外侧和前外侧选择性颈部解剖的适应症。超选择性颈部解剖，虽然不包括具体的技术部分，也将简要检查。作者的技术的重点将与相关解剖说明，以及术后护理和并发症要考虑。为了给读者提供解剖学上的手术参考，文章将附有照片。

引用次数: 0

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