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

Development of an anatomically accurate 3-dimensional (3D) digital model of the human larynx derived from published literature and radiographic imaging. The laryngeal framework was segmented from a computed tomography (CT) angiogram of a healthy 29-year-old female. Data derived from published anatomical studies were compiled to provide additional anatomical detail to each structure. Anatomical details beyond the resolution of the imaging study or which could not be elucidated from the study were refined according to descriptions in the anatomic literature. The 3D model was refined by the medical illustrator, and its mesh was reformatted to optimize online viewing and manipulation. Due to the small size of the laryngeal muscles, there was no attempt to segment these muscles using radiographic imaging. All intrinsic laryngeal muscles were generated de novo, as were the superior laryngeal nerve and recurrent laryngeal nerve. CT imaging was utilized to generate meshes of the hyoid bone, epiglottis, thyroid cartilage, cricoid cartilage, and thyrohyoid membrane. Additionally, the airway space was segmented to provide size and spatial location to the vallecula, false vocal folds, true vocal folds, piriform sinus, subglottis, and a scaffold for the mucosa. These meshes were processed to limit radiographic artifact and serve as a foundation for the construction of the remainder of the laryngeal anatomy. The model was uploaded to a 3D repository, which can be accessed here (https://shorturl.at/nJPYZ). The larynx is a highly specialized organ essential for speech, swallowing, and airway protection. This study describes a digital 3D model of the larynx, created by combining radiographic imaging with critical review of anatomic literature. Utilizing the expertise of neuroradiology, laryngeal surgery, and medical illustration, we highlight surgically-relevant anatomic relationships and important aspects to consider during laryngeal surgery.

Using published literature and radiographic imaging, this study aims to develop an anatomically accurate 3-dimensional (3D) digital model of the human parotid gland, submandibular gland, facial nerve, and adjacent anatomy. The model is available for viewing at https://shorturl.at/uzADZ. The left parotid and submandibular glands, parotid ducts, retromandibular vein, external carotid artery, and its relevant branches were segmented from a computed tomography (CT) angiography study of a healthy female. The object segmentations were exported and refined based on a literature review of relevant anatomical structures. These structures were incorporated into the head and neck model to ensure compatibility with other anatomical structures, such as the mandible and skull base. Following the segmentation of the parotid and submandibular glands, the parotid gland was divided into superficial and deep lobes based on the course of the retromandibular vein. The facial nerve and its branches were added according to the most common anatomical variants. The internal maxillary artery and its first-order branches were identified; when below the resolution of the patient's imaging study, these branches were added according to the most commonly described anatomical variants. This applies to all other neurovascular structures depicted in the final renders. This study demonstrates the critical anatomic landmarks related to surgery of the parotid and submandibular glands, with particular emphasis on vascular structures including the maxillary and facial arteries, the common facial vein, external jugular vein, and retromandibular vein, as well as the facial nerve (CN VII), great auricular nerve, auriculotemporal nerve, lingual nerve, and hypoglossal nerve. The associated 3D model can serve as a helpful tool for improving the understanding of anatomical relationships, particularly in the parotid space.

Development of an anatomically accurate 3-dimensional (3D) digital model of the human nasopharynx, oropharynx, and hypopharynx derived from published literature and radiographic imaging. Muscles of the pharynx, including the palatopharyngeus, superior, middle, and inferior constrictor, salpingopharyngeus and stylopharyngeus were manually segmented from a head and neck CT angiogram of a healthy 29-year-old female. Data derived from published anatomical studies were compiled to provide additional anatomical detail to each muscle. The eustachian tube and supporting structures, adjacent supporting structures, and adjacent major neurovasculature were also segmented. These anatomical details were then incorporated into the model by a 3D medical illustrator. A total of 6 muscles were segmented from CT angiography data as were the hyoid bone, thyroid and cricoid cartilage, epiglottis, skull base, course of the eustachian tube, and nearby major arteries and veins. Meshes were further refined in digital 3D space based on data from peer-reviewed anatomical studies. The left trigeminal, glossopharyngeal, and hypoglossal nerves were incorporated into the model to highlight important anatomical relationships relevant for surgery. Finally, the model was uploaded to a publicly available 3D repository, which can be accessed here (https://shorturl.at/qJO16). The pharynx is a complex 3D structure that plays a critical role in swallowing, speaking, and airway protection. By combining radiographic data with published anatomical descriptions, and through the collaboration between neuroradiology, head and neck surgery, and medical illustration, we developed an anatomically accurate, detailed 3D model of the pharynx for education and training purposes.

Development of an anatomically accurate, digital, 3-dimensional (3D) model of the masticator space, including the muscles of mastication and temporomandibular joint, by combining data from radiographic imaging and published literature, and augmenting this with medical illustration. The present study involved the manual segmentation of the muscles of mastication, namely the masseter, temporalis, medial pterygoid, and lateral pterygoid muscles, as well as the buccinator muscle from a head and neck CT angiogram of a healthy 29-year-old female. The skull base, supporting structures, and adjacent major arteries were also segmented from the same study. The segmentation was then refined based on a compilation of data from published anatomical studies, which were utilized to provide additional anatomical detail for each muscle. Published studies were also used to incorporate structures unable to be segmented by this imaging technique, specifically major cranial nerves and the temporomandibular joint. The resulting anatomical details were subsequently incorporated into a 3D model by a professional medical illustrator. A total of 5 left-sided muscles were segmented from CT angiography data and were incorporated with segmentations of the skull base and mandible. Meshes were further refined in digital 3D space based on data from peer-reviewed anatomical studies. The left temporomandibular joint, sphenomandibular ligament, and stylomandibular ligament, as well as the left trigeminal nerve and maxillary artery and its branches were incorporated into the model to highlight important surgical anatomical relationships. Finally, the model was uploaded to a publicly available 3D repository, available at https://shorturl.at/hnrVZ. This 3D study serves to demonstrate, in a layered fashion, the complex anatomy of the muscles of mastication, including their relationship with important cranial base and neurovascular structures relevant to common surgical procedures and approaches to the infratemporal fossa. Moreover, it serves as an adjunct to the other studies published in this issue.

Surgical approaches to the oropharynx have trended over the years from more invasive to more minimally invasive procedures, with the advent of transoral laser microsurgery and transoral robotic surgery. With less invasive procedure, visualization of critical structures may be more limited, necessitating a robust understanding and working knowledge of the underlying anatomy to avoid surgical complications and errors. Herein, we review pertinent anatomical structures in the oropharynx through use of a sagittally split cadaveric model in 2D and 3D imaging, with a focus on surgical relevance.

Odontogenic descending necrotizing mediastinitis (DNM) is a rare but sometimes fatal complication of tooth infections. The mortality rate remains high, up to 40%, and there is no consensus on optimal workup and management currently. This review aims to summarize cases of odontogenic DNM in the literature to optimize management strategies and aid physicians in its early recognition. A systematic review of the Ovid Medline, EMBASE Classic and Pubmed databases was conducted using PRISMA guidelines. Original research studies reporting an odontogenic etiology of DNM were included. Our search identified 226 articles. Final inclusion consisted of 60 studies describing 204 cases. Most patients were male (80.4%) with a mean age of 47.64 ± 15.96 years old. Patients primarily presented with edema (57.7%), fever (42.3%), trismus (37.2%), dyspnea, (26.9%), dysphagia (26.9%). Common radiologic findings were abscesses or fluid collection in the mediastinum (53.1%), air in the soft tissues (50.0%), pleural effusion or empyema (37.5%), mediastinal widening (32.8%), and pericardial effusion (7.8%). Patients were treated with intravenous antibiotics and a variety of surgical techniques such as cervicotomy only (51.2%), thoracotomy only (15.9%), cervicotomy and chest tube (3.5%). The mortality rate was 14.2% with a mean length of hospital stay of 30.1 ± 20.2 days. This systematic review reports and analyzes epidemiological, clinical and treatment-related data regarding patients with odontogenic DNM. Effective disease recognition and patient-specific targeted treatment are needed to ensure treatment success. Further research is needed to promote implementation of such data into clinical practice, with potential to reduce the associated mortality rate.

Epiglottopexy is an uncommon, but effective procedure for pediatric patients with obstructive sleep apnea. It is important to establish retroflexion and collapse of the epiglottis at the base of tongue prior to surgery. Preoperative polysomnogram, flexible fiberoptic laryngoscopy, and sometimes drug induced sleep endoscopy are critical components of the workup as many patients who benefit from epiglottopexy have already failed primary adenotonsillectomy. The surgery involves demucosalizing the base of tongue and lingual surface of the epiglottis and securing the 2 structures to one another. Patients tolerate the procedure well and can often be discharged home the following day.

Surgical treatment of obstructive sleep apnea in children who fail tonsillectomy and adenoidectomy, or in those children with small nonobstructing tonsils is performed infrequently. Further evaluation including drug induced sleep endoscopy may uncover residual upper airway obstruction at the tongue base. When this finding is identified, targeted treatment of tongue base obstruction can be performed. A straight forward easy to perform tongue reduction procedure with minimal complications and good clinical outcomes when part of a multi-level approach is described.