title: A description of arterial variants in the transoral approach to the parapharyngeal space.
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 ± 0.3 mm. 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 ± 3.9 mm 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.
authors: Department of Otolaryngology Head and Neck Surgery, China-Japan Friendship Hospital, 2 Yinghua Dongjie, Chaoyang District, Beijing, China; Department of Neurosurgery, University of Pittsburgh Medical Center, 200 Lothrop St., Pittsburgh, Pennsylvania.
authors: Chengyuan
authors: C
authors: Wang
authors: Summit
authors: S
authors: Kundaria
authors: Juan
authors: J
authors: Fernandez-Miranda
authors: Umamaheswar
authors: U
authors: Duvvuri
mesh_terms: D063405:Anatomic Variation; D001158:Arteries / Q000033:anatomy & histology; D002342:Carotid Artery, External / Q000033:anatomy & histology*; D002343:Carotid Artery, Internal / Q000033:anatomy & histology*; D006801:Humans; D008953:Models, Anatomic; D057605:Natural Orifice Endoscopic Surgery; D010159:Palate / Q000098:blood supply; D010609:Pharyngeal Muscles / Q000033:anatomy & histology*; D010614:Pharynx / Q000033:anatomy & histology / Q000098:blood supply
keywords: TORS; arterial variants; parapharyngeal space; robotic surgery