phenylephrine-hydrochloride and Cranial-Nerve-Injuries

Frontobasal fractures occur in up to 24% of head injuries and often require a multidisciplinary approach. Besides the common bone fractures, the complex anatomy can cause damage to the sense of vision and smell. Further possibly lethal complications such as cerebrospinal fluid leak followed by meningitis or internal carotid bleeding can follow. Diagnostic and treatment options are reviewed with a focus on the endoscopic endonasal approach.

Topics: Carotid Artery Injuries; Carotid Artery, Internal; Cerebrospinal Fluid Leak; Cranial Nerve Injuries; Facial Bones; Frontal Sinus; Humans; Natural Orifice Endoscopic Surgery; Nose; Olfaction Disorders; Optic Nerve Diseases; Skull Fracture, Basilar

Topics: Cerebrospinal Fluid Rhinorrhea; Cranial Nerve Injuries; Diplopia; Ethmoid Bone; Ethmoid Sinus; Fixation, Ocular; Fractures, Bone; Hemorrhage; Humans; Lacrimal Apparatus; Maxillofacial Injuries; Nose; Oculomotor Muscles; Oculomotor Nerve Injuries; Orbit; Radiography; Tendon Injuries; Vision Disorders; Visual Acuity

Expanding the ventrolateral skull base corridor from the midline of lower clivus to the petroclival fissure is a challenging endonasal surgical task. Resection of lytic lesions like chondrosarcoma can cause cranial nerve morbidities and injury of ICA, necessitating accurate knowledge of correlative endoscopic anatomy with stereotactic landmarks.. We describe an extended endoscopic endonasal approach (EEA) for a right petroclival chondrosarcoma with the demonstration of ipsilateral surgical landmarks with contralateral normal correlates, using a stepwise comparative image-guided cadaveric dissection study.. EEA for lytic lesions like chondrosarcomas needs to address brain shift and displacement of ICA, posing a chance for cranial nerve morbidities and ICA injury. Meticulous utilization of intraoperative stereotactic landmarks can help avoid and mitigate surgical complications.

Topics: Chondrosarcoma; Cranial Fossa, Posterior; Cranial Nerve Injuries; Dissection; Humans; Natural Orifice Endoscopic Surgery; Neurosurgical Procedures; Nose; Postoperative Complications; Skull Base Neoplasms

The internal nasal branch of the infraorbital nerve (ION) runs down the nose and around the ala to be distributed to the nasal septum and vestibule. The aim of this study was to measure the internal nasal branch around the ala of the nose and discuss its possible relevance in clinical/surgical practice. Twelve sides from seven specimens derived from fresh frozen and embalmed Caucasian cadaveric heads were dissected. The specimens included three males and four females. The ages of the cadavers at death ranged from 65 to 84 years. The diameter of the internal nasal branch, horizontal distance from the lateral contour of the ala (Point A) to the branch (distance H) and vertical distance from the bottom part of the ala (Point B) to the branch (distance V) were recorded. Distance H ranged from -1.6 to 1.5 mm on right sides and -1.0 to 1.5 mm on left sides. The diameter of the nerves at Point A ranged from 1.3 to 1.8 mm on right sides and 1.3 to 1.6 mm on left sides. Distance V ranged from -1.5 to 1.0 mm on right sides and -2.3 to 1.1 mm on left sides. The diameter of the nerves at Point B ranged from 0.7 to 1.3 mm on right sides and 0.8 to 1.2 mm on left sides. The results of this study are the first to detail the topography of the internal nasal branch of the ION. Clin. Anat. 30:817-820, 2017. © 2017Wiley Periodicals, Inc.

Topics: Aged; Aged, 80 and over; Cadaver; Cranial Nerve Injuries; Female; Humans; Male; Maxillary Nerve; Nose