Radiological anatomy assessment of the fissura pterygomaxillaris for a surgical approach to ganglion pterygopalatinum

The ganglion pterygopalatinum has become a therapeutic target to treat various pain syndromes in recent years. It is located in the fossa pterygopalatina, and the fissura pterygomaxillaris is the main access to surgically approach this structure. Recently, the neuromodulation of the ganglion pterygo...

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Bibliographic Details
Published in:Journal of anatomy 2017-12, Vol.231 (6), p.961-969
Main Authors: Puche‐Torres, Miguel, Blasco‐Serra, Arantxa, Campos‐Peláez, Ana, Valverde‐Navarro, Alfonso A.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Age
Aged
Aged, 80 and over
Anatomy
Classification
Computed tomography
Female
fissura pterygomaxillaris
fossa pterygopalatina
Ganglia, Sympathetic - surgery
ganglion pterygopalatinum
Headache
Humans
Implantation
Male
Middle Aged
Morphology
Neuromodulation
Original
Pain
Patients
Physical characteristics
Pterygopalatine Fossa - anatomy & histology
Pterygopalatine Fossa - diagnostic imaging
Statistical analysis
Surgery
Surgical instruments
Tomography, X-Ray Computed
Typology
Young Adult
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Summary:The ganglion pterygopalatinum has become a therapeutic target to treat various pain syndromes in recent years. It is located in the fossa pterygopalatina, and the fissura pterygomaxillaris is the main access to surgically approach this structure. Recently, the neuromodulation of the ganglion pterygopalatinum by microstimulator implantation has become the first therapeutic line in refractory cluster headache treatment. This invasive technique is performed transorally through the fissura pterygomaxillaris, and is limited by the size of the implantation device, which requires an opening of at least 2 mm. Therefore, extensive knowledge about the anatomy of the fissura pterygomaxillaris prior to surgery is necessary to predict the success of both the approach and intervention. Likewise, establishing a morphological typology of the different fissura pterygomaxillaris variations would be a valuable predictive tool in the clinical practice. In this work, an anatomical analysis was performed of the morphological characteristics of the 242 fissurae pterygomaxillares, which corresponded to 121 adult patients, 58 males and 63 females, aged between 18 and 87 years. For each subject, right and left fissures were studied with radiological computed tomography images. Aperture fissura pterygomaxillaris measurements were taken in an upper (Measure A), middle (Measure B) and lower craneo‐caudal third (Measure C). Intra‐subject differences were studied between the measurements taken of each patient's right and left fissures, and the inter‐subject measures in which fissures were compared according to patients’ age and gender. The obtained results showed no significant differences between each patient's right and left fissures in any three measurements taken. Intra‐subject differences were not significant for gender or age. No statistically significant differences were found for the inter‐subject measures between the measures of fissures according to patients’ age. However, our data revealed that males’ fissurae pterygomaxillares were significantly larger than those of females in all three measures. Having analysed fissures, a typological classification was made according to the morphological patterns found. A 2‐mm limiting measure was considered, and Measures A, B and C of each fissure were classified depending on whether they had a value above or equal to 2 mm, or below 2 mm. With this classification criterion, four fissurae pterygomaxillares types were obtained. Type I and I
ISSN:0021-8782
1469-7580
DOI:10.1111/joa.12690