Anatomical Variations of the Ascending Pharyngeal Artery: Implications for Endoscopic Surgery in the Parapharyngeal Space.
Lifeng LiPingdong LiNyall R LondonHongbo XuXiaohong ChenRicardo L CarrauPublished in: Ear, nose, & throat journal (2024)
Objectives: The ascending pharyngeal artery (APA) travels with the parapharyngeal internal carotid artery (pICA) in the parapharyngeal space (PPS). This study aimed to investigate the anatomical variations of the APA, and to explore their implications for endoscopic surgery in the PPS. Methods: Dissection of the APA in the PPS was performed on 10 cadaveric specimens (20 sides). The relationship between APA and PPS tumors was retrospectively reviewed in 20 patients, attempting to ascertain the APA during the resection of 10 pre-styloid and 10 retro-styloid PPS tumors. Results: During the cadaveric dissections, the APA was identified at the medial, posteromedial, or bilateral aspects of the pICA in 12 (60%) and 4 (20%) sides, respectively. In the remaining 4 sides (20%), the APA branched into several subcategory arteries lying at the medial and lateral aspects of the pICA. Branches of the APA were observed in 13/20 sides (65%). Two branches were found in 9/13 sides and 3 branches in 4/13, respectively. The APA was only identifiable in 1/10 (10%) of pre-styloid tumors, a patient with basal cell adenoma. In contrast, the APA was encountered surrounding the pICA in 8/10 (80%) of patients with retro-styloid tumors, all of which were schwannomas. No inadvertent injury of the APA or the pICA occurred in this cohort. Conclusions: With identification of the ascending pharyngeal artery on preoperative magnetic resonance imaging, it may serve as an additional landmark during the endoscopic extirpation of tumors arising in the PPS.
Keyphrases
- ultrasound guided
- magnetic resonance imaging
- minimally invasive
- internal carotid artery
- end stage renal disease
- stem cells
- chronic kidney disease
- magnetic resonance
- case report
- ejection fraction
- pulmonary artery
- coronary artery bypass
- newly diagnosed
- coronary artery disease
- atrial fibrillation
- peritoneal dialysis
- single cell
- coronary artery
- contrast enhanced
- aortic dissection
- middle cerebral artery
- prognostic factors
- fine needle aspiration
- endoscopic submucosal dissection