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Infratemporal fossa and pterygopalatine fossa

Core Procedures Pathology in the Infratemporal and Pterygopalatine Fossae Biopsy Partial/selective excision Total clearance/compartment resection Route for more proximal surgery Open Approaches Lateral Anterior Inferior Superior Combinations Endoscopic Approaches Endonasal Transmaxillary Transpterygoid Combinations The space behind the maxilla (retro-maxilla) and beneath the skull is principally occupied by the infratemporal fossa (ITF) and pteryogo­palatine fossa (PPF). These are well-defined spaces that contain masticatory muscles and neurovascular structures,…

Nose and paranasal sinuses

This chapter is divided into two sections, dealing with the nose and paranasal sinuses, respectively. Nose Core Procedures Endoscopic ligation of the sphenopalatine artery Septorhinoplasty Surface landmarks The proportions of the nose and face should be carefully evaluated ( Fig. 8.1 ). The angle of rotation and tip projection, height of the dorsum and any existing asymmetry are often key points to be addressed during surgery.…

Orbit and orbital adnexae

Core Procedures Anterior approach to upper eyelid ptosis repair External dacryocystorhinostomy Anterior orbitotomies in four quadrants Transcutaneous and transconjunctival orbital decompressions Clinical anatomy The orbit is a quadrilateral pyramid, with its base facing forward, laterally and slightly inferiorly. It contains the globe, extraocular muscles, nerves, vessels and some associated structures such as the nasolacrimal apparatus ( Ch. 6 ). The volume of the adult Caucasian orbit…

Orbit and orbital trauma

The paired orbits housing the globes are highly evolved and specialized structures that maintain the structural integrity of the globe and the highly complex coordinated movements that facilitate binocular vision. The neuromuscular mechanisms are complex and require considerable neurological investment, in that, of the twelve cranial nerves, three nerves are required for eye movement and one for visual information, with one contributing to the control of…

Face and scalp

Core procedures Management of scalp lacerations Development of the scalp coronal or bicoronal flap to give access to the upper facial skeleton and for craniofacial surgery Donor site for reconstruction to cover defects by mobilization of a variety of scalp flaps Use of part of the scalp primer as a vascularized flap to cover defects in craniofacial surgery, particularly to line the frontal sinus Scalp Clinical…

Osteology of the facial skeleton and naso-ethmoidal complex in relation to trauma

Core Procedures Surgical exposure of fracture articulations Reduction of displaced facial fractures Osteosynthesis of fracture sites The facial skeleton provides a framework for housing the special senses of vision, taste and olfaction; the muscle attachment of the sphincters of the orbit and mouth; and the articulating apparatus that allows movement of the mandible against the maxilla to facilitate mastication. Facial appearance and symmetry depend in part…

Overview of the head and neck

This chapter contains an overview of the topographical anatomy of the head and neck. These anatomical regions are probably amongst the most complex in the body because so many structures are contained within a relatively small area. The head contains the brain (see Section 3) and specialized sensory organs such as the eyes, ears, nose and oral cavity (for taste appreciation). The head and neck collectively…

Improving surgical performance through human factors recognition and enhanced team working

Human error is a significant cause of personal and organizational mistakes, and the need to recognize and address human factors (HF), performance optimization and team dynamics is essential to improve patient safety. Surgical errors are usually multifactorial rather than the fault of one individual: organizational issues, team dynamics and HF are often at the root of many incidents. The World Health Organization (WHO) surgical checklist and…

Clinical Applications

Cricothyrotomy Gray's Anatomy for Students: 536, 541, 543 Netter: 78, 83 Clinical Application Procedure creates an emergent airway through the cricothyroid membrane. Anatomic Landmarks ( Figs. VIII.1 and VIII.2 ) Palpation of midline structures Hyoid cartilage Thyroid cartilage Cricoid cartilage Skin/subcutaneous tissue Cricothyroid arteries and small veins (may traverse the cricothyroid membrane) Cricothyroid membrane Tracheal Intubation Gray's Anatomy for Students: 552, 553, 560 Netter: 68, 75,…

Retropharyngeal Region and Pharynx

Atlas References Netter: 75, 76, 79, 80, 86–88, 147, 148 McMinn: 45, 47 Gray's Atlas: 553–555, 565 Before You Begin Place the cadaver in the supine position, and identify the following landmarks in the postcraniotomy skull ( Fig. 29.1 ): Anterior, middle, and posterior cranial fossae Transverse and sigmoid sinuses Confluence of sinuses Dissection Steps o With toothed forceps and a scalpel, remove the dura mater…

Larynx

Atlas References Netter: 89–93 McMinn: 48–50 Gray's Atlas: 558–562 Before You Begin The larynx occupies the space between the epiglottis superiorly and the inferior border of the cricoid cartilage. Inspection Technique 1 o The inspection begins by examining the larynx in a hemisected head. o In a hemisected specimen, identify the epiglottis, laryngopharynx, thyroid cartilage, vallecula, uvula, posterior pharyngeal wall, cervical vertebrae, and trachea ( Fig.…

Pharynx and Oral Cavity

Atlas References Netter: 65–72, 77, 81–86 McMinn: 46, 52 Gray's Atlas: 552–557, 572–582 Dissection Steps o Identify the borders of the nasopharynx, oropharynx, and laryngopharynx on the cadaver ( Fig. 27.1 ). o The tensor veli palatini and the levator veli palatini muscles have been identified during the dissection of the pterygopalatine fossa (see Fig. 27.1 and Chapter 26 ). o Identify the torus tubarius, a…

Nasal Cavity

Atlas References Netter: 45–52, 61, 142 McMinn: 58, 59, 73 Gray's Atlas: 566–571 Dissection Steps o Exposure of the contents of the nasal cavity requires a midsagittal transection through the head ( Fig. 26.1 ). Dissection Tip Electric saws are usually too small for transection of the head. Make sure that one of your classmates holds the cadaver head firmly as you cut with the saw.…

Ear

Atlas References Netter: 105–110 McMinn: 60–61 Gray's Atlas: 520–525 Before You Begin Identify the following bones in your atlas, text, and on a skull: Petrous part of temporal bone Squamous part of temporal bone Petrosquamous fissure (at junction of petrous and squamous parts) Arcuate eminence (overlies anterior semicircular canal) Internal acoustic meatus Hiatus of facial canal (greater petrosal nerve exits temporal bone from here) Groove for…

Orbit

Atlas References Netter: 94–104 McMinn: 54–57 Gray's Atlas: 508–519 Before You Begin Remove all soft tissues with a scalpel and expose the frontal and temporal bones. Reflect the temporalis muscle as laterally as possible. Osteotomy of Orbital Roof o With an electric saw or a mallet and chisel, make a second vertical cut through the frontal bone, lateral to the supraorbital notch ( Fig. 24.1 ).…

Calvaria, Dural Venous Sinuses, Brain, and Cranial Nerves

Atlas References Netter: 111–126, 149–158 McMinn: 51–53, 62–72 Gray's Atlas: 490–502 Before You Begin The skin of the face has been previously removed (see Chapter 21 ). Dissection Steps o Continue the removal of the facial skin toward the occipital region, and separate the skin from the subcutaneous tissue ( Fig. 23.1 ). o Identify and expose the superficial temporal artery and its branches ( Fig.…

Infratemporal Fossa

Atlas References Netter: 9, 10, 55–62, 64, 81–84 McMinn: 42, 44, 76 Gray's Atlas: 507, 527–533 Before You Begin The infratemporal fossa dissection requires the use of an electric saw or a hammer and chisel. Make sure that you wear eye protection when you use these tools. Cut the terminal branches of the facial nerve, and reflect the nerves posteriorly toward the parotid gland ( Fig.…

Face

Atlas References Netter: 42, 53–54, 83–85 McMinn: 38–41 Gray's Atlas: 503–506 Before You Begin Review the superficial anatomy of the face: Glabella Root of nose, dorsum of nose Tip of nose Ala Columella nasi Philtrum Mental protuberance Modiolus Vermillion border Palpate the following facial landmarks on the cadaver: Jugular notch Mental protuberance Nasion Glabella Vertex External occipital protuberance (inion) Mastoid process Ramus, angle, and body of…