Distribution of Vasoative Intestinal Polypeptide in CranialParasym pathetic Ganglion of the Rat

Immunoreactivity (IR) for vasoactive intestinal polypeptide (VIP) of cranial parasympathetic ganglia of the rat was observed with indirect immunofluorescent method. It was found that there were VIP IR principal neurons in the ciliary, pterygopalatine, and otic ganglia. The highest positive ratio of VIP IR cells was located in the ciliary ganglia (34.8%), followed by that in the pterygopalatine ganglia(17.0%), and the lowest was found in the otic ganglia (15.4%). VIP IR small intensely fluorescent (SIF) cells and nerve fibers were not observed. Distributive characteristics of neuropeptides and functional significance of VIP in cranial parasympathetic ganglia were discussed.

Evolution of transmaxillary approach to tumors in pterygopalatine fossa and infratemporal fossa:anatomic simulation and clinical practice

Background:The endoscopic transnasal approach has been proven to have advantages on the removal of the tumors in pterygopalatine fossa(PPF)and infratemporal fossa(ITF).Herein,this study aimed to describe a modified approach for resection of the tumors in these areas,both in cadaveric specimen and clinical patients.Methods:The 20 adult cadaveric specimens and five patients with tumors in PPF and ITF were enrolled in this study.For the cadaveric specimens,ten were simulated anterior transmaxillary approach and ten were performed modified endoscopic transnasal transmaxillary approach.The exposure areas were compared between two groups and main anatomic structure were measured.Surgery was operated in the five patients with tumors of PPF and ITF to verify the experience from the anatomy.Perioperative management,intraoperative findings and postoperative complications were recorded and analyzed.Results:The modified endoscopic transnasal transmaxillary approach provided as enough surgical exposure and high operability to the PPF and ITF as the anterior transmaxillary approach did.The diameter of maxillary artery in the PPF was 3.77±0.78 mm(range:2.06-4.82mm),the diameter of middle meningeal artery in the ITF was 2.79±0.61 mm(range:1.54-3.78 mm).Four patients who suffered schwannoma got total removal and one of adenocystic carcinoma got subtotal removal.The main complications were facial numbness and pericoronitis of the wisdom tooth.No permanent complication was found.Conclusions:With the widespread use of neuroendoscopy,the modified endoscopic transnasal transmaxillary approach is feasible and effective for the resection of tumors located in PPF and ITF,which has significant advantages on less trauma and complications to the patients.

Three-hundred and sixty degrees of surgical approaches to the maxillary sinus

Objectives:To demonstrate three-hundred and sixty degrees of maxillary sinus(MS)surgical approaches using cadaveric dissections,highlighting the step-by-step anatomy of each procedure.Methods:Two latex-injected cadaveric specimens were utilized to perform surgical dissections to demonstrate different approaches to the MS.The procedures were documented with macroscopic images and endoscopic pictures.Results:Dissections were performed to approach the MS medially(endoscopic maxillary antrostomy and ethmoidectomy),anteriorly(Caldwell-Luc),superiorly(transconjunctival/transorbital approach),inferiorly(transpalatal approach),and posterolaterally(preauricular hemicoronal approach).Conclusion:A number of approaches have been described to address pathology in the MS.Surgeons should be familiar with indications,limitations,and surgical anatomy from different perspectives to approach the MS.This paper illustrates anatomic approaches to the MS with detailed step-by-step cadaveric dissections and case examples.