Muller's Muscle, No Longer Vestigial in Endoscopic Surgery
| Autor: | John J. DePowell, Sébastien Froelich, José Francisco Rodríguez-Vázquez, Juan Carlos De Battista, Philip V. Theodosopoulos, Lee A. Zimmer, Jeffrey T. Keller |
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| Rok vydání: | 2011 |
| Předmět: |
Maxillary sinus
Turbinates Fetus Pterygoid plexus Cadaver medicine Humans Cranial Fossa Anterior Skull Base business.industry Endoscopy Muscle Smooth Anatomy Inferior orbital fissure Skull medicine.anatomical_structure medicine.vein Superior orbital fissure Cavernous sinus Surgery sense organs Neurology (clinical) Nasal Cavity Cadaveric spasm business Orbit Orbit (anatomy) |
| Zdroj: | World Neurosurgery. 76:342-346 |
| ISSN: | 1878-8750 |
| DOI: | 10.1016/j.wneu.2010.12.057 |
| Popis: | Background As a thin filmy covering overlaying the inferior orbital fissure (IOF), Muller's muscle was considered a vestigial structure in humans, and for this reason, its anatomical significance was neglected. Because of increasing interest in endonasal approaches to the skull base that encompasses this region, we re-examined this structure's role as an anatomical landmark from an endoscopic perspective. Methods In 10 cadaveric specimens, microanatomical dissections were performed (n = 5); endoscopic dissections were performed (n = 5) via approaches of the middle turbinate or inferior turbinate, and via the Caldwell-Luc approach through the maxillary sinus. Histological examinations were performed in 20 human fetuses (Embryology Institute, Universidad Complutense de Madrid, Madrid, Spain). Results In cadaveric dissections, Muller's muscle was demonstrated in all specimens, serving as a bridge-like structure that spanned the entire IOF and separated the orbit from the temporal, infratemporal, and pterygopalatine fossas. Depending on which endoscopic corridor was used, a different aspect of the IOF and Muller's muscle was identified. In our endoscopic and microscopic observations, Muller's muscle was extensive, not only spanning the IOF but also extending posteriorly to reach the superior orbital fissure (SOF) and anterior confluence of the cavernous sinus. Histological analysis identified many anastomotic connections between the ophthalmic venous system and pterygoid plexus that may explain how infection or tumor spreads between these regions. Conclusions Muller's muscle serves as an anatomical landmark in the IOF and facilitates anatomical orientation in this region for endoscopic skull base approaches. Its recognition during endoscopic approaches allows for a better three-dimensional understanding of this anterior cranial base region. |
| Databáze: | OpenAIRE |
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