Importance of an unclear fascial layer, stylopharyngeal fascia: an anatomical study

Yıl 2024, Cilt: 18 Sayı: 2, 35 - 39, 30.08.2024

Pelin Samaraz Olgun , Halil İbrahim Acar , Aybegum Balcı

Öz

Objectives: The stylopharyngeal fascia is an important anatomical structure; however, its exact location and relationship with other neighboring structures have not been clearly demonstrated. Therefore, our aim was to reveal the stylopharyngeal fascia to demonstrate its course and neurovascular relationship in the parapharyngeal space.
Methods: Ten fresh frozen cadaveric necks were dissected through a transparotideal and transcervical approach extending to the parapharyngeal region. All the neurovascular structures and muscles were preserved to demonstrate the stylopharyngeal fascia.
Results: The stylopharyngeal fascia was mostly found on the lateral aspect of the internal carotid artery and could be found by advancing into the plane between the posterior belly of the digastric and stylohyoid muscles at the parapharyngeal space borders. The stylopharyngeal fascia covered not only the parapharyngeal segment of the internal carotid artery but also the cranial nerves X–XII at the parapharyngeal space. The cranial nerve IX coursed laterally to this fascial structure, posterior to the stylopharyngeus muscle in the parapharyngeal space.
Conclusion: Although the stylopharyngeal fascia was previously shown to be related to other neurovascular structures, its anatomical course and histology remain unclear. Moreover, the stylopharyngeal fascia was defined using different nomenclatures in different studies. In this study, the stylopharyngeal fascia was shown to be an important anatomical landmark for dissection at the border of the parapharyngeal space. Further studies investigating its histological structure and defining its proper nomenclature are required. Therefore, we propose the term “parapharyngeal fascia”.

Anahtar Kelimeler

internal carotid artery, parapharyngeal space, stylopharyngeal fascia

Kaynakça

• Nagy M, Pizzuto M, Backstrom J, Brodsky L. Deep neck infections in children: a new approach to diagnosis and treatment. Laryngoscope 1997;107:1627–34.
• Bradley PJ, Bradley PT, Olsen KD. Update on the management of parapharyngeal tumours. Curr Opin Otolaryngol Head Neck Surg 2011;19:92–8.
• Galli A, Giordano L, Mattioli F, Serafini E, Fermi M, Bramati C, Bussi M. The transcervical-transparotid corridor for management of parapharyngeal space neoplasms: strengths and limits in a bi-institutional retrospective series. Eur Arch Otorhinolaryngol 2024;281:897–906.
• López F, Suárez C, Vander Poorten V, Mäkitie A, Nixon IJ, Strojan P, Hanna EY, Rodrigo JP, de Bree R, Quer M, Takes RP, Bradford CR, Shaha AR, Sanabria A, Rinaldo A, Ferlito A. Contemporary management of primary parapharyngeal space tumors. Head Neck 2019;41:522–35.
• Ferrari M, Schreiber A, Mattavelli D, Lombardi D, Rampinelli V, Doglietto F, Rodella LF, Nicolai P. Surgical anatomy of the parapharyngeal space: multiperspective, quantification-based study. Head Neck 2019;41:642–56.
• Kuet ML, Kasbekar AV, Masterson L, Jani P. Management of tumors arising from the parapharyngeal space: a systematic review of 1,293 cases reported over 25 years. Laryngoscope 2015;125:1372–81.
• Riffat F, Dwivedi RC, Palme C, Fish B, Jani P. A systematic review of 1143 parapharyngeal space tumors reported over 20 years. Oral Oncol 2014;50:421–30.
• Lemos-Rodriguez AM, Sreenath SB, Rawal RB, Overton LJ, Farzal Z, Zanation AM. Carotid artery and lower cranial nerve exposure with increasing surgical complexity to the parapharyngeal space. Laryngoscope 2017;127:585–91.
• Varoquaux A, Fakhry N, Gabriel S, Garcia S, Ferretti A, Chondrogiannis S, Rubello D, Taïeb D. Retrostyloid parapharyngeal space tumors: a clinician and imaging perspective. Eur J Radiol 2013;82:773–82.
• Soriano RM, Rindler RS, Helman SN, Pradilla G, Solares CA. Endoscopic transoral nasopharyngectomy. Head Neck 2021;43:278–87.
• Kawai K, Kodama K, Okamoto K. Proximal communication between the glossopharyngeal and facial nerves. Acta Anat (Basel) 1989;134:151–5.
• Komune N, Matsuo S, Nakagawa T. The fascial layers attached to the skull base: a cadaveric study. World Neurosurg 2019;126:500–9.
• Schachtel MJC, Gandhi M, Midwinter MJ, Panizza BJ. Fascial layers encountered in the lateral skull base region: a cadaveric and radiological analysis. Head Neck 2023;45:1272–80.
• Meng Q. Chen T, Fang L, Ding Y, Yang J, Qin D, Kong W, Sun X, Lu Y. An anatomical road map of the parapharyngeal internal carotid artery in lateral and endoscopic ventral approaches [Article in Chinese]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2024;38:477–84.
• Nair S, Srivastava N, Brijith KVR, Aishwarya JG. Surgical landmarks for parapharyngeal internal carotid artery during extended endoscopic surgery of nasopharynx: a cadaveric and radiological study. Indian J Otolaryngol Head Neck Surg 2022;74:4525–32.
• Liu YP, Xie YL, Zou X, You R, Yang Q, Chen MY. Techniques of endoscopic nasopharyngectomy for localized stage I nasopharyngeal carcinoma. Head Neck 2020;42:807–12.