Anterior superior alveolar nerve injury after extended endoscopic medial maxillectomy: a preclinical study to predict neurological morbidity

作者：Schreiber Alberto^*; Mattavelli Davide; Ferrari Marco; Rampinelli Vittorio; Lancini Davide; Ravanelli Marco; Bertazzoni Giacomo; Rodella Luigi Fabrizio; Buffoli Barbara; Doglietto Francesco; Nicolai Piero

来源：International Forum of Allergy & Rhinology, 2017, 7(10): 1014-1021.

DOI：10.1002/alr.22001

• maxillectomy
• endoscopic sinus surgery
• endoscopic skull-base surgery
• computed tomography
• sinus anatomy

Background: Endoscopic medial maxillectomies (EMMs) are used to optimize exposure of the maxillary sinus and retromaxillary areas. Although in type D EMM (SturmannCanfield procedure) the anterior superior alveolar nerve (ASAN) is always at risk of injury, only 29% of patients complained of alveolar process and dental anesthesia. The purpose of this anatomical study is to assess the neural anastomotic network of the ASAN (ASAN-NAN) and describe different extensions of type D EMMs in a preclinical setting.
Methods: The ASAN and its medial anastomotic branches (MABs) and lateral anastomotic branches (LABs) were evaluated by cone-beam computerized tomography (CBCT). Five different extensions of type D (D1 to D5) EMMs were identified and nerves at risk of injury in each type were assessed by CBCT. Moreover, quantification of surgical corridors was performed on cadaver heads with a neuronavigation system.
Results: Fifty-seven CBCT scans were analyzed. The ASAN would be spared in 16.3% of cases with a type D1 EMM, while it would be injured in the majority of type D2 to D5 resections. At least 1 nerve of the ASAN-NAN was spared in 96.6%, 93%, 74.6%, 0%, and 65.8% of type D1 to D5 EMMs, respectively. Two cadaver headswere dissected and the incremental volume and number of maxillary subsites exposed was assessed in type D1 to D5 EMMs.
Conclusion: ASAN function impairment is probably compensated by LABs and MABs. If this hypothesis will be validated in a prospective study on patients, preoperative CBCT evaluation could predict neurological morbidity after type D EMM, and allow tailoring the procedure to minimize impairment of the ASAN-NAN.

• 出版日期2017-10