Objective: To evaluate the value of Hadad-Bassagasteguy flap (HBF) in endoscopic endonasal approaches (EEA) skull base reconstruction by radioanatomic measurements on CT of the skull base of Chinese adults. The following data in terms of anterior skull base defect and reconstruction, sphenoid platform area and middle skull base defect and reconstruction including sphenoid platform and sella area, clivus area defect and reconstruction, and HBF were collected and assessed. Methods: CT image data of 42 Chinese adults were selected to obtain radioanatomic measurement data related to HBF, anterior skull base defect and reconstruction, middle skull base defect and reconstruction, and defect and reconstruction of clivus area. SPSS 26.0 software was used to analyze the data. Results: The radioanatomic measurement data about HBF and skull base of 42 Chinese adults were obtained. The width of the leading edge of HBF [(37.49±2.86) mm] was 6 mm more than the anterior skull base width at the level of the anterior ethmoidal artery [(30.87±8.61) mm], and the width of the trailing edge of HBF [(42.61±3.95) mm] was also 6 mm more than the anterior skull base width at the level of the sphenoethmoidal junction [(26.79±2.79) mm]. The total length of HBF including the pedicle [(79.68±4.96) mm] was 6 mm more than the length of the anterior skull base reconstruction [(54.06±8.67) mm], and the length of HBF without pedicle [(46.27±3.14)] mm was 6 mm more than the length of anterior skull base defect [(30.87±8.61) mm]. The trailing edge width was 6 mm more than the planum sphenoidal width at the level of the optic strut [(30.87±8.61) mm]. The total length of HBF including the pedicle was 6 mm more than the length of the planum sphenoidal, and the sella reconstruction [(64.44±10.25) mm], also was 6 mm more than the length of the planum sphenoidal reconstruction [(73.61±8.28) mm]. The length of HBF without pedicle was 6 mm more than the length of the planum sphenoidal, and the sella defect [(27.88±3.74) mm], also was 6 mm more than the length of the planum sphenoidal defect [(15.50±3.38) mm]. The width of the leading edge of HBF and the width of the trailing edge were both 6 mm more than the width of clivus reconstruction at the level of the foramen lacerum [(21.68±2.30) mm]. The total length of HBF including pedicles was 6 mm more than the clivus reconstruction length [(67.09±5.44) mm], while the length of HBF without pedicles was also 6 mm more than the clivus defect length [(37.19±3.80) mm]. Conclusions: In this study, the radiosanatomic measurements ensured that HBF could provide sufficient tissue flap for the reconstruction of the anterior skull base and sphenoid plateau and extend the reconstruction area to sella and clivus. Preoperative radiosanatomic measurement can be used to predict the size of HBF required for skull base reconstruction, which provides important guidance for flap harvest.
Adult ; Endoscopy ; Humans ; Nose/surgery* ; Reconstructive Surgical Procedures ; Skull Base/surgery* ; Skull Base Neoplasms/surgery* ; Sphenoid Bone ; Surgical Flaps

BACKGROUND: The infratemporal fossa (ITF) is an anatomical lateral skull base space composed by the zygoma, temporal, and the greater wing of the sphenoid bone. Due to its difficult approach, surgical intervention at the ITF has remained a heavy burden to surgeons. The aim of this article is to review basic skull base approaches and ITF structures and to avoid severe complications based on the accurate surgical knowledge. METHODS: A search of the recent literature using MEDLINE (PubMed), Embase, Cochrane Library, and other online tools was executed using the following keyword combinations: infratemporal fossa, subtemporal fossa, transzygomatic approach, orbitozygomatic approach, transmaxillary approach, facial translocation approach, midface degloving, zygomatico-transmandibular approach, and lateral skull base. Aside from our Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) trial, there have been very few randomized controlled trials. The search data for this review are summarized based on the authors’ diverse clinical experiences. RESULTS: We divided our results based on representative skull base approaches and the anatomy of the ITF. Basic approaches to the ITF include endoscopic endonasal, transzygomatic, orbitozygomatic, zygomatico-transmandibular, transmaxillary, facial translocation, and the midfacial degloving approach. The borders and inner structures of the ITF (with basic lateral skull base dissection schemes) are summarized, and the modified zygomatico-transmandibular approach (ZTMA) is described in detail. CONCLUSIONS: An anatomical basic knowledge would be required for the appropriate management of the ITF pathology for diverse specialized doctors, including maxillofacial, plastic, and vascular surgeons. The ITF approach, in conjunction with the application of microsurgical techniques and improved perioperative care, has permitted significant advances and successful curative outcomes for patients having malignancy in ITF.
Humans ; Pathology ; Perioperative Care ; Plastics ; Skull Base ; Sphenoid Bone ; Surgeons ; Zygoma

Frontotemporal dermoid cysts with a cutaneous sinus tract in the sphenoid bone are rarely found, and furthermore, the spreading of these cysts across the frontal branch of the facial nerve has not been reported. Herein, we present a 5-year-old case of a dermoid cyst successfully resected with preservation of this nerve using a combined extracranial and intracranial approach. This approach is recommended for a safe and radical resection of the lesion and for securing an aesthetic outcome.
Child, Preschool ; Dermoid Cyst ; Facial Nerve ; Humans ; Skull ; Sphenoid Bone

PURPOSE: To report the treatment results of a frontotemporal dermoid cyst with a cutaneous fistula and sinus tract that caused recurrent periorbital cellulitis in a child. CASE SUMMARY: A 4-year-old girl who presented with left orbital swelling and tenderness visited our hospital. She had a cutaneous fistula with a small amount of purulent discharge at the left frontotemporal area. Orbital computed tomography scans showed a well-defined low density lesion in the fronto-zygomatic suture, and there was a bony defect in the left greater wing of the sphenoid bone of the orbit. Orbital magnetic resonance imaging showed a cutaneous fistula and sinus tract that extended into the middle cranial fossa. The patient was treated with intravenous antibiotics until the inflammation was resolved. Surgery was performed to remove the dermoid cyst with sinus tract. After surgery, there was no evidence of recurrence, and complications included neurologic and ophthalmic symptoms. CONCLUSIONS: Orbitofacial lesions, particularly frontotemporal cutaneous fistulas that present with recurrent discharge, should be regarded with suspicion in cases of deep extended dermoid cysts with sinus tract. Additionally, imaging tests should be carefully conducted before surgery.
Anti-Bacterial Agents ; Cellulitis ; Child* ; Child, Preschool ; Cranial Fossa, Middle ; Cutaneous Fistula ; Dermoid Cyst* ; Female ; Fistula ; Humans ; Inflammation ; Magnetic Resonance Imaging ; Orbit ; Recurrence ; Sphenoid Bone ; Sutures

BACKGROUND/OBJECTIVE: Skeletal metastasis is one of the major clinical problems in managing cases of NPCA. Beginning osseous metastasis in the form of sphenoid bone extension is commonly seen in NPCA.Imaging modalities mainly used in detecting sphenoid bone extension are bone scintigraphy with SPECT and MRI. In this paper, the ability of bone scintigraphy with SPECT and MRI in detecting sphenoid bone extension was compared.
MATERIALS AND METHODS: Twelve patients with nasopharyngeal carcinoma were studied by bone scintigraphy with SPECT and MRI. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of each modality against the gold standard, which is sphenoid bone biopsy, were computed. Statistical analysis was done using the McNemar's Test.
RESULTS: The overall performances of bone scintigraphy with SPECT versus MRI were the following: sensitivity 89% vs 78%, specificity 33% vs 67%, positive predictive value 80% vs 88% and negative predictive value 50% vs 50%. There was no significant difference between the two modalities using McNemar's test (p>0.05).
CONCLUSION: Bone scintigraphy with SPECT and MRI were both equally effective and were complementary with each other in detecting sphenoid bone extension in patients with NPCA.

Human ; Male ; Female ; Middle Aged ; Adult ; Nasopharyngeal Carcinoma ; Tomography, Emission-computed, Single-photon ; Sensitivity And Specificity ; Nasopharyngeal Neoplasms ; Bone Neoplasms ; Sphenoid Bone

BACKGROUND/OBJECTIVE: Skeletal metastasis is one of the major clinical problems in managing cases of NPCA. Beginning osseous metastasis in the form of sphenoid bone extension is commonly seen in NPCA.Imaging modalities mainly used in detecting sphenoid bone extension are bone scintigraphy with SPECT and MRI. In this paper, the ability of bone scintigraphy with SPECT and MRI in detecting sphenoid bone extension was compared.
MATERIALS AND METHODS: Twelve patients with nasopharyngeal carcinoma were studied by bone scintigraphy with SPECT and MRI. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of each modality against the gold standard, which is sphenoid bone biopsy, were computed. Statistical analysis was done using the McNemar's Test.
RESULTS: The overall performances of bone scintigraphy with SPECT versus MRI were the following: sensitivity 89% vs 78%, specificity 33% vs 67%, positive predictive value 80% vs 88% and negative predictive value 50% vs 50%. There was no significant difference between the two modalities using McNemar's test (p>0.05).
CONCLUSION: Bone scintigraphy with SPECT and MRI were both equally effective and were complementary with each other in detecting sphenoid bone extension in patients with NPCA.

Human ; Male ; Female ; Middle Aged ; Adult ; Nasopharyngeal Carcinoma ; Tomography, Emission-computed, Single-photon ; Sensitivity And Specificity ; Nasopharyngeal Neoplasms ; Bone Neoplasms ; Sphenoid Bone

OBJECTIVE: Rapid maxillary expansion (RME) is used to expand the maxilla and increase arch perimeter; yet, there are few reports on its effects on the sphenoid bone. With cone-beam computed topography (CBCT), it is possible to visualize sphenoid bone changes. The purpose of this study was to investigate sphenoid bone changes observed in conjunction with RME treatments, using CBCT. METHODS: Sixty patients (34 women and 26 men, aged 11–17 years) underwent RME as part of their orthodontic treatment. Patients were randomly assigned to one of three groups: a tooth-anchored group, a bone-anchored group, or a control group. Initial CBCT scans were performed preceding the RME treatment (T₁) and again directly after the completion of expansion (T₂). Statistical analysis included ANOVA, descriptive statistics, and the intraclass correlation coefficient (ICC). RESULTS: The reliability of the landmark location was at least 0.783, and the largest ICC mean measurement error was 2.32 mm. With regard to distances, the largest change was 0.78 mm, which was not statistically significant (p > 0.05). Statistical significance was established in patient groups of the same sex and treatment type for the following distance measurements: right anterior lateral pterygoid plate to the right edge of the hypophyseal fossa (d₂), anterior distance between the medial pterygoid plates (d₄), and anterior distance between the left medial and lateral plates (d₈). CONCLUSIONS: In this study, there were no clinically significant changes in the sphenoid bone due to RME treatments regardless of sex or treatment type.
Cone-Beam Computed Tomography* ; Female ; Humans ; Male ; Maxilla ; Palatal Expansion Technique* ; Sphenoid Bone*

We report a case of retiform hemangioendothelioma (RH) located in the infratemporal fossa and buccal area in a 13-year-old Korean boy. The tumor originated from the sphenoid bone of the infratemporal fossa area and spread into the cavernous sinus, orbital apex, and retro-nasal area with bone destruction of the pterygoid process. Tumor resection was conducted via Le Fort I osteotomy and partial maxillectomy to approach the infratemporal fossa and retro-nasal area. The diagnosis of RH was confirmed after surgery. In the presented patient, surgical excision was incomplete, and close follow-up was performed. There was no evidence of expansion or metastasis of the residual tumor in the 8 years after surgery. In cases of residual RH with low likelihood of expansion and metastasis, even though RH is an intermediate malignancy, close follow-up can be the appropriate treatment choice over additional aggressive therapy. To date, 29 papers and 48 RH cases have been reported, including this case. This case is the second reported RH case presenting as primary bone tumor and the first case originating in the oromaxillofacial area.
Adolescent ; Cavernous Sinus ; Diagnosis ; Follow-Up Studies ; Hemangioendothelioma* ; Humans ; Male ; Neoplasm Metastasis ; Neoplasm, Residual ; Orbit ; Osteotomy ; Osteotomy, Le Fort ; Sphenoid Bone

A 15-year-old female patient with progressive pulsatile exophthalmos caused by intraorbital encephalocele was evaluated with computed tomography (CT) and magnetic resonance imaging (MRI) in our clinic. She had no history of trauma or reconstructive surgery. When she was a little girl, she had undergone surgery for congenital glaucoma on the right eye. On the three-dimensional image of CT, a hypoplasic bone defect was observed in the greater wing of the right sphenoid bone. MRI and CT scan showed herniation through this defect of the arachnoid membrane and protruded cerebral tissue into the right orbita. Intraorbital encephalocele is an important entity that can cause pulsatile exophthalmos and blindness.
Adolescent ; Arachnoid ; Blindness ; Encephalocele* ; Exophthalmos* ; Female ; Glaucoma ; Humans ; Imaging, Three-Dimensional ; Magnetic Resonance Imaging* ; Membranes ; Orbit* ; Sphenoid Bone ; Tomography, X-Ray Computed

Aneurysmal bone cysts (ABCs) are benign and rapidly expanding bone destructive lesions of any bone. They are commonly localized in the metaphysis of long bones, whereas skull base ABCs are rare. We report a case of a 21-year-old man who had been misdiagnosed as chordoma and undergone surgery. However, histopathological examination revealed it to be an ABC.
Aneurysm* ; Bone Cysts* ; Bone Cysts, Aneurysmal ; Chordoma* ; Cranial Fossa, Posterior* ; Humans ; Magnetic Resonance Imaging ; Skull Base ; Sphenoid Bone* ; Young Adult