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J Neurol Surg B Skull Base 2022; 83(04): 430-434
DOI: 10.1055/s-0041-1739237
Original Article

Endoscopic Anatomy of the Zygomatic Nerve: Implications for the Endoscopic Transmaxillary Approach

Yuanzhi Xu
1   Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
2   Department of Neurosurgery, Stanford Hospital, Stanford, California, United States
,
Maximiliano Alberto Nunez
2   Department of Neurosurgery, Stanford Hospital, Stanford, California, United States
,
Ahmed Mohyeldin
2   Department of Neurosurgery, Stanford Hospital, Stanford, California, United States
,
Juan C. Fernandez-Miranda
2   Department of Neurosurgery, Stanford Hospital, Stanford, California, United States
,
Aaron A. Cohen-Gadol 
3   The Neurosurgical Atlas, Carmel, Indiana, United States
4   Department of Neurological Surgery, Indiana University, Indianapolis, Indiana, United States
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Abstract

Introduction Understanding the anatomic features of the zygomatic nerve is critical for performing the endoscopic transmaxillary approach properly. Injury to the zygomatic nerve can result in facial numbness and corneal problems.

Objective To evaluate the surgical anatomy of the zygomatic nerve and its segments from an endoscopic endonasal perspective for clinical implications of performing the endoscopic transmaxillary approach.

Methods The origin, course, length, and segments of the zygomatic nerve were studied in four specimens from an endonasal perspective.

Results The zygomatic nerve arises 4.1 ± 1.7 mm from the foramen rotundum of the maxillary nerve in the superolateral pterygopalatine fossa (PPF). According to its anatomic region in endonasal endoscopic surgery, we divided the zygomatic nerve into two segments: the PPF segment, from origin to the point of entry under Muller's muscle, which runs superolaterally to the inferior orbital fissure (IOF) (length, 4.6 ± 1.3 mm), and the IOF segment, starting at the entry point in Muller's muscle and terminating at the exit point in the IOF, which travels between Muller's muscle and the great wing of the sphenoid bone (length, 19.6 ± 3.6 mm). In the transmaxillary approach, the zygomatic nerve is a critical landmark in the superolateral PPF.

Conclusion The zygomatic nerve travels in the PPF and the IOF; better visualization and preservation of this nerve during endonasal endoscopic surgery are crucial for successful outcomes.

Keywords

endonasal endoscopic surgery - foramen rotundum - zygomatic nerve


Publication History

Received: 20 May 2021

Accepted: 03 October 2021

Article published online:
14 December 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
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