En the glenoid fossa and the petrous segment in the internal carotid artery (petrous carotid). The dura in the middle fossa was elevated to expose the middle meningeal artery and greater petrosal nerve (Methoxyfenozide Inhibitor Figure 1A). Dividing the middle meningeal artery and splitting the dura over V2 and V3 permitted the elevation in the dura medially. The foramen ovale was opened by drilling the middle cranial base though preserving the glenoid fossa (Figure 1B). The bone amongst the glenoid fossa and foramen ovale was drilled to expose the eustachian tube, roofed with all the tensor tympani mus cle (Figure 1C). The carotid canal was situated promptly lateral towards the bony portion in the eustachian tube and ran parallel towards the superficial higher petrosal nerve. Soon after cutting the ten sor tympani and greater petrosal nerve and drilling the bone superior and lateral to the hori zontal and vertical portion of your petrous carotid, the course on the petrous carotid was ex posed in the vertical to the horizontal segment (Figure 1D). The entrance in the carotid canal was surrounded by a fibrocartilaginous ring (Figure 1E). The levator veli palatine muscle was inferiorly attached to the cartilaginous eustachian tube (Figure 1E). Right after cutting the fibrocar tilaginous ring around the artery at the entry inside the carotid canal, the artery was translocated anteriorly to supply space for drilling the bone medial towards the artery (Figure 1F). Lastly, the mandibular condyle was removed to investigate the connection amongst the glenoid fossa and petrous carotid (Figure 1G). If the glenoid fossa/temporomandibular joint (TMJ) demands to be resected en bloc together with the EAC so it prevents exposure of the tumor, the petrous carotid needs to be controlled from the middle cranial fossa floor, as opposed to the glenoid fossa. When the glenoid fossa is exposed and it will not lead the exposure of cancer, the carotid canal canCancers 2021, 13,15 ofbe exposed by drilling the vaginal process from the temporal bone via the glenoid fossa. The relationship involving the vaginal process and petrous carotid is illustrated in Figure 1H.Figure 1. Partnership involving the glenoid fossa and petrous carotid. (A) Temporal dura is ele vated and also the middle meningeal artery is identified. The blue 1-?Furfurylpyrrole Autophagy dotted line indicates the position of the glenoid fossa/temporomandibular joint. (B) Middle cranial base is drilled to expose the course from the middle meningeal artery and CN V3. (C,D) Bone is drilled involving the foramen ovale and glenoid fossa to expose the course on the petrous carotid. (E) Immediately after opening the carotid canal, the fibrocartilaginous tissue is exposed. (F) Anterior translocation with the petrous carotid. (G) Con dyle with the mandible is removed to investigate the connection among the glenoid fossa and pe trous carotid (asterisk indicates the fibrocartilaginous tissue). (H) The partnership among the vaginal process in the tympanic part of the temporal bone along with the petrous carotid is depicted. The red dotted line indicates the course with the petrous carotid medial for the vaginal approach. The blue dotted line shows the course of the jugular bulb. The yellow region shows the course from the eusta chian tube lateral for the petrous carotid. A., artery; Auto., carotid; CN, cranial nerves; Eust., eusta chian tube; Gang., ganglion; Gasser., gasserian; Genic., geniculate; Gr., higher; IAM, internal audi tory meatus; L, lateral semicircular canal; Less., lesser; Lev., levator; M., muscle;.
