RT Journal Article
T1 Muller's Muscle, No Longer Vestigial in Endoscopic Surgery
A1 Battista, Juan Carlos
A1 Zimmer, Lee
A1 Rodríguez Vázquez, José Francisco
A1 Froelich, Sebastien
A1 Theodosopoulos, Philip
A1 DePowell, John
A1 Keller, Jeffrey
AB BackgroundAs a thin filmy covering overlaying the inferior orbital fissure (IOF), Muller's muscle was considered a vestigial structure in humans, and for this reason, its anatomical significance was neglected. Because of increasing interest in endonasal approaches to the skull base that encompasses this region, we re-examined this structure's role as an anatomical landmark from an endoscopic perspective.MethodsIn 10 cadaveric specimens, microanatomical dissections were performed (n = 5); endoscopic dissections were performed (n = 5) via approaches of the middle turbinate or inferior turbinate, and via the Caldwell-Luc approach through the maxillary sinus. Histological examinations were performed in 20 human fetuses (Embryology Institute, Universidad Complutense de Madrid, Madrid, Spain).ResultsIn cadaveric dissections, Muller's muscle was demonstrated in all specimens, serving as a bridge-like structure that spanned the entire IOF and separated the orbit from the temporal, infratemporal, and pterygopalatine fossas. Depending on which endoscopic corridor was used, a different aspect of the IOF and Muller's muscle was identified. In our endoscopic and microscopic observations, Muller's muscle was extensive, not only spanning the IOF but also extending posteriorly to reach the superior orbital fissure (SOF) and anterior confluence of the cavernous sinus. Histological analysis identified many anastomotic connections between the ophthalmic venous system and pterygoid plexus that may explain how infection or tumor spreads between these regions.ConclusionsMuller's muscle serves as an anatomical landmark in the IOF and facilitates anatomical orientation in this region for endoscopic skull base approaches. Its recognition during endoscopic approaches allows for a better three-dimensional understanding of this anterior cranial base region.
PB Elsevier
SN 1878-8750
YR 2011
FD 2011
LK https://hdl.handle.net/20.500.14352/111196
UL https://hdl.handle.net/20.500.14352/111196
LA eng
NO Juan Carlos De Battista, Lee A. Zimmer, Jose Francisco Rodríguez-Vázquez, Sebastien C. Froelich, Philip V. Theodosopoulos, John J. DePowell, Jeffrey T. Keller, Muller's Muscle, No Longer Vestigial in Endoscopic Surgery, World Neurosurgery, Volume 76, Issues 3–4, 2011, Pages 342-346, ISSN 1878-8750, https://doi.org/10.1016/j.wneu.2010.12.057
DS Docta Complutense
RD 6 abr 2025