颞下经下颌入路相关骨性结构解剖及其临床意义  

Anatomy of Bony Structure and Clinical Significance of the Subtemporal Transmandibular Approach

作　　者：蒋健[1] 刘宁[1] 朱风仪[1] 赵春生[1] 陈新成[1] 骆慧[1] 

机构地区：[1]南京医科大学第一附属医院神经外科,江苏南京210029

出　　处：《解剖科学进展》2005年第2期102-104,107,共4页Progress of Anatomical Sciences

基　　金：江苏省科技厅社会发展重点项目(No.BS2000050)

摘　　要：目的研究与颞下经下颌入路相关的骨性结构解剖,为扩大手术暴露提供解剖学参考。方法选用成人尸头10例(20侧),经模拟手术后去除软组织,显露相关骨性结构,进行观察和测量。结果颧弓是暴露中颅底和颞下窝的关键,颧弓长度和下颌关节窝宽度分别为32.9±2.6mm和15.5±1.3mm;下颌孔位于下颌升支内侧面中央略偏后上方,下颌升支的斜行截骨安全且可以获得最佳的纵向暴露;颞下窝,翼腭窝和咽旁间隙骨性结构复杂,腔隙众多且互为交通;茎突是重要的解剖标志,其根部至颈静脉孔后缘仅2.95±0.25mm。结论颞下经下颌入路暴露充分,掌握相关骨性解剖对手术治疗侧颅底区沟通性肿瘤具有重要意义。Objective To study the anatomy of the bony structures related to the subtemporal transmandibular approach and provide an advisable anatomy reference for exposure. Methods Ten adult cadaver specimens (20 sides) by imitating operations were used. The soft tissues adherent to them were removed and osseous structures concerned to the subtemporal transmandibular approach were observed and measured by gross anatomical method. Results Zygomatic arch was an anatomical key for medial skull base and infratemporal fossa exposure.The length of the zygomatic arch and the width of the mandibular fossa were 32.9±2.6 mm and 15.5±1.3 mm respectively. Mandibular foramen was located on the inner surface just postero-superior to the midpoint of the ramus of the mandible, and vertical oblique osteotomy for ramus can provide safe and adequate exposure longitudinally. Bony structures in infratemporal fossa, pterygopalatine fossa, and parapharyngeal space are complicated with walls and communicating paths. Styloid process was an important sign and the distance from root of it to the posterior rim of the jugular fossa was only 2.95±0.25 mm. Conclusion The subtemporal transmandibular approach has good exposure and the bony anatomy related to this approach has an important significance for surgical operation of communicative tumors in lateral skull base and medial skull base.

关 键 词：骨性结构 颞下经 相关 临床意义 入路 沟通性肿瘤 扩大手术 成人尸头 颧弓长度 下颌升支 解剖标志 颈静脉孔 重要意义 手术治疗 骨性解剖 暴露 解剖学 软组织 手术后 中颅底 关节窝 内侧面 下颌孔 颞下窝 翼腭窝 侧颅底 

分 类 号：R782.4[医药卫生—口腔医学] R322.81[医药卫生—临床医学]