上颌骨掀翻入路颅底应用显微解剖学  

Maxillary swing approach to the cranial base: microsurgical anatomy

作　　者：廖华[1] 华清泉[1] 吴展元[1] 

机构地区：[1]武汉大学人民医院耳鼻咽喉头颈外科,湖北武汉430060

出　　处：《中国耳鼻咽喉头颈外科》2009年第11期615-618,共4页Chinese Archives of Otolaryngology-Head and Neck Surgery

摘　　要：目的研究上颌骨掀翻入路所暴露的颅底解剖区域以及所受到的限制,为采用该术式处理颅底病变提供显微解剖学资料。方法对10例(20侧)经甲醛固定的成人尸头,模拟上颌骨掀翻入路,对涉及的组织结构,神经、血管进行显微解剖观测。结果上颌骨掀翻入路可暴露广阔的颅底解剖区域,可以同时处理中颅底和侧颅底包括鞍区、垂体、斜坡全程和至少第1颈椎、手术侧海绵窦、鼻咽部、翼腭窝、颞下窝、咽旁间隙的茎突前、后间隙,颈内动脉岩骨内段及岩尖等区域的病变。结论①经一侧上颌骨掀翻入路可同时获得对中颅底及侧颅底良好的暴露;②蝶骨翼突及其后方的腭帆张肌、腭帆提肌及咽鼓管等结构是限制同时处理中颅底和侧颅底病变的主要障碍;③经一侧上颌骨掀翻入路处理咽旁间隙的茎突后间隙、茎突外区域、颈内动脉岩骨水平段及海绵窦区域病变时会受到一定限制。OBJECTIVE To define the microsurgical anatomy and exposure obtained by the maxillary swing approach. METHODS Ten adult cadaver specimens fixed by formalin solution were dissected under 5 to 20 times magnification. The microsurgical anatomy and measurement were performed by mimicking the maxillary swing approach. The anatomic relationship of the muscles, arteries,veins,nerves were carefully recorded. RESULTS The maxillary swing approach provides wide exposure extending from the central base to the lateral cranial base,including turkish saddle,the ipsilateral cavernous sinus,the clivus and C1,the nasopharynx,the pterygopalatine and infratemporal fossa,and the parapharyngeal space,etc. CONCLUSION The maxillary swing approach provides a suitable route for accessing lesions involving both the central and lateral cranial base. The sphenoid pterygoid process,the Eustachian tube,and the lateral pharyngeal wall separates the central cranial base from the lateral cranial base and limits anterolateral access to the central cranial base. Removing the pterygoid process provides exposure extending from the central to the lateral cranial base and allows for wide anterolateral access to the clivus and upper cervical spine. The maxillary swing approach is difficult and limited to reach the poststyloid compartment of the parapharyngeal space,the lateral region of styloid process,the horizontal segment of the petrous carotid.

关 键 词：上颌骨 显微外科手术 颅底 解剖学 局部 

分 类 号：R322[医药卫生—人体解剖和组织胚胎学]