显微镜下经鼻上颌窦后壁进路翼腭窝的显微解剖学研究  

Preliminary anatomic study of an microscopy-based operative approach from the posterior wall of the maxillary sinus to the pterygopalatine fossa

作　　者：金涌[1] 白志强[1] 陶宝鸿[2] 

机构地区：[1]台州学院医学院附属市立医院神经外科,台州318000 [2]台州学院医学院附属市立医院耳鼻喉科,台州318000

出　　处：《中国眼耳鼻喉科杂志》2013年第5期293-296,共4页Chinese Journal of Ophthalmology and Otorhinolaryngology

基　　金：浙江省医药卫生科技计划一般项目(2011KYB139);台州市科技研究计划一般项目(2012A33274)

摘　　要：目的通过显微镜下鼻腔上颌窦后壁手术入路,对翼腭窝及入路的相关结构进行解剖学研究,为临床内镜下翼腭窝手术提供解剖学及形态学资料。方法对10具(20侧)动静脉灌注乳胶的成人尸头标本,完全模拟经鼻腔上颌窦后壁的手术入路逐层显微解剖,对入路相关解剖标志及翼腭窝进行观察、分析、拍摄和测量。结果该入路可分3步:寻找上颌窦口、进入上颌窦、进入翼腭窝;鼻小柱距上颌窦口的距离为(45.07±2.01)mm,与蝶腭孔的距离为(64.84±3.00)mm,距翼管前孔距离为(71.34±2.99)mm;以鼻小柱至鼻后棘的连线为底边,其与鼻小柱与上颌窦口连线的夹角为(38.81±1.72)°;其与鼻小柱与蝶腭孔连线的夹角为(25.92±2.05)°。翼腭窝区结构复杂,其内的上颌动脉及其终支蝶腭动脉和腭降动脉变异较大;沿蝶腭动脉逆行解剖有助于寻找上颌动脉及其分支结构。结论显微镜下经鼻腔上颌窦后壁入路可较安全直接地暴露翼腭窝的解剖结构;翼腭窝中浅部血管结构的解剖有助于深部神经结构的保护,深部神经结构(如翼管神经和上颌神经)及其穿行的骨孔有助于在颅底辨别和控制颈内动脉。Objective By simulating the operative approach to the pterygopalatine fossa（PPF） through the posterior wall of the maxillary sinus under microscope, the relevant structure of the PPF and operative approach was anatomically studied to provide the anatomic and morphologic information for the PPF surgery by endoscope. Methods The observation, analysis, photography and measurement about the operative approach-relevant anatomic landmarks was performed when successive layer microscopic anatomy of the operative approach to the PPF through the posterior wall of the maxillary sinus was fully simulated by utilizing 10 cadaveric heads（20 sides） of adults which had been arterially and venously affused with latex. Results The approach was divided into 3 steps： finding ostium of the maxillary sinus, entering the maxillary sinus and entering PPF. The distance from the nasal columella to the ostium of the maxillary sinus was （45.07 ＋ 2.01 ） rrml;the distance from the nasal columella to the sphenopalatine foramen was （64.84 ＋ 3.00） mm; the distance from the nasal eolumella to the anterior foramen of the pterygoid canal was （71.34 ＋2.99） mm. The angle between the link from nasal columella to posterior nasal spine and the link from nasal columella to apertura maxillaries was （38.81 ＋ 1.72）~;The angle between the link from nasal columella to posterior nasal spine and the link from nasal eolumella to sphenopalatine foramen was（25.92 ＋ 2.05 ） ~. Since the PPF region was structurally complicated with the inside maxillary artery and its ending branch-sphenopalatine artery as well as descending palatine artery drastically varied, the retro-anatomy along the sphenopalatine artery would make it easier to locate the maxillary artery and its branches. Conehltsions The microscopical approach through the posterior wall of the maxillary sinus might provide direct exposure to the PPF. A dissection superficial to the vascular structures might preserve the neural elements. These nerves and their bony foramin

关 键 词：显微镜 翼腭窝 神经解剖学 

分 类 号：R322[医药卫生—人体解剖和组织胚胎学]