鼻内镜下鼻后神经的应用解剖研究  

Endoscopic endonasal anatomy of the posterior nasal nerve

作　　者：刘怀涛[1] 周宇[1] 闫小会[1] 冯宁宇[1] 马瑞霞[1] 

机构地区：[1]宁夏医科大学总医院耳鼻咽喉头颈外科,宁夏银川750004

出　　处：《宁夏医学杂志》2017年第8期685-687,共3页Ningxia Medical Journal

基　　金：宁夏科技攻关项目(2012ZYS191)

摘　　要：目的在鼻内镜下明确鼻后神经(PNN)出蝶腭孔后分支走行,为开展经鼻内镜PNN切断术提供解剖学基础。方法选择10%福尔马林固定的成人尸头5具(10侧),在鼻内镜下距中鼻甲后端附着处前缘和下缘约0.5 cm处沿中鼻甲长轴方向切开中鼻道黏膜及骨膜,至中鼻甲尾端附近将切口向后延伸,向后上掀起中鼻甲尾端,仔细分离至蝶腭孔,并完全显露蝶腭孔,辨认并游离蝶腭动脉各分支和PNN各分支,观察其走行特点。结果 PNN出蝶腭孔后主干分出4~6支,部分与蝶腭动脉分支伴行,形成血管神经束,另有部分独立走行。其下鼻甲支与动脉血管分支伴行进入下鼻甲,而进入中鼻甲及鼻中隔的神经分支也有血管伴行。独立走行分支主要向上分布于中鼻甲和下鼻甲上部,另有细小分支走向下鼻甲后部及鼻咽部。在4侧标本中发现单独骨管穿出的神经束,有1~2支,分布于鼻腔后部。这些骨管均位于蝶腭孔下方和后方,距蝶腭孔边缘2.6~8.3 mm,平均(4.23±0.56)mm。结论 PNN分支较多,主要进入下鼻甲、中鼻甲及鼻中隔,与蝶腭动脉分支的关系较密切;手术中为保证安全、完整地切断PNN各分支,应充分暴露蝶腭孔周围骨面。Objective To investigate the course and branches of the posterior nasal nerve （PNN） after leaving sphenopalatine foramen （SPF） through an endoscopic endonasal dissection and provide anatomical basis for the endoscopic resection of the PNN. Methods Dissections were performed using nasal endoscopy in five formalin - fixed adult cadaveric heads （ ten sides）. Nasal mucosa and periosteum incision was made longitudinally in the middle meatus along the tail and posterior attachment of the middle turbinate ap- proximately 0.5 cm from the anterior and inferior margin. The tail of the middle turbinate was elevated medially off the lateral nasal wall, and dissected mueoperiosteal flap was carefully separated until the SPF was fully exposed. With this approach, we identified and freed the peripheral branches of the sphenopalatine artery and PNN, and then observed their course character. Results After leaving SPF, the main trunk of the PNN were divided into 4 to 6 branches. Some nerve branches were accompanied by the sphenopalatine artery branches to form neurovascular bundles, while several nerve branches could also be identified independently of the blood vessels. The inferior turbi- nate branch of the PNN entered the inferior turbinate was together with artery branch, and the branches of the nerve entering middle turbi- nate and nasal septum also ran along with blood vessels. The independent branches of the PNN mainly innervated the middle turbinate and the superior portion of inferior turbinate, while several small peripheral branches entered the posterior portion of inferior turbinate and nasopharynx. Moreover, 1 to 2 neural bundles passing through the individual bone canals could be identified in 4 sides＇ specimens, which were distributed in the posterior nasal cavities. These bone canals were located behind and below the SPF, where from the edge of the SPF 2.6 to 8.3 mm （4.23 a- 0.56） ram. Conclusion PNN has multiple branches that mainly enter the inferior turbinate, middle turbinate and nasal septum.

关 键 词：鼻后神经 蝶腭动脉 蝶腭孔 解剖 内镜 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]