内镜下经鼻-口-眶联合径路单侧上颌骨全切术的解剖学研究  

Combined transnsasal transoral transorbital endoscopic approach for u nilateral total maxillectomy:An anatomical study

作　　者：王奎吉[1,2] 赵国强 王平 王成硕 张罗[1,2,3,4] WANG Kuiji;ZHAO Guoqiang;WANG Ping;WANG Chengshuo;ZHANG Luo(Department of Otolaryngology Head and Neck Surgery,Beijing Tongren Hospital,Capital Medical University,Beijing,100730,China;Beijing Laboratory of Allergic Diseases,Beijing Key Laboratory of Nasal Diseases,Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases,Chinese Academy of Medical Sciences,Beijing 100005,China;Beijing Institute of Otolaryngology,Beijing 100005,China;Department of Allergy,Beijing Tongren Hospital,Capital Medical University,Beijing,100730,China)

机构地区：[1]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科,北京100730 [2]过敏性疾病北京实验室,鼻病研究北京市重点实验室,中国医学科学院慢性鼻病诊疗策略研究创新单元,北京100005 [3]北京市耳鼻咽喉科研究所,北京100005 [4]首都医科大学附属北京同仁医院鼻过敏科,北京100730

出　　处：《中国耳鼻咽喉头颈外科》2022年第6期390-394,共5页Chinese Archives of Otolaryngology-Head and Neck Surgery

基　　金：国家杰出青年科学基金项目计划(82025010);教育部长江学者创新团队(IRT13082);中国医学科学院医学与健康科技创新工程项目资助(2019-I2M-5-022);北京市科技计划首都健康保障培育研究项目(Z181100001618002)。

摘　　要：目的探讨内镜下经鼻-口-眶联合径路单侧上颌骨全切术的解剖进路,明确进路中的解剖标志。方法10例干颅骨标本,观察上颌骨周围毗邻关系,定位上颌骨全切术中的截骨线;解剖5例(10侧)尸头标本,模拟内镜下经鼻-口-眶联合径路上颌骨全切术。结果内镜下经鼻-口-眶联合径路上颌骨全切术的主要步骤:①经鼻径路:经鼻行上颌窦内侧壁切除;②经口径路:唇龈沟切口,形成半侧面中掀翻进路,显露上颌骨前壁及后外侧壁,解剖上颌动脉,定位硬腭截骨线;③经眶径路:做外眦延长切口,骨膜下分离显露眶外侧壁及眶底壁,通过眶下裂定位显露颧弓和颧颌缝;④截骨:分别于上颌骨额突及鼻骨、颧弓、硬腭、上颌结节与翼突连接处四个区域截骨,完整切除上颌骨。结论内镜下经鼻-口-眶联合径路可以完整切除单侧上颌骨,避免传统入路大的面部切口,,该术式为上颌骨区域病变治疗提供新选择。OBJECTIVE Aimed to explore the anatomical approach of combined transnasal transoral transorbital endoscopic approach for total maxillectomy and identifying the important anatomical landmarks.METHODS Ten skull specimens were used to observe the adjacent relationship between the maxilla and the surrounding bone,and to locate the osteotomy line for total maxillectomy.Endoscopic dissection was performed in 5 cadaveric specimens(10 sides)to simulate the total maxillectomy by combined transnasal transoral transorbital approach.RESULTS The main steps of endoscopic total maxillectomy via combined trransnasal transoral trandsorbital approach were as follows:1.Transnasal approach:endoscopic resection of the medial wall of the maxillary sinus;2.Transoral approach:the procedure began with gingivobuccal sulcus and gingival sulcus incision and developed Hemifacial degloving approach to exposing the anterior and posterior lateral walls of the maxillary sinus,dissecting the maxillary artery and locating osteotomy line in hard palate;3.Transorbital approach:the skin incision was made in Outer canthus and extended laterally.The lateral and floor wall of the orbit were exposed and the zygomatic arch and zygomandibular suture were located with inferior orbital fissure.4.Osteotomy:osteotomy were performed in the frontal process of the maxilla and the nasal bone,the zygomandibular suture,the hard palate,the junction of the maxillary nodule and the pterygoid process before the whole maxilla bone was excised completely.CONCLUSION Combined transnasal transoral transorbital endoscopic approach allows complete resection of the maxilla and avoids large facial incisions.This approach provides new option for total maxillectomy dealing with maxilla lesions.

关 键 词：内窥镜检查 上颌骨 鼻窦肿瘤 解剖学 上颌骨全切术 

分 类 号：R739.62[医药卫生—肿瘤]