咽腭肌应用解剖学研究

The applied anatomic study of palatopharyngeus muscle

目的 为进一步认识咽腭肌的解剖学形态及腭裂的咽腭肌瓣手术对该肌的影响而进行此应用解剖学研究。方法 对正常成人新鲜尸体头颈部固定标本 17例 ,正常及唇腭裂新生儿新鲜尸体头颈部固定标本各 4例进行解剖学观察。对 6例胎儿头颈部标本进行组织学连续切片观察。结果 咽腭肌起于咽部 ,止于软腭。肌腹位于咽腭弓 ,成人长 (2 7 5 8± 6 73)mm ,截面积 (34 1±10 5 )mm2 。该肌血供主要来源于咽升动脉和扁桃体动脉 ,其次为腭升动脉和舌背动脉 ,呈多源性和节段性。该肌神经支配来源于咽丛神经分支 ,在硬腭水平下 15mm以内均有神经分支进入该肌。结论 咽腭肌是咽侧壁及软腭的主要肌肉之一 ,是咽腭肌瓣的良好供区。其血供呈现多源性和节段性。咽腭肌瓣咽成形术对该肌血供及神经支配造成一定的影响 ,应在手术中予以注意。

Objective The aim of this investigation was to examine the anatomic basis of palatopharyngeus and clinical implications for sphincter pharyngoplasty. Methods Detailed dissections were performed on 17 sides of adult human head and neck specimens. The eight sides newborns' head and neck cadavers were also used in the study (4 normal and 4 cleft lip and palate). The observations of histologic serial sections were undertaken in six fetus haed and neck specimens on coronal,transverse and sagittal direction. Results The palatopharyngeus with three components of pharyngeal origins and two heads of velar insertions contributes the continuity between the velum and lateral pharyngeal wall and the bulk of muscle fibers were extended to the posterior tonsilar pillars with (27.58±6.73)mm length and (34.1±10.50)mm2 section area. The muscles were supplied dominantly from the branches of ascending pharyngeal artery and tonsilar artery and partly from the branches of ascending palatine artery and dorsal lingual artery . The muscles were innervated by the branches of pharyngeal plexus which foucs on the level 10 mm to 25 mm below the hard palate and at the level of 15mm below the hard palate there was at least one of the nerve branch entered the muscle. Conclusion The palatopharyngeus muscle is not only a major musculature of lateral pharyngeal wall but also an important portion of the soft palate,participating the middle and posterior velum,which means that the muscle may play a significant effect in the velar function and pharyngeal wall movements. It is also a good doner site for palatopharyngeus flap. The sphincter pharyngoplasty has some influence to the blood supply and innervation of the muscles,which may result to blood reversion and denervation for the distal component of palatopgaryngeal flap. ;