颞下经下颌入路显露侧颅底区的应用解剖学研究

Applied anatomy of subtemporal transmandibular approach for lateral skull base exposure

目的研究颞下经下颌入路应用解剖,为术中保护重要结构提供解剖学参考。方法选用成人尸头10例(20侧),摹拟手术入路,解剖观察、测量相关结构,探求入路涉及的骨、肌肉和神经血管间的解剖关系。结果影响该入路暴露的主要结构包括面神经、腮腺、颧弓和下颌升支。颞下窝和翼腭窝血管神经丰富,茎突及其筋膜将咽旁间隙分为咽旁前和咽旁后间隙,后者容纳颈内静脉、颈内动脉和Ⅸ、Ⅹ、Ⅺ及Ⅻ对脑神经。结论颞下经下颌入路暴露充分,熟悉其应用解剖对手术治疗侧颅底区沟通性肿瘤具有重要意义。

Objective To explore the applied anatomy of the subtemporal t ransmandibular approach and provide an advisable anatomic reference for protecti on of vital structures. Methods Ten adult cadaveric specimens(20 sides)were obs erved and measured by imitating operations through the subtemporal transmandibul ar approach. Dissections were performed to emphasize the relationships between b one, muscles, and neurovascular structures in the surgical region. Results The main obstacles encountered in this approach were the zygomatic arch, the parotid gland, the facial nerve, and the ascending ramus of the mandible. Infratemporal fossa and pterygopalatine fossa exhibited complicated microanatomical structure s. Parapharyngeal space was divided into preparapharyngeal and retroparapharynge al space by styloid process and fascias.There were internal carotid artery,jugul ar vein and the Ⅸ,Ⅹ,Ⅺ,Ⅻ cranial nerves in the latter space. Conclusion The subtemporal transmandibular approach has good exposure and the applied anatomy for this approach, and it has an important significance for surgical operation o f communicative tumors in lateral skull base.