鼻内镜手术相关的骨性翼腭窝临床应用解剖

The clinical anatomy of bony pterygopalatine fossa related with endoscopic surgery

目的:为鼻内镜颅底外科提供翼腭窝解剖学基础。方法:15例30侧成人干颅骨标本,观察翼腭窝的形态、组成以及与周围结构的关系;测量翼上颌裂缘翼突根部至颧弓下缘中点的距离;翼上颌裂宽度与长度,蝶腭孔形态、其前缘到前鼻棘的距离,在鼻内镜下观察蝶腭孔与翼管前口形态。结果:翼腭窝通过7个孔道与周围相通。翼上颌裂翼突根部至颧弓下缘中点的距离为(33.6±6.0)mm。蝶腭孔70.0%(21侧)位于中鼻甲后端的上方,30.0%(9侧)被中鼻甲分为上下两部分,未见蝶腭孔在中鼻甲水平以下者。经鼻内镜下咬除上颌窦骨性开口后份腭骨垂直部以及上颌窦后壁内侧骨质,可窥见翼腭窝全貌。结论:翼腭窝解剖结构复杂,鼻内镜下可以显露完整翼腭窝,有助于对翼腭窝立体结构的认识。

Objective： To provide anatomic data of bony structures of pterygopalatine fossa for skull base surgery under the endoscope. Methods： The bony structures of the pterygopalatine fossa were observed on 15 dry skulls, The shape and construction of pterygopalatine fossa and its relationship with adjacent structures were analyzed. Some related measurements were made. Results： The pterygopalatine fossa showed a long and narrow cleft with seven paths communicating with nasal cavity, mouth cavity, pharynx, orbit, infratemporal fossa and middle cranial fossa, The distances from pterygomaxillary fissures to the beneath midpoints of the zagmatic arch were 33.6±6.0 mm. 70% of sphenopalatine foramen lay on the posterior extremity of the middle turbinate, 30% were separated to two parts by the middle turbinate and no were under the middle turbinate. With endoscope, the pterygopalatine fossa could be observed as a whole. Conclusions： The data of our study could be regarded as the important anatomical parameters for the operation in pterygopalatine fossa adopting endoscopic transnasal surgery.