鼻内镜下处理翼腭窝病变的应用解剖

Applied anatomy for management of pterygopalatine fossa lesions via endoscopic transnasal approach

目的:为鼻内镜下行翼腭窝区手术防止伤及窝内结构提供解剖学资料。方法:用手术显微镜对15具成人头颅标本按照鼻内镜下中鼻道经腭进路,中鼻道经上颌窦进路和中鼻甲切除进路要求进行显微解剖,观察不同手术进路暴露翼腭窝的范围。解剖20例(40侧)干性颅骨标本并测量相关解剖学数据。结果:3种手术进路对翼腭窝内结构都有不同的暴露。圆孔距前鼻棘的距离平均为(61.86±3.67)mm,圆孔上缘距眶上裂内下端的距离平均为(3.56±0.75)mm,圆孔上缘距视神经管下端的距离平均为(11.23±1.24)mm。结论:3种手术进路能有效地处理不同的翼腭窝病变;圆孔可以作为手术中安全范围标志。

Objective：To provide anatomic data for management of pterygopalatine fossa lesions via endoscopic transnasal approach. Methods： Fifteen （30 sides） formalin-preserved human skulls were subjected to microsurgical dissection to evaluate the exposure scopes of 3 different endoscopic surgery approaches： endonasal middle meatal transpalatine approach, endonasal middle meatal transantral approach, and endonasal inferior turbinectomy transantral approach. Meanwhile, 20 （40 sides） dry skulls were dissected and the related measurements were obtained. Results： The 3 approaches allowed for different exposure of the pterygopalatine fossa structure. The mean distances from foramen rotundum to anterior nasal spur, superior orbital fissure, and optic canal were （61.86±3.67）mm,（3. 56±0. 75） mm,and （11.23±1.24） mm, respectively. Conclusion： The 3 endoscopic approaches are safe and effective for resection of different pterygopalatine fossa lesions and foramen rotundum serves as a landmark for safe management of the pterygopalatine fossa.