中鼻道上颌窦内窥镜开窗术相关的断层解剖研究及临床意义

An Sectional Anatomical Study of Maxillary Sinus Nasal Meatus Middle Endoscopic Fenestration and Its Clinical Significance

目的为上颌窦内窥镜开窗术提供相关断层解剖学参数。方法对30个(60侧)成人干性颅骨标本进行切片,10个行矢状面切片,10个行水平面切片,10个行冠状面切片。观察上颌窦口的形态,测量上颌窦口及其毗邻结构的相关数据,并对所得结果进行统计学分析。结果①矢状面上,上颌窦口位于上颌窦的内侧壁,为不规则的四边形。上颌窦口最高点高于或平行于通过眶底最低处的水平面;在矢状位上,80%(16/20)上颌窦口与眶底板同处一垂面。钩突位于鼻泪管后内侧,其游离缘中上部距鼻泪管后壁较近,平均值为3.3mm左右;②水平面上,骨性上颌窦口的前后径为18.24±2.28mm;其前界与鼻泪管后壁的距离为2.96±0.87mm,鼻泪管后壁的厚度为0.24±0.13mm。③冠状面上,上颌窦口的上下径为10.64±2.48mm,上颌窦口上界至眶下壁与上颌窦内壁交界处的距离为3.12±0.63mm,眶下壁的厚度为2.12±0.83mm.结论骨性上颌窦口与眶底和骨性鼻泪管后壁关系密切,内窥镜下中鼻道行上颌窦开窗,扩大窦口的安全方向为向下和向后,向前向上咬除至骨质时应当停止,避免损伤眶底和鼻泪管等并发症的发生。

Objective To provide sectional anatomy mutuality parameter for maxillary sinus endoscopic fenestration. Methods 30 dry skull species （60 sides） were sliced, 10 skull were sliced in sagittal plane, 10 in horizontal plane, and 10 in coronal plane. Mnrphnlogy and Ginical Observation of the ostiuro of maxillary sinus, ostiuro of maxillary sinus and its adjacent structures were measured, the results of the test were analysis by statistics, results①On sagittal plane, ostium of maxillary sinus like irregular quadrilaterals was located on the medial wall of maxillary sinus. The highest point of the ostium of maxillary sinus was either higher or parallal the horizontal plane of the lowest point of the orbital floor; ostium of maxillary sinus and orbital lamina situated at the same level was 80%. Uncinate Process located at the posteromedial of the nasolacrimal duct. The average distance from the upper part of the margin of the Uncinate Process to the posterior wall of the of the nasolacrimal duct was 3.3 mm; ②On horizontal plane, anteroposterior diameter of bony ostium of maxillary sinus was 18.24 ± 2.28 mm, the distance from its anterior boundary to posterior wall of nasolaerimal duct was 2.96 ± 0.87 nun, the thickness of the posterior wall of nasolacrimal duct was 0.24 ± 0.13 ram. ③On coronal plane, the vertical height of the ostiuro of maxillary sinus was 10.64±2.48 taro, the distance of the superior Doundary of the ostiuro of maxillary sinus to the junction of the orbital floor wall and the medialwall of the maxillary sinus was 3.12± 0.63mm,the thicness of the orbital floor wall was 2.12 ± 0.83mm. Conclusion There are intimate relationships among the Lony ostium of maxillary sinus, the orbital floor and nasolacrimal duct, Fenestration Operation of maxillary sinus Under Endoscopein Middle Meatus, the safty direction of ostium enlarge were downward and backwards, stoped when reach the Lone upwards, Avoiding Complications like injury of orbital floor wall or nasolacrimal duct.