鼻内镜手术颌内动脉翼腭段的应用解剖

Applied anatomy of the internal maxillary artery in pterygopalatine fossa under transnasal endoscopic surgery

目的:研究颌内动脉翼腭段的走行及分支规律,为经鼻内镜手术过程中合理处理颌内动脉提供解剖学依据。方法:10具去脑颅底骨正中裂开,显微镜下解剖蝶腭动脉,经鼻内镜上颌窦入路开放翼腭窝,暴露颌内动脉翼腭段所有分支,将上颌窦后、内壁交界的凹陷定义为A点,通过眶下孔的水平线与上颌窦前壁、后外侧壁交线相交于B点,上颌窦前壁、后外侧壁和底壁的交点为D点,BD连线的中点为C点,颌内动脉翼腭段发出的第一分支点为C′点,观察其分支及走行规律。结果:蝶窦口下缘到鼻后中隔上动脉的距离为(5.88±2.21)mm;C′点位于AC上13侧,占65%(13/20);位于AB上5侧,占25%(5/20);位于AD上1侧,占5%(1/20);高于AB1侧,占5%(1/20)。结论:熟悉颌内动脉的分支及走行对于治疗顽固性鼻出血和翼腭窝手术有重要意义;本实验中利用A、B、C、D点为参照点确定颌内动脉走行的方法,有助于内镜经鼻(上颌窦)手术中颌内动脉的定位及结扎处理。

Objective：To explore the rules about the pathway and branch patterns of the internal maxillary artery in pterygopalatine fossa, provide the anatomic basis for treating the internal maxillary artery during the transnasal endoscopic surgery. Method：Ten adult cadaveric skull base were dissected, the sphenopalatine artery and its branches were observed. The pterygopalatine fossa was opened through trans maxillary sinus endoscopic approach, all the branches of the internal maxillary artery in pterygopalatine fossa were exposed. The concave of the maxillary sinus posterior medial wall was defined as point A, the cross point of the horizontal line pass through the infraorbital foramen, the maxillary sinus anterior wall and posterior-lateral wall as point B, the cross point of the maxillary sinus anterior wall, floor and posterior-lateral wall as point D, the midpoint of BD as C, the C＇ denoted the first branch root of internal maxillary artery in pterygopalatine fossa. Observed the pterygopalatine segment of internal maxillary artery based on the marking points. Result： The distance between the sphenoid sinus os and the sphenopalatine fossa was（5.88±2.21 ）mm. The C＇ point locate on AC at 13 sides specimen, locate on AB at 5 sides specimen, locate on AC at 1 side specimen, higher than AB at 1 side specimen. Conclusion： Being familiar with the pathway and branch patterns of the internal maxillary artery in pterygopalatine fossa is important for treating the uncontrol epistaxis and endoscopic pterygopalatine fossa surgery, the rules described by A,B,C,D in our experiments will be helpful in ligation of internal maxillary artery during the endoscopic transnasal/maxillary-peterygopalatine fossa surgery.