经鼻内镜翼腭窝和颞下窝应用解剖学研究

Endoscopic endonasal applied anatomy of pterygopalatine fossa and infratemporal fossa

目的探索经鼻内镜翼腭窝、颞下窝恒定的解剖标志,为手术处理该区域病变奠定基础。方法对11例尸头行鼻内镜侧颅底解剖学研究。经鼻内镜经中鼻道、蝶腭孔、上颌窦后壁入路,暴露翼腭窝及颞下窝的重要血管、神经及骨性解剖标志,并测量各解剖标志间的距离。结果经鼻内镜可恒定暴露蝶腭孔、翼管、圆孔、蝶腭神经节、眶下神经、卵圆孔、棘孔等重要侧颅底标志。鼻小柱基底到蝶腭孔、翼管、圆孔、卵圆孔、棘孔、破裂孔的距离分别为(69±3)、(73±3)、(75±3)、(90±5)、(96±4)、(88±3)mm。结论经鼻内镜可显露翼腭窝及颞下窝重要解剖结构,且各解剖结构可通过相互之间的距离及位置在鼻内镜二维平面上互相定位,以更直观、安全的处理该区域的病变。

OBJECTIVE To investigate the feasible endoscopic anatomic landmarks of pterygopalatine fossa（PPF）and infratemporal fossa（ITF）,and to pave the way for performing operations of lateral skull base successfully and safely.METHODS Eleven fixed cadaver heads were dissected to achieve endoscopic surgical landmarks.The important endoscopic landmarks of PPF and ITF were dissected via middle nasal meatus,sphenopalatine foramen（SF）and the posterior wall of maxillary sinus,and the distances were measured among those landmarks.RESULTS The endoscopic feasible landmarks of PPF and ITF included SF,vidian canal（VC）,infraorbit nerve,sphenopalatine ganglion,foramen ovale（FO）,oramen spinosum（FS）and so on.The distance from basilar part of nasal columella to SF,VC,FR,FO,FS,and FL were（69±3）,（73±3）,（75±3）,（90±5）,（96±4）,and（88±3）mm.CONCLUSION The important anatomic structures of PPF and ITF can be visualized clearly and comprehensively through an endoscopic endonasal view.We can deal with the lesions of this area safely and intuitively according to the location and distances of the anatomic landmarks.