Le FortⅠ型截骨术与翼腭管周围解剖结构的关系

Posterior maxillary anatomy in relation to the Le Fort I osteotomy

目的 :研究LeFortⅠ型截骨术与其周围结构的关系。方法 :对 30例干燥人头颅标本及 5例成人尸头标本进行直接测量分析研究。结果 :翼上颌骨性融合占 10 % ;翼腭管内侧骨壁部分缺失占40 % ;上颌在LeFortⅠ型截骨水平上颌窦内侧壁从梨状孔边缘至翼腭管的平均距离是 35 .2 5mm ;翼腭管及梨状孔边缘至中线的距离分别是 16 .6 8mm、12 .87mm ;犁骨缘至翼上颌缝的距离为 40 .72mm ;鼻泪管开口至鼻底的距离 15 .98mm ;翼腭管长度为 17.34mm ;翼腭管从后向前下与腭平面的角度为 5 8°47′。骨性鼻中隔长度是 46 .2 7mm ;梨状孔边缘至翼腭管连线与矢状面所成的夹角为 6°14′ ;颌内动脉距牙龈缘的距离是 32 .2 5mm。结论 :本文结果可为临床医师行LeFortⅠ型截骨术避免损伤颌内动脉及分支腭降动脉提供安全指导。

Objective:The most co mmon site of heamorrhage in maxillary osteotomies is the posterior maxilla.Better understanding of the anatomy in this region may minimize possible vasular complications.The aim of the study is to investigate the anatomy of posterior maxilla and establish safty guidelines for the Le Fort I Osteotomy.Methods:Thirty dry human skulls and five cadavers were selected for direct measurement and computerized image analysis.Results:Results showed that synostosis of the pterygomaxillary junction was observed in 10%of the samples,and absence of interior wall of desending palatine canal was observed in 40% of the samples.The average distance from the piriform rim to the desending palatine canal was 35.25 mm;The average length from anterior nasal spine to the posterior nasal spine was 46.27 mm;The average distance from the piriform rim to the pterygomaxillary junction was 40.72 mm;and the angle between desending palatine canal and the palate plane was 58° 47’.The average length of the desending palatine canal was 17.60 mm.The average distance from the nasolcrimal canal opening to nasal base was 15.82 mm.The average distance from the desending palatine canal to central line was 16.68 mm.The average distance from the piriform rim to the central line was 12.87 mm.The angle between the line from the piriform rim to the desending palatine canal and the certral line was 6°14’ .The average distance from the most inferior point of the internal maxillary artery to the most inferior junction of the maxilla and pterygoid plate was 32.25 mm.Conclusion:The study provide understanding of the posterior maxillary anatomy in relation to the bone cut design of Le fort I osteotomy,and create clinically safe guidelines to avoid damaging the desending palatine vessels.