鼻腔外侧壁相关结构的解剖研究及其临床意义

Anatomic study and clinical significance of the lateral nasal wall

目的研究鼻腔外侧壁重要解剖结构的显微外科解剖关系,为临床手术治疗相关疾病提供解剖学依据。方法成人尸头标本15例(30侧),采用手术显微镜及鼻内镜观察鼻腔外侧壁相关解剖结构。结果蝶腭动脉是供应鼻腔外侧壁的主要动脉,经过蝶腭孔时分为鼻后外侧动脉及鼻中隔后动脉两支。80%(24侧)鼻后外侧动脉从蝶腭动脉下方发出,20%(6侧)从蝶腭动脉上方发出,分出处位于筛骨嵴后方。鼻中隔后动脉有86.7%(26侧)在蝶窦前下壁分为上、下两支,13.3%(4侧)在进入鼻中隔后分为上、下2支。上颌窦开口位于中鼻道半月裂孔内,66.7%(20侧)开口位于半月裂孔中1/3段,30%(9侧)位于半月裂孔后1/3段,3.3%(1侧)开口于上鼻道,86.7%(26侧)上颌窦内口高于眶底水平。鼻囟门平均大小为(14.81±4.28)mm(前后径)×(9.71±1.43)mm(上下径)。结论蝶腭动脉及其分支和鼻囟门是鼻腔外侧壁手术中重要的解剖标志,熟悉其解剖关系有助于有效安全地开展鼻内镜手术。

Objective To study the anatomical characteristics of several important structures in the human lateral nasal wall in order to offer anatomical evidence for surgical application. Methods Thirty sides of 15 adult cadaver heads were used. The relationship of the key structures in the lateral nasal wall was observed using microscope and endoscope. Results The sphenopalatine artery is the main blood supply of the lateral nasal wall. It divides into two major branches （the posterior lateral nasal artery and the septal artery） when passing through the sphenopalatine foramen. The posterior lateral nasal artery leaves the sphenopalatine artery by its inferior side in 24 cases （80%） and by its superior side in 6 cases （20%）. The location where the sphenopalatine artery branches is right behind the ethmoidal crest. The septal artery divides into two branches at the anteroinferior wall of the sphenoid sinus in 26 cases （86.7%） and after entering the nasal septum in 4 cases （13.3%）. The natural ostium of the maxillary sinus is at the hiatus semilunaris in the middle meatus, with 20 cases （66.7%） in the middle part of the hiatus semilunaris, 9 cases （30%） in the posterior part of the hiatus semilunaris and one case （3.3%） in the superior meatus. The superior margin of the ostium locates higher than the lowest orbital floor in 26 of 30 cases （86.7%）. The average size of the nasal fontanelle is （14.81±4.28）mm （anteroposterior axis） ×（9.71±1.43）mm （inferosuperior axis）. Conclusion The sphenopalatine artery and its branches, as well as the nasal fontanelle, are the key landmarks in the surgery relative to the lateral nasal wall. Better understanding of their anatomic relationships will guarantee efficacy and safety in endoscopic sinus surgery.