颞肌瓣鼻颅底区转位的解剖

Anatomy of transposition of the temporalis muscle flap for skull base reconstruction

目的探讨颞肌瓣的显微和内镜解剖,为使用颞肌瓣(TMF)进行内镜下颅底重建提供解剖学资料。方法在6例共12侧新鲜灌注的头颅标本上进行颞肌瓣的解剖,测量颞肌瓣的长度和宽度,显露颞肌瓣的血供;将获取的颞肌瓣经颞下窝、上颌窦路径转位至鼻颅底区进行颅底重建,分析其所能覆盖的颅底区域。结果获取的颞肌瓣平均长度为(11.7±0.7)cm,宽度为(9.2±0.8)cm。颞肌瓣经颞下窝、上颌窦路径可有效地转位至鼻颅底区,覆盖前颅底、鞍区和斜坡区。结论将颞肌瓣经颞下窝、上颌窦径路转位至鼻颅底区进行有效的颅底重建,在内镜颅底手术后的颅底重建方面具有较好的应用前景。

Objective To investigate surgical anatomy of transposition of the temporalis muscle flap(TMF)for skull base reconstruction.Methods The dissection of the temporalis muscle flap was performed on six fresh cadaver heads(12 sides).The temporalis muscle was harvested through a traditional open approach.The length and width of the temporalis muscle flap were measured and the arterial supply of the temporalis muscle flap was also exposed.The temporalis muscle flap was transposed into the maxillary sinus and nasal cavity through the infratemporal fossa by an endoscopic transnasal transmaxillary approach.The simulate operation that the temporalis muscle flap was used to reconstruct the skull base defects was performed on six fresh cadaver heads.Results The length of the temporalis muscle flap harvested from temporal line to the tip of the coronoid process of the mandible was(11.7±0.7)cm.Maximum width of the flap was(9.2±0.8)cm.The temporalis muscle flap could reconstruct the defects of cranial skull base,sellar and clivus.Conclusion Transposition of the temporalis muscle flap via the infratemporal fossa is an alternative and effective method for reconstruct the skull base after the endoscopic surgery.