经泪前隐窝入路至翼腭窝和颞下窝的内镜解剖学研究

Study Endoscopic anatomical study of the prelacrimal recess approach to the pterygopalatine fossa and infratemporal fossa

目的探讨经泪前隐窝入路至翼腭窝、颞下窝的方法及相关解剖结构,为临床手术提供解剖学数据。方法采用8具成人头颅标本,通过神经内镜下模拟经泪前隐窝入路至翼腭窝、颞下窝进行逐层解剖,并测量和采集相关数据或图片,对神经内镜解剖过程中的不确定结构和数据,通过显微镜下模拟耳前颞下-颞下窝开放入路证实。结果8具尸头标本(16侧)的膜性鼻泪管位于上颌窦内壁的骨性鼻泪管内,开口于下鼻道,其长度为(14.3±3.6)mm,直径为(5.3±1.8)mm。眶下神经和眶下动脉在眶下裂处形成神经血管束,走行于上颌窦顶壁的眶下管内;颊神经自下颌神经分出后从翼外肌上、下头之间穿出,在颞肌与翼外肌之间向前走行并支配颊肌。结论经泪前隐窝入路至翼腭窝、颞下窝的关键为膜性鼻泪管的显露和保护;进行神经内镜手术时,眶下神经血管束可作为识别翼腭窝内结构的标志,颊神经可作为识别颞下窝内各肌肉的标志。

Objective To investigate the method and related anatomy of the endoscopic prelacrimal recess approach to the pterygopalatine fossa and infratemporal fossa and to provide anatomical data for clinical practice.Methods Eight adult cadaver heads(16 sides)were dissected through the endoscopic prelacrimal recess approach to the pterygopalatine fossa and infratemporal fossa and relevant data were measured and pictures were collected.The uncertain structures and data of endoscopic anatomy were confirmed by simulating the open approach of subtemporal infratemporal fossa under microscope.Results The nasolacrimal duct was located in the osseous nasolacrimal duct and open to the inferior meatus.Its length was 14.3±3.6 mm and diameter was 5.3±1.8 mm.The infraorbital nerve and the infraorbital artery formed the infraorbital neurovascular bundle at the infraorbital fissure and ran through the infraorbital canal in the top wall of the maxillary sinus.After the buccal nerve was separated from the mandibular nerve and it passed through the superior and inferior head of the lateral pterygoid muscle and travelled forward between the temporalis muscle and the lateral pterygoid muscle to innervate the buccal muscle.Conclusions The key to the prelacrimal recess approach to the pterygopalatine fossa and infratemporal fossa is the exposure and protection of the nasolacrimal duct.The infraorbital neurovascular bundle can be used as a landmark to identify the structure of the pterygopalatine fossa,and the buccal nerve can be used as a landmark to identify the muscles in the infratemporal fossa.