内镜经翼突及上颌窦前壁上咽旁间隙的解剖

Endoscopic transpterygoid transmaxillary approach to the upper parapharyngeal space

目的研究内镜下经翼突联合上颌窦前壁上咽旁间隙的解剖,为临床上内镜经鼻处理上咽旁间隙的病变提供解剖学标志。方法在新鲜头颅标本上进行内镜经翼突联合上颌窦前壁入路暴露上咽旁间隙,测量翼内板、翼外板与茎突之间的距离;测量蝶骨棘、翼外板与颈动脉管入口之间的距离。结果共完成10例(20侧)新鲜头颅标本的内镜下上咽旁间隙的解剖,翼内板与茎突之间的距离为(28.1±3.3) mm,翼外板后缘距离茎突的距离为(18.9±4.9) mm;翼外板与蝶骨大翼交界处距离颈内动脉管入口的距离为(14.1±3.7) mm,蝶骨棘位于颈动脉入口的前方为(6.7±1.5) mm。咽颅底筋膜、腭帆张肌和翼内肌是上咽旁间隙重要的软组织标志。结论内镜下经翼突联合上颌窦前壁入路处理上咽旁间隙病变中,可使用骨性标志翼外板根部和蝶骨棘协助定位颈动脉管外口,从而有助于咽旁段颈内动脉的定位。

Objective To present anatomical landmarks for endoscopic transpterygoid transmaxillary approach to the upper parapharyngeal space. Methods Anatomy of the upper parapharyngeal space using endoscopic endonasal transpterygoid transmaxillary approach was performed in cadaveric head. The distances between medial pterygoid plate,lateral pterygoid plate and styloid process were measured,respectively. The distances between lateral pterygoid plate,sphenoid spine and the entrance of carotid canal were also investigated. Results The dissection was performed in 10 fresh cadaver heads( 20 sides). The distance between medial pterygoid plate,lateral pterygoid plate and styloid process were( 28. 1±3. 3) mm and( 18. 9±4. 9) mm respectively. The distances between lateral pterygoid plate,sphenoid spine and the entrance of carotid canal were( 14. 1±3. 7) mm and( 6. 7± 1. 5) mm respectively. Pharyngobasilar fascia,medial pterygoid muscle and tensor veli palatini muscle were key landmarks of the upper parapharyngeal space. Conclusion The bone landmarks of lateral pterygoid plate and sphenoid spine are effective in identification of the entrance of carotid canal,which is helpful to locate the parapharyngeal segment of internal carotid artery.