眶上切迹指引下内镜经眶径路额窦手术的解剖学研究

Endoscopic transorbital frontal sinus surgery guided by supraorbital notch:An anatomical study

目的 探讨眶上切迹(孔)引导下内镜经眶径路额窦手术的解剖学径路。方法 50例干颅骨标本,观察眶上切迹(孔)的形态,测量其距面中线的距离;解剖5例(10侧)额窦发育良好的尸头标本,定位眶上切迹(孔)后行眶上缘皮肤切口,分离并保护眶上神经血管束,磨除部分眶顶壁骨质(额窦底壁)进入额窦,观察额窦暴露范围。结果 50例(100侧)颅骨标本中,表现为单个眶上切迹48侧(48%),单个眶上孔25侧(25%),表现为切迹与孔混合形式27侧(27%)。眶上切迹(孔)至面中线距离为(2.66±0.22)cm(95%CI:2.61~2.70 cm),右侧眶上切迹(孔)距面中线距离为(2.65±0.25)cm,左侧眶上切迹(孔)距面中线距离为(2.66±0.19)cm,双侧比较无统计学差异(t=0.17,P=0.86)。所有尸头标本均可准确定位眶上切迹(孔),眶上神经血管束保护良好,内镜下经眶磨除部分额窦底壁可顺利进入额窦,暴露范围向内侧达额窦中隔,向外侧达额窦外侧隐窝。结论 对于气化良好的额窦,以眶上切迹(孔)为指引的内镜经眶径路可以安全进入额窦,充分显露额窦腔。

OBJECTIVE Aimed to explore endoscopic transorbital frontal sinus approach using supraorbital notch(foramen) as anatomical landmarks.METHODS The topographical anatomy of supraorbital notch(foramen) in 50 dry skulls was studied and the distance from supraorbital notch(foramen) to the facial midline was measured.Five cadaveric head specimens(10 sides) were dissected.The supraorbital notch(foramen) was located and then an incision was performed medial to the supraorbital notch(foramen) in supraorbital margin.The supraorbital neurovascular bundle was identified and preserved.Part of the orbital roof(frontal sinus floor) was removed using diamond burr for providing adequate visualization and access of the frontal sinus.RESULTS Of the 50 skull specimens(100 sides),48 sides(48%) were present as a single supraorbital notch,25 sides(25%) as a single supraorbital foramen,and 27 sides(27%) showed a mixed form of notch and foramen.The average distance from the supraorbital notch(foramen) to the facial midline was (2.66±0.22)cm (95%CI:2.61-2.70 cm) with no statistical difference between the two sides(t=0.17,P=0.86).The supraorbital notch(foramen) could be accurately located in all cadaver head specimens.Endoscopic removing of part of the frontal sinus floor leaded to access into the frontal sinus and the supraorbital neurovascular bundle was preserved.The exposed area reached the medial septum and the lateral recess of the frontal sinus.CONCLUSIONEndoscopic transorbital approach guided by supraorbital notch(foraman) provides excellent and safe access to frontal sinus for accessing the frontal sinus boundary.