摘要
目的创建内镜下经上颌窦入路翼腭窝及颞下窝解剖模型,寻找内镜下咽旁间隙段颈内动脉的定位方法。方法对100例成人行鼻、颅底CT扫描并用Mimics软件进行三维重建;在重建模型上分别测量犁骨后缘中点至颈内动脉相关解剖标志的角度和距离。同时对6具尸头于鼻内镜下经上颌窦联合入路解剖翼腭窝和颞下窝,以咽鼓管为中心向外、向后逐步暴露并定位咽旁间隙段颈内动脉。结果犁骨后缘中点至破裂孔、颈动脉管外孔、颈静脉孔的角度平均值分别为72.0°、57.6°、54.1°,犁骨后缘中点至以上各孔的距离平均值分别为13.65、31.81、32.5 mm,蝶骨角棘与颈动脉管外口前界平均距离为5.92 mm。结论鼻内镜下经鼻联合上颌窦开窗入路能充分的暴露翼腭窝和颞下窝结构。犁骨后根、蝶骨翼突、蝶骨角棘、卵圆孔和茎突是颈内动脉相关颅底解剖的重要标志;蝶骨角棘、骨性咽鼓管口为颈动脉管外口前界的重要骨性标志,术中不超越该界限有助于减少损伤咽旁间隙段颈内动脉。
ObjectiveTo develop an endoscopic anatomic and surgical model of pterygopalatine fossa, infratemporal fossa via endonasalmaxillary approach, and to establish endoscopic methodology for localization of internal carotid artery in the parapharyngeal space.Methods100 normal adult heads （200 sides） were scanned by CT and reconstructed threedimensionally, and their anatomical data （such as distance from superior margin of choana narium to foreman lacerum） were measured and recorded. 12 pterygopalatine and infratemporal fossae were dissected in 6 adult cadaver heads in accordance with institutional protocols. Both the pterygopalatine and infratemporal fossae were accessed via transpterygoid approach, which included medial maxillectomy. Location of the internal carotid artery in parapharyngeal space was highlighted.ResultsThe mean distances from superior margin of choana narium to foreman lacerum, outer foreman of carotid artery and jugular foreman were 13.65 mm, 31.81 mm, 32.5 mm respectively, while the related angles were 72.0°,57.6°,54.1°. The alar spine of sphenoid bone and the Eustachian tube were the most important landmarks for the localization of the outer foreman of carotid artery, and the mean distance between them was 5.92（4.90-6.94） mm.ConclusionThe posterior margin of vomer, pterygoid process and alar spine of sphenoid bone, fossa ovale and styloid process are important marks in dissection of internal carotid artery related nasopharyngealskull base. The alar spine of sphenoid bone and the bone portion of the Eustachian tube are landmarks of anterior border of the outer foreman of carotid artery. These landmarks are essential to prevent surgical damage of the internal carotid artery.
出处
《中国耳鼻咽喉颅底外科杂志》
CAS
2013年第6期495-501,共7页
Chinese Journal of Otorhinolaryngology-skull Base Surgery
关键词
鼻内镜
颅底
手术
解剖
颈内动脉
Nasal endoscope
Skull base
Surgery
Anatomy
Internal carotid artery
