不同内镜手术入路对翼腭窝及颞下窝的显露程度比较及其临床应用价值探讨

目的应用不同的内镜手术入路解剖翼腭窝及颞下窝,比较内镜下各手术入路的显露范围,为恰当选择内镜手术入路处理翼腭窝及颞下窝病变提供解剖学方面的依据。方法 4具8侧成人尸头标本,0°内镜引导下分别采取上颌窦后壁入路、扩大上颌窦后壁入路、鼻腔外侧壁入路、揭翻经上颌窦入路进行解剖学研究,观测各手术入路的有效显露范围。结果上颌窦后壁入路能显露翼腭窝上部和颞下窝内侧区深部;扩大上颌窦后壁入路在以上手术入路的基础上进一步显露翼腭窝下部;鼻腔外侧壁入路再进一步显露整个上颌窦和上颌窦底壁平面以上的颞下窝内外侧区;揭翻经上颌窦入路则能更进一步显露整个颞下窝。结论不同的内镜手术入路对翼腭窝及颞下窝的显露程度各不相同,以此为基础选择相应的手术入路处理不同范围的翼腭窝及颞下窝病变将有利于充分显露和有效切除病变,并尽可能避免不必要的手术损伤和并发症。

Different endoscopic surgical approaches to the pterygopalatine fossa and infratemporal fossa: anatomic study and clinical evaluation

Objective To provide anatomic evidences for appropriate selection of the endoscopic surgical approaches to manage the lesions of the pterygopalatine fossa and infratemporal fossa via dissection of these areas and comparison of the exposure ranges.Methods Eight sides of four cadaveric heads were dissected under 0° endoscope.Transnasal transmaxillary（TTM） approach,extended transnasal transmaxillary（ETTM） approach,nasal lateral wall dissection（NLWD） approach,and extranasal maxillary sinus（EMS） approach were used and their exposure ranges were evaluated.Results The TTM approach offered a good view on the superior part of the pterygopalatine fossa and deep part of the medial area of the infratemporal fossa.The ETTM approach provided a good view on above mentioned anatomic structures with additional exposure of the inferior part of the pterygopalatine fossa.The NLWD approach not only provided an excellent view on the regions as the same as the EITT approach,but also provided a good view on the whole maxillary sinus and medial and lateral areas of the infratemporal fossa above the plane of the inferior wall of the maxillary sinus.EMS approach could further expose the whole infratemporal fossa.Conclusion The exposure of the pterygopalatine fossa and infratemporal fossa varied with different endoscopic approaches.Therefore,the endoscopic surgical approaches should be tailored to different lesions of pterygopalatine fossa and infratemporal fossa,both to optimize the exposure and removal of the lesion and to minimize the traumatism of the anatomic structures.