成人颅骨标本翼腭窝的CT表现

目的　在CT上测量翼腭窝的有关径值和孔距 ,并探讨翼腭窝的形态。方法　对 2 0个干颅上左右两侧的翼腭窝行CT横断与冠状扫描 ,测量并观察翼腭窝各扫描层面的有关径线和形态 ,对所得结果行统计学分析。结果　CT横断面上 ,翼腭窝上 1/ 4主要为凸面向后的双弧形 (88% ) ,其前后径与内外径最大值为 (6 .6± 2 .2 )mm和 (13 .7± 3.7)mm ;中 1/ 4主要表现为凸面相对的双弧形 (6 7% ) ,前后径与内外径最大值为 (6 .6± 2 .1)mm和 (12 .1± 2 .7)mm ;下 1/ 2全部表现为管形 ,直径为 (3.8± 1.7)mm。冠状面上翼腭窝上 1/ 4和中 1/ 4主要表现为斜的倒梯形(6 0 % ) ,余 40 %表现为斜的四边形 ,下 1/ 2全部表现为管形。圆孔位于眶下裂下方 (5 .2± 2 .3)mm处 ,翼管在圆孔内侧 (7.4± 2 .5 )mm和下方 (6 .2± 4.2 )mm。结论　翼腭窝形态多变 ,在不同层面可见到双弧形、波浪状、直弧形、弧直形、管形以及斜的倒梯形和斜的四边形 ;CT上采用合适窗宽和窗位 ,可对翼腭窝进行有关测量 ;根据所测翼腭窝各孔、裂间距 ,可推测病变是否侵犯以上孔隙     

颌内动脉翼腭段的应用解剖及其临床意义

目的:通过对翼腭窝颌内动脉及其分支的显微解剖研究,为颌面外科和颅底外科提供形态学资料。方法:以外侧颞下入路对12具成人湿颅标本行双侧翼腭窝显微解剖,观察颌内动脉及其分支走行、毗邻关系,并测量相关数据。结果:颌内动脉翼腭段依其走行,可分为4型:Y型(20.8%)、T型(25.0%)、中间型(37.5%)和M型(16.7%),其分支走行变异常见;翼上颌裂下界距上牙槽后孔、眶下裂切迹和腭降动脉分别为15.5、32.0mm和24.7mm。眶下裂孔位置恒定,其至圆孔和视神经管颅口间的平均距离分别是13.34mm和23.13mm。结论:经外侧翼腭窝手术时,可借助翼上颌裂确认颌内动脉第3段及其分支的相对位置,通过眶下裂孔辨认圆孔和视神经管,以获得相对安全的手术界面。     

翼腭窝的解剖学特点及其相关技术进展

翼腭窝是位于眶尖后下方、颞下窝内侧的一个狭小骨性间隙,窝内有丰富的血管、重要的神经等结构通过,众多起源于口鼻腔、眶内、颅中窝、颞下窝和鼻旁窦的病变均可累及此窝。本文总结了近年来翼腭窝的解剖学及其相关临床诊疗技术的研究进展。     

翼腭窝肿瘤手术方法的改良

目的:对改良Borbosa手术进路在原发或继发性翼腭窝肿瘤处理的疗效评价。方法：在Borbosa手术切口的基础上，把口内上颌结节的切口经翼下颌韧带外侧向下达磨牙后区，然后向前达尖牙处以更好地暴露翼腭窝。对利用该手术进路治疗原发性或继发性翼腭窝肿瘤患者9例进行了影像学检查分析。结果：9例患者中4例肿瘤原发于翼腭窝，其中2例继发性地侵犯上颌窦；2例肿瘤原发于上颌骨；2例原发于腮腺深叶；1例为颅外脑膜瘤。9例均进行了术后3个月～9年6个月的追踪，其中1例术后2年2个月复发。结论：改良的Borbosa手术进路对翼腭窝肿瘤或翼腭窝肿瘤扩展进入上颌窦是特别有用的。     

关于翼腭窝CT图象之我见

关于翼腭窝ＣＴ图象之我见朱光第翼腭窝是颌面深部的重要结构，系位于上颌骨和翼突之间的三角形狭窄间隙；其内侧壁为腭骨的垂直板，前壁为上颌骨体的后面，后壁为翼突根部的前面，外侧经翼上颌裂与颞下窝交通。ＣＴ扫描可清晰地显示此窝。作者见到国内文献著述对翼腭窝的...     

翼腭窝神经阻滞麻醉的临床应用

通过对60个成人整颅、120个翼腭窝进行测量.发现翼腭窝有三种类型:第一种为锥体型,有63个(52.5%);第二种为窄隙型,有20个(16.7%);第三种为中间型,有37个(30.8%).自行设计了两个体表定位点即.颧骨点、眶外下点.测出了两点至翼腭窝内侧壁和后壁的距离.从临床麻醉需要提出了两种新的上颌神经和封闭翼腭神经节的麻醉方法,临床应用315例,完成口腔颌面部大中手术219例.结果显示:有效率295例(93.65%),显效20例(6.35%),无效0.笔者认为该方法在应用中,具有效果良好易掌握,无污染等优点.     

翼腭窝及翼腭窝邻近结构中良、恶性肿瘤的诊断与外科处理

翼腭窝区域的手术因为位置深在、解剖结构复杂,使得发生在该区域的肿瘤切除具有巨大的挑战性。当翼腭窝的肿瘤累及上颌骨、进入上颌窦,腮腺深叶的肿瘤扩展进入翼腭窝时,广泛的切除通常是必要的。随着影像学、病理诊断学、外科技术、手术器械和重建技术的进步,颅底外科已成为多学科外科医师关注的热点。本文就翼腭窝及翼腭窝邻近结构中良、恶性肿瘤的诊断与外科处理进行系统的论述。     

颞肌在翼腭窝肿瘤侵犯软硬腭术后缺损修复中的应用

目的评价翼腭窝肿瘤侵犯硬软腭术后组织缺损颞肌修复重建的效果。方法在1998年2月-2003年1月5年，共有11例患者接受手术治疗。11例患者中，男8例，女3例。年龄31—68岁，平均49．6岁。11例患者均为翼腭窝肿瘤侵及硬软腭者，手术均采用改良Barbosa联合侧颞部切口进路摘除肿瘤，术中遗留的硬、软腭缺损采用患侧前和中颞肌瓣修复。结果11例患者中，粘液表皮样癌4例，腺样囊性癌3例，骨肉瘤1例，低分化腺瘤2例，成釉细胞瘤1例。硬软腭缺损面积为30～50％，术后创面均一期愈合，肌瓣无坏死，4周后肌瓣口腔面粘膜化。术后患者进食与术前无差异，腭咽闭合无影响。结论使用颞肌瓣修复翼腭窝肿瘤侵犯硬、软腭术后缺损是一种有效的好方法。     

翼腭窝原发肿瘤的CT诊断探讨（附4例报告）

翼腭窝原发肿瘤的ＣＴ诊断探讨（附４例报告）广州军区广州总医院口腔科朱光第，汪维健翼胯窝原发肿瘤的文献报告不多。我们对４例手术证实翼跨窝受累的鼻咽部血管性肿瘤进行ＣＴ资料分析，就ＤＬｆｆｉ肿瘤的原发部位问题进行初步探讨。ｌ病例报告例１，男，门岁。右鼻塞...     

肝癌翼腭窝转移1例

大约50％～64％肝癌有肝外转移，但口腔颌面部转移少见，肝癌口腔颌面部转移常多见于下颌骨，翼腭窝转移极其少见。现将诊治的1例肝癌翼腭窝转移报告如下：     

The clinical anatomy of the maxillary artery in the pterygopalatine fossa.

PURPOSE: The purposes of this study were to delineate the maxillary artery and its branching arteries and to develop a classification of the various branching patterns by means of serial cadaver dissections of the pterygopalatine fossa region. MATERIALS AND METHODS: Fifteen Korean adult cadavers were used; 2 sides of each cadaver were examined, for a total of 30 sides. Before dissection of the pterygopalatine region, computed tomography scan was taken of 20 cadaver heads. Sectioned specimens of 9 sides of the cadaver heads in 3.0-mm thickness were made for this study. Then we dissected 21 sides of fresh cadavers under the microscope. In this investigation, we observed branching patterns of the third portion of the maxillary artery, a relationship of the terminal branches of the maxillary artery to the pterygomaxillary junction, and the course of descending palatine artery. Then we classified the branching patterns of the maxillary artery in the pterygopalatine fossa. RESULTS: From the pterygomaxillary junction to the pterygopalatine fossa region, the maxillary artery was usually branched into 5 arteries in the following order: posterior superior alveolar artery, infraorbital artery, artery of the pterygoid canal, descending palatine artery, and sphenopalatine artery. Of 21 cadavers, 18 showed this order (85.7%). There were 2 types of branching patterns of the posterior superior alveolar artery and the infraorbital artery. The average distance from the most inferior point of the pterygomaxillary junction to the posterosuperior alveolar artery, infraorbital artery, and descending palatine artery was 15.2, 32.2, and 24.8 mm, respectively. In most cases (95.2%), the greater and lesser palatine arteries were divided from the short descending palatine artery. According to the contours of the third portion of the maxillary artery, we classified them into 5 types: the "Y" type (19%), "intermediate" type (33.3%), "T" type (23.8%), and "M" type (14.3%). CONCLUSION: The results of this investigation show the common patterns of the maxillary artery.     

侵犯翼腭窝、颞下窝肿物的内镜手术入路选择

目的 探讨在侵犯翼腭窝、颞下窝肿瘤中选择内镜手术入路,为根据肿瘤性质和侵犯程度选择手术入路提供依据。方法 回顾分析第四军医大学西京医院2010年1月—2014年8月收治的50例侵犯翼腭窝或颞下窝并行内镜切除手术的肿瘤患者的临床资料,所有患者术前均行CT和MRI检查,根据肿瘤侵犯的方式和性质制定手术方案,选择手术入路。术后常规随访及影像学检查。重点评估不同入路的显露范围,安全手术的可能性,肿物全切率,以及术中、术后并发症。结果 经内镜手术治疗侵犯翼腭窝、颞下窝肿瘤50例,其中恶性肿瘤11例,包括腺样囊性癌5例,恶性成釉细胞瘤2例,软骨肉瘤2例,神经纤维肉瘤1例,恶性神经鞘膜瘤1例;良性肿瘤31例,鼻咽纤维血管瘤24例,神经鞘瘤5例,脊索瘤2例;囊肿8例,其中牙源性囊肿5例,表皮样或皮样囊肿3例。根据肿物侵犯范围,采用3种内镜下手术入路。内镜下经鼻腔入路27例,其中经中鼻道20例,经泪前隐窝7例;内镜下经柯-陆上颌窦入路9例;内镜下经鼻联合经柯-陆上颌窦入路14例。所有手术均能彻底切除肿物。随访时间6~55个月,平均34.3个月,3例失访,3例恶性肿瘤出现复发和远处转移。良性肿瘤和囊肿均无复发。结论 翼腭窝、颞下窝肿瘤在临床上并不少见,根据肿物的生物学特点、侵犯方式和范围选择恰当的手术入路,可以切除病变,降低并发症,减少手术创伤。     

Vascular changes in the pterygopalatine fossa after craniofacial dysjunction surgery.

A study was undertaken to determine vascular changes and the timing of these changes after craniofacial dysjunction surgery. Ten adult male Macaca cynomulgus monkeys were studied with techniques using angiograms and vascular vinyl cast preparations before and after unilateral Le Fort III osteotomy. After surgical disruption of the maxillary artery, the flow of blood was initially maintained by anastomotic branches of the ipsilateral internal carotid artery. Stepwise reconstruction of the disrupted maxillary artery took place via numerous collateral vessels that bridged the site of disruption; continuity of the artery was nearly normal by five weeks.     

Le Fort I型截骨相关的翼腭管解剖研究

目的　研究翼腭管的解剖及其与周围结构的关系 ,为临床LeFortI型截骨手术提供指导。方法　对 30具国人头颅标本进行测量分析。结果　在LeFortI型截骨水平 ,上颌窦内侧壁从犁状孔边缘至翼腭管的平均距离是 35 2 5mm。颧牙槽嵴至翼腭管 2 5 41mm ,翼腭管至中线 16 6 8mm ,犁状孔边缘至中线的距离是 13 87mm ,骨性鼻中隔长度是 46 2 7mm。犁状孔边缘至翼腭管连线与矢状面的夹角为 6°14′。结论　本结果对LeFortI型截骨时上颌后区的解剖提供了数据 ,为避免损伤腭降动脉提供安全的指导     

Surgical anatomy & pathology of the popliteal fossa

The requirement to use the posterior approach to the knee is uncommon, and many orthopaedic surgeons may not be familiar with the surgical anatomy. However, it is relatively common for a candidate in final professional examinations to be asked to describe the posterior approach to the knee joint, with reference to the relationship of major vessels and nerves. This article will cover the anatomy of the posterior knee and popliteal fossa, the surgical approach used and the common pathologies encountered in the posterior knee and popliteal fossa.     

虚拟仿真系统在口腔实验教学中的应用

口腔实验教学中采用计算机虚拟仿真技术,通过虚拟仿真操作进行训练,运用实时感知的三维立体界面,允许学生对其交互仿真操作,调动学生学习的积极性和主动性,让学生反复操练,提高诊疗操作能力。优化学生实习前培训,加强学生理论知识学习和实践操作的有机结合。本文将对虚拟仿真系统在口腔实验教学中的应用现状作一分析。     

Image features of aspergillosis arising from the pterygopalatine fossa: a case report and literature review

Aspergillosis of the skull base is an unusual disease entity, mainly found in immunocompromised patients. Aspergillosis originating in the pterygopalatine fossa (PPF) without contiguous spread from the sinuses is extremely rare. A 79-year-old woman complained of having suffered pain in her left cheek and headaches for 4 months. Computed tomography (CT) scans revealed soft tissue filling the left PPF with sclerotic change and erosion of the adjacent bone. A follow-up CT scan 1 month later after supportive care showed an increase in the extent of the soft tissue lesion in the left PPF with progressive erosion of the posterior wall of the left maxillary sinus. Magnetic resonance imaging revealed a low-signal-intensity mass in the PPF on T2-weighted images; the mass displayed strong enhancement on contrast-enhanced T1-weighted images and extended into the left maxillary sinus, infratemporal fossa, and cavernous sinus. The patient underwent a Caldwell-Luc operation with debridement of the PPF; the histopathological diagnosis was aspergillosis. The patient eventually died from cerebral ischemic change and brain edema during the postoperative period.