经单侧鼻孔-蝶窦入路手术的解剖标志观察

目的:探讨经单侧鼻孔-蝶窦入路手术中具有导向价值的一系列解剖学标志。方法:在148例显微手术中,观察相关的重要解剖结构,分析它们在手术导向中的定位价值。结果:中鼻甲、上鼻甲、蝶窦粘膜开口、后鼻孔、蝶窦前壁轮廓、鼻中隔骨部与软骨交接区、蝶窦前壁骨质形态特征、蝶窦前壁的滋养动脉、蝶窦分隔、鞍底隆起等均是手术径路上的重要"路标",其形态均有一定变异,但总体方位大体一致,它们组成了经鼻蝶手术的路线图。结论:找到蝶窦口是准确进入蝶窦的金标准,经鼻中隔粘骨膜间隙进路时所见的"船头"征是导向蝶窦骨性开口的重要标志,探测蝶骨平板的方位可以辅助确定不太隆起的鞍底。准确识别、合理运用标志性解剖结构,可以使手术更为微创化。     

窦口鼻道复合体解剖变异与前组鼻窦炎的关系

目的研究窦口鼻道复合体解剖变异,探讨其与前组鼻窦炎的关系。方法分析754例患者的鼻窦冠状CT,从中分出正常组227例,前组鼻窦炎组527例。统计这两组中Haller气房、中鼻甲气化、反常曲线中鼻甲、直形中鼻甲、钩突气化、钩突反向弯曲、钩突上端分叉七种解剖变异的发生率,并分析其与前组鼻窦炎的相关性。结果Haller气房、直形中鼻甲、钩突反向弯曲、钩突上端分叉在正常组与前组鼻窦炎组间发生率有显著性差异(P<0.05);中鼻甲气化、反常曲线中鼻甲、钩突气化在这两组中的发生率差异无显著性(P>0.05),但中鼻甲气化中的泡性中鼻甲在两组中的发生率有显著性差异(P<0.05)。结论Haller气房、直形中鼻甲、钩突反向弯曲、钩突上端分叉、中鼻甲气化中的气泡中鼻甲与前组鼻窦炎的发病有关。     

内镜经鼻入路视神经管和眼眶的解剖学

目的通过研究对视神经管和眼眶的解剖研究,为内镜经鼻入路视神经管减压和治疗眼眶内病变提供解剖基础。方法国人尸头5例,采用大体解剖和内镜下经鼻入路两种方法,观察重要的解剖标志;使用内直肌内移技术,观察视神经管和眼眶内结构的暴露情况以及重要结构的位置、毗邻、走行等。结果钩突位于中鼻甲的前下方;筛泡在钩突的后方,切开筛泡可进入筛窦;筛前后动脉是筛窦内的重要解剖标志;视神经管隆突、颈内动脉隆突和视神经管颈内动脉隆突(OCR)是蝶窦内重要的解剖标志;纸样板位于筛窦的外侧壁,切开纸样板可暴露眶内容物;在眶内,可从内直肌与下直肌之间的通路暴露视神经。在本次10侧标本中,9侧眼动脉起自于颈内动脉的床突上段;1侧眼动脉起自于颈内动脉海绵窦段。7侧眼动脉在视神经管内走行于视神经的下外侧;2侧走行于视神经的正下方;1侧走行于视神经的下内侧。结论内镜下经鼻入路可以进行视神经管和眼眶内侧部分的暴露。钩突、筛泡、筛前后动脉及后组筛窦是本入路重要解剖标志。视神经管隆突、颈内动脉隆突及视神经管颈内动脉隆突(OCR)是进行视神经管减压的重要标志。眼动脉及其眼眶内分支、筛前后动脉和颈内动脉是重要的血管结构。眼内直肌内移技术可以有助于暴露眶内解剖结构。     

A new approach to the classification of maxillary sinus hypoplasia with relevant clinical implications

The purpose of this study was to discover the prevalence of maxillary sinus hypoplasia (MSH) and associated malformations. A total of 490 consecutive axial and coronal computerized tomographic (CT) scans of the paranasal sinuses were obtained from patients with chronic sinusitis. CT scans were assessed for the presence of MSH and associated anatomic variations. A new classification of MSH was made, and the diagnostic criteria listed. The frequency of anatomic variations coexisting with MSH was also estimated. MSH was encountered in 21 (4.2%) of the 490 patients. Unilateral types I, II and III MSH were seen in 7 (1.4%), 6 (1.2%) and 8 (1.6%) respectively. MSH was bilateral only in 3 (0.6%) patients, one of which was a bilateral type II. In the remaining two bilateral MSH cases, there was a type II MSH on one side and type III MSH on the other in each patient. Middle conchal pneumatization was the most common coexisting anatomic anomaly in MSH, followed by agger nasi cell, secondary middle concha,paradoxical middle concha and superior conchal pneumatization. A patient with MSH should be carefully evaluated prior to any sinus surgery in order to avoid surgical complications. With precise CT assessments, an MSH can be diagnosed and distinguished from other maxillary sinus anomalies. With the additional criterion of orbital enlargement, and the help of reproducible measurement techniques explained in this study, an objective diagnosis and classification can be made in further investigations of MSH.     

A new approach to the classification of maxillary sinus hypoplasia with relevant clinical implications

The purpose of this study was to discover the prevalence of maxillary sinus hypoplasia (MSH) and associated malformations. A total of 490 consecutive axial and coronal computerized tomographic (CT) scans of the paranasal sinuses were obtained from patients with chronic sinusitis. CT scans were assessed for the presence of MSH and associated anatomic variations. A new classification of MSH was made, and the diagnostic criteria listed. The frequency of anatomic variations coexisting with MSH was also estimated. MSH was encountered in 21 (4.2%) of the 490 patients. Unilateral types I, II and III MSH were seen in 7 (1.4%), 6 (1.2%) and 8 (1.6%) respectively. MSH was bilateral only in 3 (0.6%) patients, one of which was a bilateral type II. In the remaining two bilateral MSH cases, there was a type II MSH on one side and type III MSH on the other in each patient. Middle conchal pneumatization was the most common coexisting anatomic anomaly in MSH, followed by agger nasi cell, secondary middle concha, paradoxical middle concha and superior conchal pneumatization. A patient with MSH should be carefully evaluated prior to any sinus surgery in order to avoid surgical complications. With precise CT assessments, an MSH can be diagnosed and distinguished from other maxillary sinus anomalies. With the additional criterion of orbital enlargement, and the help of reproducible measurement techniques explained in this study, an objective diagnosis and classification can be made in further investigations of MSH.     

The pterygopalatine recess of the superior nasal meatus

The pneumatizations surrounding the pterygopalatine fossa (PPF) and closely related to the sphenopalatine foramen are anatomically variable. During the assessment of a cone beam computed tomography of a 64-year-old male patient, we found bilaterally a previously unreported anatomic variant. This was represented by a lateral or pterygopalatine recess (PPR) of the superior nasal meatus which extended in the anterior wall of the PPF and protruded within the maxillary sinus to determine a maxillary bulla. The PPR was antero-superior to the sphenopalatine foramen. Additionally were found a right nasal septal deviation, seemingly compensated by a left middle concha bullosa and a left prominent ethmoidal bulla. The superior turbinates were also pneumatized. Such anatomic variants related to the pterygopalatine angle of the maxillary sinus should be explored prior to surgical or endoscopic procedures which target the maxillary sinus, the pterygopalatine fossa, or the skull base.     

鼻内镜下泪囊鼻腔吻合术的解剖学基础

目的为提高内镜下泪囊鼻腔吻合术的有效率和减少并发症提供解剖学基础。方法 15具(30侧)头颈部标本经双侧颈总动脉灌注红色乳胶,在国产手术显微镜下进行解剖,1具保留骨骼的头颈部血管铸型标本。结果①外鼻的动脉:分布到外鼻的动脉非常丰富,主要有鼻背动脉、鼻外侧动脉、鼻翼动脉、鼻翼下缘动脉及上唇动脉的分支等,且在鼻端处它们之间形成非常丰富的吻合;②鼻中隔动脉:鼻中隔血供属多源性,主要来自鼻后中隔动脉上支、下支,筛前?筛后动脉,筛前、筛后动脉主要分布于鼻中隔上部;③鼻腔外侧壁的动脉:蝶腭动脉大多(90%)在蝶腭孔处已分为鼻后外侧动脉和鼻后中隔动脉,鼻后外侧动脉发出下鼻甲动脉和中鼻甲动脉;下鼻甲动脉沿途分支分布于下鼻甲及下鼻道,且有分支与中鼻甲动脉吻合。结论本文结果对鼻内镜下泪囊鼻腔吻合术具有参考价值。     

窦口鼻道复合体解剖异常与慢性鼻窦炎的相关性研究

为了探讨窦口鼻道复合体解剖异常与慢性鼻窦炎的关系，作者对７３例慢性鼻窦炎患者采用鼻窦部薄层（２ｍｍ）ＣＴ冠状面扫描及重建放大处理，显示鼻腔侧壁，尤其是窦口鼻道复合体的结构，并与２３例正常人的对照组比较。发现７３例鼻窦炎患者中窦口鼻道复合体存在解剖异常：中鼻甲卷曲肥大２６例，中隔高位偏曲（〉１２度）２８例，钩突弯曲肥大１６例，Ｈａｌｌｏｒ’ｓ气房３例；而正常组未见解剖异常。而且鼻窦炎组钩突与上颌窦外     

视神经管手术入路断层与应用解剖学研究

目的为开展视神经管新型手术提供精细的解剖学基础。方法在大体解剖学研究基础上,应用改进的火棉胶包埋技术对前颅底区域进行连续的三维薄切片,通过两者的有机结合,深入研究视神经管区域精细的解剖结构与复杂的毗邻关系。结果对视神经管区域解剖结构与毗邻关系显示良好精确。中鼻甲根部上缘至视神经管距离左侧为(28.0±5.0)mm,右侧为(29.0±6.0)mm。蝶窦下壁厚度左侧为(3.0±0.9)mm,右侧为(2.7±0.9)mm,视神经管与蝶窦或(和)筛窦间壁厚度左侧为(1.0±0.3)mm,右侧为(1.0±0.4)mm。结论经鼻、蝶窦或(和)筛窦入路行视神经管手术安全可行。     

窦口鼻道复合体的应用解剖

目的：确定窦口鼻道复合体的境界，为临床在内窥镜下施行上颌窦手术提供解剖学依据。方法：在６０例成人鼻腔外侧壁的标本上，测量半月裂、钩突、筛泡、额鼻管和筛漏斗的有关数据。并观察了它们相互间的关系以及上颌窦的自然开口。结果：半月裂、钩突、筛泡、额鼻管的长度分别为１５．０ｍｍ，１８．３ｍｍ，１６．２ｍｍ和５．９ｍｍ；钩突与筛泡的高度分别为６．９ｍｍ和５．８ｍｍ；筛漏斗宽３．９ｍｍ、深３．７ｍｍ。上颌窦自然开口９８％在半月裂内，其中６０％位于半月裂后部、３３％位于中部、５％位于前部、１例变异。结论：窦口鼻道复合体的形态和病变与鼻窦炎的发病有直接联系     

额窦开口的临床应用解剖学研究

目的：探讨额窦开口部位,为鼻内镜下额窦开放手术提供解剖学基础。方法：成人颅骨100例、尸头30例,观察额窦开口部位,测量额窦矢状径、额骨的内侧骨板和眶部骨板的厚度、额窦口距筛前动脉管的距离。结果：100例成人颅骨有8侧额窦未发育,占4．0％;额窦开口于额隐窝者92侧（47．9％）,开口于筛漏斗者52侧（27．1％）,开口于筛漏斗上隐窝者40侧（20．8％）;额窦的矢状径为（12．16±7．62）mm;额窦口与筛前动脉管的距离平均为（3．40±2．32）mm。30例湿性尸头额窦矢状位观测,发现有3侧额窦末发育,占5．0％;额窦开口于额隐窝者27侧（47．4％）,开口于筛漏斗者17侧（29．8％）,开151于筛漏斗上隐窝者12侧（21．1％）;中鼻甲前下附着点至额窦开口的距离为（11．74±2．60）mm。结论：熟悉额窦开口部位及周围毗邻结构的解剖,可减少额窦开放手术中并发症的发生。     

鼻腔外侧壁相关结构的解剖研究及其临床意义

目的　研究鼻腔外侧壁重要解剖结构的显微外科解剖关系,为临床手术治疗相关疾病提供解剖学依据。 方法 成人尸头标本15例（30侧）,采用手术显微镜及鼻内镜观察鼻腔外侧壁相关解剖结构。 结果 蝶腭动脉是供应鼻腔外侧壁的主要动脉,经过蝶腭孔时分为鼻后外侧动脉及鼻中隔后动脉两支。80%（24侧）鼻后外侧动脉从蝶腭动脉下方发出,20%（6侧）从蝶腭动脉上方发出,分出处位于筛骨嵴后方。鼻中隔后动脉有86.7%（26侧）在蝶窦前下壁分为上、下两支,13.3%（4侧）在进入鼻中隔后分为上、下2支。上颌窦开口位于中鼻道半月裂孔内,66.7%（20侧）开口位于半月裂孔中1/3段,30%（9侧）位于半月裂孔后1/3段,3.3%（1侧）开口于上鼻道,86.7%（26侧）上颌窦内口高于眶底水平。鼻囟门平均大小为（14.81±4.28）mm（前后径）×（9.71±1.43）mm（上下径）。 结论 蝶腭动脉及其分支和鼻囟门是鼻腔外侧壁手术中重要的解剖标志,熟悉其解剖关系有助于有效安全地开展鼻内镜手术。     

Variations of the uncinate process of the lateral nasal wall with clinical implications

The morphology of the uncinate process (UP) and nasal fontanelle is described in 119 human specimens, which were examined both before and after removal of the mucosa. Forms of the UP are classified and based on which site the process is articulated, and each form is characterized in relation to the endonasal endoscopic operative technique. Type I: The infero-posterior tip of the UP is articulated to the inferior concha (turbinate). This was the most frequently observed type. Subtype I-b: The UP adhered to the inferior concha along the antero-inferior margin. The anterior nasal fontanelle was closed by the UP adhesion; therefore, special attention is required not to damage the lacrimal bone. Type N: The tip of the UP had no articulation and made a free edge. It reduces the bony resistance at surgery. Type S: The tip articulated to the superior structures, such as the bulla ethmoid, medial orbital wall, tegument of the maxillary sinus, and basal area of the ethmoid sinus. These structures are known as high-risk areas of endonasal surgery (Levine, 1993). Type P: The tip articulated with the perpendicular plate of the palatine bone. The UP was prolonged posteriorly. Attention should be paid to the sphenopalatine artery, which goes through the posterior edge of the middle concha. Four additional variations (combinations of the above basic types, Variations IS, IP, SP, and ISP) were also observed. Clin. Anat. 11:295–303, 1998. © 1998 Wiley-Liss, Inc.     

Chronic sinusitis among pediatric patients with chronic respiratory complaints

We examined the prevalence of chronic sinusitis among children who presented to allergy clinics with chronic ( 3 months) respiratory symptoms. Ninety-one patients, ranging from 2 to 17 years of age with 62% male and 72% white, completed the study. Fifty-nine percent of patients had positive skin test results, and 25.3% had chronic asthma. Paranasal sinuses were examined by coronal sinus computed tomographic scan. Sixty-three percent (58 of 91) had chronic sinusitis, 5.5% (5 of 91) had concha bullosa, 1% (1 of 91) had foreign body, and 19% (19 of 91) had deviated nasal septums. Among symptoms of sneezing nasal congestion, postnasal drip, coughing, wheezing rhinorrhea, and headache, no single symptom was an acceptable predictor o f abnormality on computed tomographic scan examinations. Combining the symptoms of moderate to severe rhinorrhea and cough with minimum sneezing had a specificity of 95 % and a sensitivity of 38% in predicting the presence of chronic sinusitis. Allergic rhinitis (p = 0.27), mild deviated nasal septum (p = 0.11), unobstructive concha bullosa (p = 0.13), and passive exposure to cigarette smoke (p = 0.53) were not risk factors associated with sinus abnormalities. Age (r = 0.30, p = 0.004) in pediatric patients with chronic respiratory symptoms was the single risk factor significantly associated with abnormalities on sinus computed tomographic scan. Seventy-three percent of children 2 to 6 years of age, 74% of children 6 to 10 years of age, and 38% of children older than 10 had chronic sinusitis. Chronic sinusitis is common among pediatric patients with chronic respiratory symptoms. Because the clinical symptoms are not acceptably sensitive, imaging studies of the sinus such as a Waters' view roentgenogram should be considered as part of an allergy evaluation, especially in a high-risk group o f patients from 2 to 10 years of age.     

神经内镜扩大经鼻入路中的几个重要解剖标志及其临床意义

目的　观察扩大经鼻手术入路中的几个重要解剖标志,为经鼻颅底外科手术入路方案的制定提供形态学依据。 方法　对10 例尸头标本进行扩大经鼻入路神经内镜解剖, 操作方法为双鼻孔入路,颅底开放范围包括后组筛窦、蝶窦及中上斜坡,外侧完整暴露两侧颈内动脉海绵窦\斜坡段。 结果　确认了筛前、筛后动脉的正常解剖位置,探明了视神经-颈内动脉隐窝(OCR)的解剖构成,内镜下观察重新对海绵窦进行解剖分区,并从经鼻内镜视角对展神经进行解剖分段。 结论　熟悉上述经鼻入路重要解剖标记,对于提高该手术入路的有效性及安全性具有重要意义。     

经鼻内镜颅底手术的常用路径及解剖学标志

目的:探讨鼻内镜颅底手术适应范围、常用路径及其解剖标志.方法:复习相关文献,对经鼻内镜颅底手术各种入路及相关解剖标志的研究成果加以分析、总结.结果:鼻内镜颅底手术常用入路有经鼻中隔旁入路、经中鼻道入路及经中鼻甲切除入路3种,入路涉及的重要解剖学标志有筛前动脉、筛后动脉、中鼻甲、筛窦、蝶骨翼突、蝶筛隐窝、视神经-颈内静脉隐窝及球形鞍底.结论:熟练掌握鼻内镜颅底常用路径及其解剖标志,能够提高手术质量,减少并发症的发生.     

筛动脉筛窦段的鼻内窥镜手术相关解剖

目的：研究筛动脉在筛窦内的走行特点,为减少鼻内窦镜手术并发症提供解剖指导。方法：通过３０具湿性成人尸头（男１９,女１１）的解疲、观察了筛动脉在筛窦段的走行部位、方向、骨管厚度及其与筛窦气房的关系。结果（１）筛前动脉与中鼻甲基板的位置关系密切,多走行于中鼻甲基板之前的紧邻筛房顶（６６．６）及中甲基板顶（２６．７％）;筛后动脉则以位于最后筛房顶最为多见（６４．９％）;（２）筛前、后动脉骨管的下壁明显薄