颏棘的解剖学形态与螺旋CT影像学形态的对比研究

目的探讨颏棘的解剖学测量值与螺旋CT影像学测量值的相关性。方法选取40具黄色人种成人尸头,男29具,女11具。先进行螺旋CT扫描,测量颏棘及其相关参数,然后对下颌骨及颏舌肌进行解剖,观察颏舌肌的起止点和走行,测量颏棘及其相关参数,所得到的数据应用SPSS100统计软件计算平均值及标准差(x±s),采用配对t检验和相关分析。结果颏舌肌几乎都起于上颏棘,颏舌骨肌起于下颏棘。颏棘及相关参数的解剖学测量和影像学测量值分别为上颏棘高度为(582±071)mm和(617±071)mm,宽度为(698±135)mm和(701±113)mm;颏下点至上颏棘下缘之间的距离为(1108±205)mm和(1041±155)mm;下中切牙根尖至上颏棘上缘的距离男性为(1557±182)mm和(1434±206)mm,女性为(936±279)mm和(878±253)mm;颏棘处下颌骨的厚度为(1195±159)mm和(1219±164)mm,颏下点至上颏棘上缘的距离为(1691±230)mm和(1573±212)mm。除上颏棘高度外,其他参数的解剖学测量与CT影像学测量显著相关(相关系数为059~092)。结论颏棘的螺旋CT扫描能够真实地反映其解剖学形态,可为颏前移术中骨切口的准确定位和个体化设计提供有益的参考。     

国产颏棘环钻系统行颏舌肌前移术

目的探讨国产颏棘环钻系统行颏舌肌前移术的可行性。方法2005年6月～8月对3例阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome,OSAHS）患者行悬雍垂腭咽成形术（uvulopalatopharyngoplasty,UPPP）,同时采用颏棘环钻系统（genial bone advancement trephinesystem,GBAT system）行颏舌肌前移术。结果颏棘环钻系统颏舌肌前移术的手术时间30分钟～1小时,术中未发生下前牙根尖损伤、颏神经损伤及下颔骨骨折等并发症,术后无口底血肿,伤口感染等。结论应用国产颏棘环钻系统行颏舌肌前移术具手术时间短、创伤小、操作容易等优点。     

颏舌肌前移舌骨悬吊联合悬雍垂腭咽成形术的初步应用

目的 探讨不使用环钻行颏舌肌前移舌骨悬吊术联合悬雍垂腭咽成形术(UPPP)治疗重度阻寒性睡眠呼吸暂停低通气综合征(OSAHS)的可行性及疗效.方法 2006年6月至2008年1月26例伴舌根肥厚、舌后间隙狭窄的中重度OSAHS患者接受本研究.按呼吸暂停低通气指数(AHI)分为中度(12例)和重度(14例)2组;根据Friedman分型,Ⅱ型18例,Ⅲ型8例.电子鼻咽喉镜检查及Muller试验检杳腭咽及舌咽狭窄.先行UPPP,同时一期采用线锯、胸科电锯、耳科电钻等非环钻技术行颏舌肌前移及舌骨悬吊术.结果 手术时间120～180 min,颏舌肌前移手术出血50～100 ml.术中和术后未出现严重并发症.术后1年随访,14例重度OSAHS患者AHI由术前的(42.9±6.6)次/h(x±s,下同)下降至(16.2±5.7)次/h,其中11例患者AHI下降大于等于50%,有效率71.4%.12例中度OSAHS患者AHI由术前的(21.3±4.4)次/h下降至(11.3±5.2)次/h,其中10例患者AHI下降大于等于50%,有效率83.3%.中、重度OSAHS患者术后AHI较术前均明显下降,而中度的有效率明显优于重度患者,差异均有统计学意义(P值均<0.01).结论 不使用环钻也可行颏舌肌前移舌骨悬吊术,联合UPPP治疗伴舌根肥厚、舌后间隙狭窄的中、重度OSAHS,手术创伤小,操作容易,不需要特殊器械,治疗效果好.     

与喉癌有关的颈淋巴结定位新的影像学分类

半个世纪以来 ,颈部淋巴结分类的主要标志仅仅是参照颈部触诊和术中发现 ,其不足之处日益显现。该文作者根据近 2 0年 CT和 MRI在头颈癌症患者中的应用经验 ,提出了新的影像学分类法 ,概括如下。 区 :淋巴结位于舌骨上、颏舌肌下及下颌下腺背侧前方。 区 A:淋巴结位于舌骨上与颏舌肌下方之间二腹肌前腹中部 (以前称颏下淋巴结 )。 区 B:淋巴结位于颈的左或右侧 ,IA区淋巴结侧面 ,下颌下腺背侧前方。 区 :淋巴结由颅底扩展至舌骨体底水平 ,位于下颌下腺后面及胸锁乳突肌后缘前方。 区 A:淋巴结位于颈内静脉前方、侧方、中间或后方 ,如果…     

慢性间歇性缺氧对颏舌肌的影响及脂联素干预的探讨

目的 探讨慢性间歇性缺氧(chronic intermittent hypoxia,CIH)对颏舌肌肌电、超微结构及血清脂联素水平的影响,并观察补充脂联素后有无干预效果.方法 健康雄性Wistar大鼠42只,随机数字表法分为健康对照组(A组)、慢性间歇性缺氧组(B组)和脂联素干预组(C组),每组14只.对B组、C组大鼠间歇缺氧(每日8 h,连续5周);同时C组大鼠给予注射用脂联素10μg/次,A组与B组给予无菌生理盐水0.5 ml/次,颈静脉注射,每周2次,持续5周.第5周末采用插入式双极针电极引导大鼠颏舌肌肌电,检测各组动物颏舌肌肌电电压基线及低氧刺激和低氧刺激终止后各时间段平均肌电电压;透射电镜观察颏舌肌肌细胞超微结构的改变.电生理检测后抽血检测脂联素水平.结果 B组大鼠的血清脂联素质量浓度(1226.0±112.0)ng/ml((-)x±s,下同)显著低于A组(2491.8±117.9)ng/ml,q=38.2,P<0.01;C组大鼠的血清脂联素质量浓度(1988.3±114.7)ng/ml较B组显著增高(q=23.0,P<0.01).在低氧刺激前的基线状态时,B组颏舌肌肌电电压水平明显低于A组和C组(P值均<0.01);低氧刺激5 min,A、B、C三组颏舌肌肌电电压较基线时明显增高(P值均<0.01),其增高幅度A组最高,B组最低,C组居中,差异均有统计学意义(P值均<0.01);低氧刺激终止后的15 min、30 min及45 min,A、C两组颏舌肌电压仍维持在较高的水平,显著高于B组(P值均<0.01).CIH还造成颏舌肌结构的变性,使B组大鼠肌原纤维结构紊乱,肌丝溶解、消失,线粒体水肿、嵴断裂,部分线粒体空泡改变或溶解消失,而脂联素注射组病理改变较轻.结论 CIH可引起颏舌肌病理改变及肌电活动下降,该变化可能与CIH所致的低脂联素血症有关.     

鼓岬区底转骨螺旋板的分段定位及其临床意义

目的:为耳蜗植入术提供耳蜗鼓岬区底转骨螺旋板的解剖资料,同时寻找从鼓岬表面定位骨螺旋板的方法.方法:取成人颞骨标本15例(30侧),经乳突后鼓室进路,进入鼓室;在手术放大镜下对鼓岬区骨螺旋板走行、分段及毗邻结构进行观测.结果:①耳蜗底转骨螺旋板在鼓岬区可通过位于蜗窗龛上缘及下部的转折点分成3段:钩段(1.52±0.16)mm,蜗窗前下段(3.83±0.37)mm和前行段(2.70±0.36)mm;②蜗窗前下段所在平面与面神经水平段成角为(51.00±5.97)°,且较恒定地与镫骨头后缘相交;以镫骨头后缘为一固定点,在鼓岬上画一经过此点与面神经水平段成51°的直线,可代表骨螺旋板蜗窗前下段在鼓岬上的投影,也即此段骨螺旋板在鼓岬上的投影线;③鼓岬区鼓阶宽度:蜗窗龛上缘中点处宽度为(0.36±0.06)mm;蜗窗龛前缘中点处宽度为(0.97±0.14)mm;蜗窗前下3 mm处宽度为(1.24±0.21)mm.结论:①鼓岬区骨螺旋板可通过2个转折点分成3段,即钩段、蜗窗前下段和前行段;②骨螺旋板在鼓岬上的投影线及与毗邻结构的距离可以为人工耳蜗植入术中准确定位鼓阶,避免损伤基底膜提供形态学依据.     

蝶腭孔的显微解剖学研究

目的 :通过对尸颅蝶腭孔的测量和观察 ,为经鼻内镜蝶腭孔相关手术提供解剖学依据。方法 :应用显微解剖学方法对 4 0侧正中线切开的尸颅蝶腭孔进行了位置、形状、大小及毗邻关系的观察与有关数据的测量。结果 :将蝶腭孔分成 3类 ,Ⅰ类 :孔位于上鼻甲、上鼻道的后方 ,Ⅱ类 :孔位于中鼻甲或中鼻道的后端 ,Ⅲ类 :Ⅰ类加Ⅱ类。各类分别占 35 %、5 %、6 0 %。孔上缘与蝶窦底间距离男 (1.75± 1.10 )mm ,女 (1.13± 0 .5 5 )mm ,与蝶窦口距离男 (9.80± 3.2 7)mm ,女 (8.30± 3.4 5 )mm ,孔的后缘与鼻咽部距离男 (11.12± 3.30 )mm ,女 (10 .85± 3.12 )mm ,孔的前缘与上颌窦口距离男 (18.5 0± 6 .‘80 )mm ,女 (14 .5 7± 5 .0 7)mm ,与鼻尖距离男 (6 9.5 4± 6 .98)mm ,女(6 6 .5 7± 5 .0 7)mm ,与前鼻棘距离男 (5 6 .6 9± 5 .70 )mm ,女 (5 3.2 5± 8.80 )mm ,以蝶腭孔中心点为准前后径女(4 .6 1± 1.80 )mm ,男 (5 .12± 2 .0 5 )mm ,上下径男 (5 .37± 2 .6 7)mm ,女 (4 .74± 2 .74 )mm ,与硬腭水平板的夹角男(2 2 .83± 4 .71)°,女 (2 2 .73± 3.81)°。蝶腭动脉外径男 (2 .12± 0 .6 6 )mm ,女 (1.6 1± 0 .70 )mm ,蝶腭神经外径男(0 .6 5± 0 .4 9)mm ,女 (0 .35± 0 .0 7)mm。鼻腔外侧壁的血供及     

颈部切割伤2例报告

1临床资料 例1男，65岁。自刎后半小时急诊入院。来诊时出现呼吸困难，在气管内插管全身麻醉下行气管低位切开术(解除呼吸困难)改善通气功能。探查伤口见颈前部喉结(甲状软骨)上方有一横切口，长约12cm，边缘齐。伤口较深，达食管前壁颈动脉前缘。胸骨舌骨肌、胸骨甲状肌等颈前肌群部分断裂，甲状软骨膜、甲状软骨上缘断裂，会厌、声带损伤，舌骨骨     

耳内镜手术相关面神经解剖

目的为安全实施耳内镜手术,避免面神经损伤提供解剖依据。方法对12例2 4侧成人尸头样本进行解剖,暴露面神经全程,对面神经进行相关解剖测量,从外耳道、鼓窦、迷路（乙状窦）后径路用耳内镜对面神经进行观察。结果所有标本均能通过上述径路在耳内镜下完整观察面神经全程,且清晰显露面神经隐窝以及咽鼓管鼓口周围结构。面神经垂直段恰位于骨迷路中轴线位置,面神经水平段介于外半规管和镫骨头之间;面神经鼓室段和上半规管顶、外半规管上缘距离分别为（8.59±1.75）mm和（3.83±1.11）mm,面神经乳突段距后半规管下缘距离为（3.13±1.53）mm;面神经乳突段和外耳道前、后壁距离分别为（10.50±1.91）mm和（3.8 5±0.9 9）mm;鼓索神经出外耳道后壁处和面神经鼓室段之间垂直距离为（2.2 1±0.7 6）mm,鼓索神经和面神经乳突段间夹角为2 7.3 0°±5.9 7°,内耳门外侧距乳突骨质表面水平距离为（33.82±2.80）mm,内耳门上缘距岩骨上缘距离为（4.96±1.40）mm。结论耳内镜可以清晰显示显微镜难以暴露的手术区域,能清晰分辨并避免损伤面神经,在耳显微外科有广阔的应用前景。     

颏下逆行带蒂岛状皮瓣的应用解剖研究

目的 为颏下逆行带蒂岛状皮瓣修复颜面部皮肤软组织缺损的可行性及手术操作提供解剖学依据.方法 解剖20例40侧福尔马林固定、颈总动脉灌注红色乳胶的成人头颈标本及4例灌注汞溴红、2例灌注亚甲蓝的新鲜成人头颈标本,测量相关动脉的外径及相关标志点之间的距离(以-x±s表示);观察两侧面动脉之间、面动脉与颞浅动脉及眼动脉终术之间的吻合情况,观察面动、静脉的行程要点及其与面神经各分支之间的位置关系,观察面静脉与相关静脉之间的吻合情况.结果 颏下动脉、上唇动脉、下唇动脉起点处的外径(-x±s,以下同)分别为(1.42±0.30)mm、(1.34±0.35)mm、(1.34±0.27)mm.下唇动脉起点至颏下动脉起点直线距离为(35.19±9.18)mm,实际距离为(50.13±13.79)mm;上唇动脉起点至颏下动脉起点直线距离为(64.99±5.24)mm,实际距离为(92.09±8.73)mm.双侧面动脉之间、面动脉与颞浅动脉及眼动脉终末之间有丰富的吻合.在下颌缘水平,面动、静脉相贴伴行,面神经下颌缘支跨过其浅面;在下颌缘水平以上,面静脉行于面动脉后外约1 cm处,面神经颊支经面静脉表面于面动、静脉之间人表情肌.面静脉通过内眦静脉与眼静脉、面深静脉与上颌静脉之间有良好的交通.结论 以颏下逆行带蒂岛状皮瓣修复颜面部皮肤软组织缺损在解剖上具有可行性,建议皮瓣的旋转点选择在口角或口角以下平面.     

The anatomical basis for mandibulotomy: midline versus paramidline

OBJECTIVE: To provide an anatomical basis for mandibulotomy. STUDY DESIGN: Prospective. METHODS: The angles between the long axis of the two mandibular central incisors and between the lateral incisor and canine and the corresponding root length were measured in panoramic films of 50 Taiwanese patients who had oral or oropharyngeal carcinomas. RESULTS: The angle and horizontal distance between the mandibular lateral incisor and canine were significantly wider than between the two central incisors. The root length of the canine measured 16 mm on average. CONCLUSIONS: Paramidline mandibulotomy, which cuts through a wider space between the lateral incisor and canine, preserves dentition and the genioglossus and geniohyoid muscles. It appears to be a more preferable approach than midline mandibulotomy.     

Anatomic relation between the external branch of the superior laryngeal nerve and the thyroid gland

AimThis prospective study investigated the anatomic relations between the external branch of the superior laryngeal nerve (EBSLN), the superior thyroid artery (STA) and the thyroid gland in human cadavers.Material and MethodsTwenty-two human cadavers aged over 18 years old, less than 24 hours after death.ResultsThe mean distance between the EBSLN and the superior pole of the thyroid gland was 7.68 ±3.07 mm. A tangent to the inferior edge of the thyroid cartilage between the EBSLN and the STA measured 4.24 ±2.67 mm. A line from the intersection of the EBSLN - related to the STA - to the superior pole of the thyroid gland measured 9.53 ±4.65 mm. A line from the EBSLN to the midline of the most caudal point of the thyroid cartilage measured 19.70 ±2.82 mm. A line from the RENLS to the midline on the most cranial point of the cricoid cartilage was 18.35 ±3.66 mm.ConclusionThere is a variable proximity relation between the EBSLN and the superior pole of the thyroid gland; this distance ranges from 3.25 to 15.75 mm. There was no evidence of significant variation between the measures in the ethnic groups comprising the sample.     

Morphometric study of the medial aspect of the human maxillary sinus with special reference to the nasal fontanelle

OBJECTIVE: The purpose of this study was to clarify configurations of the nasal fontanelle (NF) from the morphometrical point of view, especially variations of its four margins (anterior, posterior, superior, and inferior), for clinical application. METHODS: We used 136 sides of hemi-sectioned heads that were obtained from 119 donated Japanese cadavers (66 men and 53 women with an average age of 77.6+/-12.0). After mucosal examination, the specimens were boiled with a small amount of powdered soap and treated with protease. The residual mucous membrane was then gently removed. These specimens were originally made for our previous study describing variations of the uncinate process (Isobe M, Murakami G, Kataura A. Variations of the uncinate process of the lateral nasal wall with clinical implications, Clin. Anat. 1998;11:295-303). Different series of measurements were conducted based on surgical approaches and angles of observation. RESULTS: The superior margin of the NF is difficult to identify because the ethmoidal infundibulum, which leads the anterior end of the margin upward, often interrupts the superior margin. Because the inferior and posterior margins are modified by thin paper-like bony structures and because the anterior margin is disturbed by variations of the lacrimal bone and/or the inferior turbinate, they are also difficult to identify. Knowing these variables, we evaluated the NF morphometrically. The NF was located 12.6+/-4.3 mm posterior to the anterior nasal spine and 6.6+/-2.2 mm anterior to the sphenopalatine foramen. The size of the NF was 17.9+/-3.2 mm (anteroposterior axis) x 11.5+/-3.0 mm (inferosuperior axis). The lowest orbital floor was located 10 mm below the superior margin of the anterior NF (-10 mm), and the distance was therefore measured as -3.7+/-2.4 mm on average. Viewed from the maxillary sinus, the location of the NF varied along the anteroposterior axis, whereas it was located consistently at the most superior portion of the medial aspect of the sinus wall. CONCLUSION: During endoscopic sinus surgery for tumor resection in the maxillary sinus, a large and primary window should be prepared in the posterior NF, including partial removal of the uncinate process. Preparation of an additional window in the inferior meatus is preferable to enlargement of the primary window. Approaching the anterior NF should be avoided, if possible, due to its complicated configuration as well as its proximity to the orbital floor.     

Evaluation of safe surgical treatment of peritonsillar abscess using computed tomography

With the development of new antimicrobial agents, the incidence of peritonsillar abscess (PTA) is on the decline. PTA is still often encountered in general practice, however, where it requires immediate diagnosis and treatment. Because the internal carotid artery runs medially to the medial parapharyngeal space, damage to nearby vascular or other structures is a surgical risk of PTA. We used contrast computed tomography (CT) from PTA patients to investigate the anatomical relationship between the abscess and parapharyngeal space, and to determine safe surgical sites. We observed 31 patients with PTA--19 men and 12 women--between February 1997 and April 1999, all examined by contrast CT and undergoing drainage or incision. The average age was 30.7 years (range: 12-54 years). The abscess was on the right side in 20 cases and on the left side in 11. We determined the sites of the abscess and carotid artery, internal jugular vein, and surrounding soft tissue density area including nerves in the parapharyngeal space based on the angle and distance from recognizable anatomical structures in CT scans. The anterior margin of the parapharyngeal space was 29 +/- 5 mm posterior from the upper posterior alveolar margin. The medial margin of that space was at 15 +/- 2 degrees laterally from the midline of the incisors, and 24 +/- 4 mm laterally from the midline sagittal plane. The internal carotid artery was located medially to the parapharyngeal space, running on the sagittal plane containing the upper posterior alveolar margin. The distance from the anterior margin of the parapharyngeal space to the posterior wall of the PTA was 9 +/- 4 mm, and the distance to the anterior wall of the abscess (including the pharyngeal mucosa) was 31 +/- 5 cm. The relationship between the upper posterior alveolar margin and midline sagittal plane was useful for determining the site of the parapharyngeal space. Because the internal carotid artery is located on the same sagittal plane as the upper posterior alveolar margin, when conducting drainage or incision of PTA, we should advance sagittaLly from the point of incision to a depth of no more than 20 mm. If the tip of the instrument is kept medial to the sagittal plane of the upper posterior alveolar margin, effective treatment should be achievable without the risk of vascular damage.     

迷路下入路开放内耳道手术相关解剖结构的CT测量

目的　为临床上开展迷路下入路开放内耳道手术提供影像学参考信息。方法　选择40例（80侧）正常成人颞骨CT影像资料,对迷路下入路开放内耳道手术的相关解剖标志进行影像学测量。结果　后半规管下端到颈静脉球顶端之间的最短距离平均值为左侧（4.69±2.91）mm,右侧（3.10±3.01）mm,后半规管下部骨质厚度平均值左 侧（0.92±0.37）mm,右侧（0.69±0.37）mm,迷路下区面神经垂直段骨管和乙状窦骨板之间的最短距离平均值左侧（8.66±2.71）mm,右侧（7.74±1.99）mm,颈静脉球顶端到内耳道下界距离平均值左侧（6.32±2.88）mm,右侧（5.39±2.61）mm,颈静脉球顶端到单孔距离平均值左侧（6.82±3.02）mm,右侧（5.84±2.82）mm,前庭导水管开口到内耳门后缘的距离平均值为左侧（14.38±2.56）mm,右侧（14.12±2.76）mm,前庭导水管开口到内耳道中点的距离平均值为左侧（12.02±2.46）mm,右侧（11.91±2.53）mm。前3组测量值左右侧差异有统计学意义,后4组测量值左右侧差异无统计学意义。结论　术前行影像学测量能够为开展 迷路下入路开放内耳道手术提供有价值的信息。     

Computer-aided 3-D temporal bone anatomy for cochlear implant surgery

To define anatomical relationships important in cochlear implantation, computer-aided three-dimensional reconstruction and measurement of middle and inner ear structures in six normal temporal bones were performed. Our findings were as follows: 1. When viewed from the posterior hypotympanotomy (facial recess) approach, the inferior 10% to 30% of the round window (RW) membrane was visible in only half the cases. 2. The most inferior portion of the basal turn of the scala tympani was not only inferior but also slightly anteriorly behind the RW membrane in more than half the cases. 3. The shortest distances from the aperture of the RW niche and from the margin of the RW to the stapes head were 2.38 +/- 0.33 and 2.15 +/- 0.22 mm, respectively. 4. The distance between the RW and the most inferior portion of the basal turn scala tympani was 5.15 +/- 0.34 mm. 5. The direction of the electrode advancement lay at a sharp angle to the inferior part of the RW (mean 31.9 +/- 3.6 degrees). 6. The direction from the RW to the most inferior portion of the basal turn scala tympani lay 16.0 +/- 5.3 degrees anteroinferior to the direction of the advancement of the electrode to the RW. 7. The distance between the margin of the RW and the basilar membrane of the cochlea was 0.58 +/- 0.10 mm at the superior aspect of the RW, and was 1.23 +/- 0.12 mm at the lateral aspect of the RW. 8. Dissecting away less than 1 mm (mean 0.7 +/- 0.27 mm) of the RW margin inferiorly or inferolaterally was enough to permit straight insertion of the electrode in most cases.     

The effect of neuromuscular stimulation of the genioglossus on the hypopharyngeal airway

OBJECTIVES: To determine the effects of neuromuscular stimulation (NS) of the genioglossus muscle on hypopharyngeal airway size. STUDY DESIGN: Fourteen consecutively recruited healthy volunteers underwent percutaneous electrical NS of the genioglossus muscle. METHODS: Bipolar hooked wires were inserted percutaneously into the genioglossus muscle and used for NS. The anterior--posterior diameter of the hypopharynx was measured at the level of the superior edge of the epiglottis at baseline and during NS from recorded video endoscopic examinations. RESULTS: NS of the genioglossus muscle resulted in a significant increase in the diameter of the hypopharyngeal airway (P =.002) compared with baseline, ranging from a 33% to 284% increase in airway diameter. Three of the 14 patients demonstrated modest decreases in airway diameter, likely the result of faulty electrode placement in surrounding tongue retrusive muscles. CONCLUSIONS: NS of the genioglossus muscle was effective in increasing the hypopharyngeal airway and may provide a useful alternative to direct stimulation of the hypoglossal nerve with a nerve cuff electrode in the development of neuroprosthetic treatments for obstructive sleep apnea.