鼻-翼腭窝神经鞘瘤

目的通过对鼻一翼腭窝区域神经鞘瘤的临床病例回顾,探讨该部位神经鞘瘤的临床诊断及治疗策略。方法回顾性分析5个鼻一翼腭窝区域神经鞘瘤的临床病例资料,并列举其主要的临床表现、辅助检查、治疗方法和预后情况。结果5例神经鞘瘤分别位于上领窦（1例）、蝶窦（1例）,鼻腔（1例）、鼻中隔（1例）及翼腭窝（1例）。临床表现多由肿物的局部压迫所引起,包括眼眶深部隐痛、鼻塞、清水涕、嗅觉减退、额顶部头昏和头痛等。查体可见鼻腔神经鞘瘤呈灰白色,质软,表面光滑。神经鞘瘤在C1上主要表现为软组织密度影,并且伴有不同程度的周围骨质破坏,在MR此的的特点主要是T1wI呈等信号,T2wI呈不均匀稍高信号。5个病例均行手术切除治疗。5个病例的术后病理中HE染色的特点主要为梭形细胞肿瘤。术后随访中无1例患者出现复发,总体预后良好。结论鼻一翼腭窝神经鞘瘤临床表现较为隐蔽,影像学表现与其他类型肿瘤不易区分,因此直接诊断困难,需结合术后病理。手术为其主要治疗方式,并且总体预后良好。     

内镜下翼腭窝肿瘤手术进展

翼腭窝(pterygopalatine fossa,PPF)是位于颅底交界处眶尖后下方的狭长骨性间隙,由蝶骨体、蝶骨翼突、腭骨垂直板与上颌骨体围成,是头颈交界区颅底的重要结构,位置深在、空间狭小、解剖关系复杂,分别与     

腭鞘管、翼管与岩骨段颈内动脉的内镜手术应用解剖与进展

近年来,国外内镜下围绕着翼腭窝及颈内动脉区病变的内镜手术逐渐开展,对翼腭窝及其通道腭鞘管、翼管区的解剖研究亦不断深入。国内相关学者内镜下经鼻入路岩尖、颈内动脉区、斜坡及颅颈交界区解剖和临床应用解剖研究极少报道,究其原因,主要还是因为该区域重要解剖结构复杂而多变异,缺乏可以信赖的恒定的解剖标记,导致内镜颅底手术进展缓慢。内镜手术中,定向、定位障碍是耳鼻喉科医生和神经外科医生面临的最大风险^[1]。     

鼻内镜下经鼻径路解剖翼腭窝区临床观察

目的 研究鼻内镜下经鼻径路观察翼腭窝区的临床解剖特点, 以期为手术提供参考。方法 5例(10侧)成人尸头标本经乳胶灌注后, 在0°鼻内镜下分别经蝶腭孔和上颌窦后壁两种手术径路显露翼腭窝, 再开放蝶窦, 充分暴露视神经、颈内动脉及蝶窦外侧壁相关结构, 观察各解剖结构的三维立体关系。结果 不同手术径路显露翼腭窝的范围不同, 祛除上颌窦内侧壁后能最大程度显露翼腭窝内所有解剖结构, 开放蝶窦后能观察翼腭窝与蝶窦区域相关结构的解剖关系。结论 只要熟悉鼻内镜下翼腭窝及邻近区域的解剖结构及关系, 选择合适的病例, 鼻内镜下经鼻行翼腭窝区手术是安全可行的。     

鼻内镜下颌内动脉翼腭段应用解剖及其意义

目的通过鼻内镜经鼻腔入路对颌内动脉翼腭段及其周围区域的解剖学研究,为临床鼻内镜下颌内动脉翼腭段区域手术提供解剖学基础。方法对10具(20侧)新鲜尸头经鼻内镜下鼻腔外侧壁入路对侧颅底翼腭窝区域进行解剖学观测,正中矢状锯开标本观测内镜下解剖标志及颌内动脉翼腭段分支变异及邻近血管神经结构。结果①颌内动脉翼腭窝段变异较大,颌内动脉翼腭段按顺序发出分支占25%(5/20),眶下动脉和上牙槽后动脉共干发出占50%(10/20),分别由颌内动脉发出占40%(8/20);颌内动脉同时发出眶下动脉、腭降动脉、蝶腭动脉占10%(2/20);眶下动脉和腭降动脉共干发出占10%(2/20);翼管动脉和圆孔动脉分别由颌内动脉发出及共干发出各占50%(10/20);②鼻内镜下能够较好的控制颌内动脉及其分支,对周围结构触动少。结论掌握颌内动脉翼腭段及其周围区域的解剖可降低鼻内镜下该区域手术的并发症,对于翼腭窝手术及治疗顽固性鼻出血有重要意义。     

鼻内镜手术颌内动脉翼腭段的应用解剖

目的：研究颌内动脉翼腭段的走行及分支规律,为经鼻内镜手术过程中合理处理颌内动脉提供解剖学依据。方法：10具去脑颅底骨正中裂开,显微镜下解剖蝶腭动脉,经鼻内镜上颌窦入路开放翼腭窝,暴露颌内动脉翼腭段所有分支,将上颌窦后、内壁交界的凹陷定义为A点,通过眶下孔的水平线与上颌窦前壁、后外侧壁交线相交于B点,上颌窦前壁、后外侧壁和底壁的交点为D点,BD连线的中点为C点,颌内动脉翼腭段发出的第一分支点为C′点,观察其分支及走行规律。结果：蝶窦口下缘到鼻后中隔上动脉的距离为（5．88±2．21）mm;C′点位于AC上13侧,占65%（13／20）;位于AB上5侧,占25％（5／20）;位于AD上1侧,占5％（1／20）;高于AB1侧,占5％（1／20）。结论：熟悉颌内动脉的分支及走行对于治疗顽固性鼻出血和翼腭窝手术有重要意义;本实验中利用A、B、C、D点为参照点确定颌内动脉走行的方法,有助于内镜经鼻（上颌窦）手术中颌内动脉的定位及结扎处理。     

累及翼腭窝肿瘤的鼻内镜下治疗

翼腭窝毗邻结构复杂,累及此处肿瘤的治疗方式包括传统入路和鼻内镜入路。就翼腭窝的解剖、翼腭窝肿瘤的种类以及鼻内镜手术治疗方式进行阐述。     

鼻内镜下翼腭窝区解剖观察

目的研究翼腭窝区解剖特征并测量有关解剖数据,为经上颌窦入路进行翼腭窝区域手术提供参考数据。方法鼻内镜下观测10具(20侧)成人尸头,选择上颌窦前壁内下(和内上)与内壁交角点、上颌窦自然口为基点。选择颌内动脉(又称上颌动脉)第一分支动脉根部、腭降动脉根部、圆孔外口、蝶腭孔为测量点。观察两者的间距及空间位置关系,确定观测结果的临床意义。结果三个基点与测量点的距离依次为48.33±3.35mm、44.62±4.11mm、60.31±2.73mm、51.16±2.86mm;21.52±2.13mm、18.92±2.56mm,23.15±2.37mm、18.99±3.25mm;14.62±1.82mm、12.16±1.63mm,17.48±1.41mm、3.50±1.20mm。结论经上颌窦进入翼腭窝的骨壁开窗位置应选择在上颌窦后壁的中上1/3处。上颌窦内口和上颌窦后壁内上与内壁交角点可以作为手术中重要的标志性结构。     

翼腭管内注射消痔灵治疗顽固性鼻后部出血的疗效观察

我科自 1 996年 1月至 1 999年 1 0月选择 31例顽固性鼻后部出血患者 ,用翼腭管内注射消痔灵的方法进行治疗 ,获得较满意的效果 ,现报告如下。1 　 临床资料本组 31例 ,男 2 2例 ,女 9例 ;年龄 2 3～ 72岁 ,平均 38.5岁。其中高血压者 1 5例 ,上颌窦囊性腺癌术后出血 1例。所有患者都是鼻后部出血 ,至少行 2次前后鼻孔填塞术后仍不能止血 ,并排除因鼻腔内血管瘤、息肉、恶性肿瘤所致的鼻出血。2 　 操作方法鼻腔填塞或未填塞者都可以进行操作。患者取坐位或仰卧位 ,张大口。术者用手指在第三磨牙内侧触摸时此处粘膜下有一浅凹即翼腭管开口 (…     

Cavernous hemangioma of the external ear canal

OBJECTIVE: To document the occurrence of a cavernous hemangioma of the external ear canal and to review the relevant literature.STUDY DESIGN Case report and literature review. METHODS: Review of a patient chart, imaging studies, operative report, and histologic findings. RESULTS: A cavernous hemangioma of the external ear canal not involving the tympanic membrane was surgically excised without complication. This is the third documented cavernous hemangioma of the external ear canal without tympanic membrane involvement in the English literature. Computed tomography scan is invaluable to narrow the differential diagnosis. Complete removal is curative. CONCLUSIONS: Cavernous hemangioma of the external ear canal with or without tympanic membrane involvement is a rare otologic entity amenable to surgical treatment. Temporal bone computed tomography scan imaging is an important preoperative diagnostic tool.     

Pleomorphic adenoma of the pterygopalatine fossa: a case report

Pleomorphic adenoma (PA) is the most common benign tumor of the major salivary glands. It can also occur in the minor salivary glands, mainly in the oral cavity, and in other sites in the head and neck region. We present a very rare case of PA in the pterygopalatine fossa. Surgical resection of the tumor was performed via the transmaxillary approach. The patient has experienced neither surgical complications nor recurrence in the past 3 years. This case suggests that a localized benign tumor in the pterygopalatine fossa can be removed safely and efficaciously via a transmaxillary approach. Received: 8 February 2000 / Accepted: 18 May 2000     

维吾尔族成人下颌神经管在CBCT中的影像分析

摘要：目的利用CBCT初步探讨维吾尔族成年人下颌神经管分支的发生率及分型。方法收集2014~2016年就诊于新疆医科大学第一附属医院口腔科维吾尔族患者214例,利用CBCT评估其下颌管及有无分支,并进行统计学分析。结果214例（428侧）维吾尔族患者,51例（23.8%）观察到下颌管分支,其中女31例（14.48%）,男20例（9.34%）。发现下颌管双分支1例,最为常见的下颌管分支为前行管（第Ⅲ类）,发生率为8.88%;其次是磨牙管（第Ⅰ类）,发生率为8.41%;牙管（第Ⅱ类）,发生率为4.67%;最后是颊舌管（第Ⅳ类）,发生率为1.87%。结论利用 CBCT能够很好地观察下颌管有无分支这一解剖结构。     

The superior petrosal triangle as a constant anatomical landmark for subtemporal middle fossa orientation

OBJECTIVES/HYPOTHESIS; Anatomical landmarks including the arcuate eminence and the superficial petrosal nerve serve as orienting landmarks for middle fossa dissection. However, because of considerable variation among patients, these landmarks are not always readily identifiable. We expand on a previously described method for identifying the head of the malleus as a constant anatomical landmark to optimize exposure when employing a middle fossa approach. METHODS; We completed an anatomical study using 10 preserved human cadaveric temporal bones to define the anatomical relationship among the root of the zygoma, the posterior-lateral lip of the foramen spinosum, and the bony tegmen over the head of the malleus. Subsequently, 5 fresh whole human cadaveric heads (10 temporal bones) were dissected using a surgically oriented anterior petrosectomy-middle fossa approach to evaluate the consistency of localizing the head of the malleus. RESULTS; We defined the superior petrosal triangle as a stable anatomical relationship. Our cadaveric data demonstrated that the distance from the root of the zygoma to the head of the malleus was 18.7 mm (SD = 1.7 mm) and the distance from the foramen spinosum to the head of the malleus was 19.2 mm (SD = 1.0 mm). The intersection of an arc transcribed 19 mm from the root of the zygoma and an arc transcribed 19 mm from the foramen spinosum localized the head of the malleus within 2.5 mm (SD = 2.4 mm). CONCLUSIONS: The landmarks defined by the superior petrosal triangle represent a means to localize the bony tegmen over the head of the malleus. Identification of the head of the malleus as a landmark in middle fossa surgery when other landmarks are not recognizable optimizes patient safety and surgeon confidence during complex surgical procedures.     

骨性外耳道后壁重建鼓室成形术治疗胆脂瘤型中耳炎的疗效观察

目的：探讨处理乳突根治术后遗留的外耳道后壁缺损及开放的乳突腔的方法。方法：应用骨性外耳道后壁重建鼓室成形术治疗胆脂瘤型中耳炎58例（58耳）,清除病变的同时以颞骨皮质骨行骨性外耳道后壁重建并Ⅰ期行鼓室成形术。结果：随访1～3年,仅有1例胆脂瘤复发（复发率1．72％）。外耳道接近正常形态,保留含气乳突腔。纯音听阈提高30dBHL以上者（极效）5耳,提高20～29dBHL者（显效）11耳,提高10～19dBHL者（有效）30耳,总有效率为79．31％（46／58）,〈10dBHL者（基本无效）8耳,无听力提高者（无效）4耳。术后平均气导听阈明显减少。结论：乳突根治术后以颞骨皮质骨行骨性外耳道后壁重建并Ⅰ期行鼓室成形术,有助于修复乳突根治术后遗留的外耳道后壁缺损及开放的乳突腔,改善听力,降低胆脂瘤复发率,是一种较为实用的手术方法。     

The chondroid syringoma: report of a case arising from the external auditory canal

Chondroid syringoma is an uncommon, benign skin adnexal tumour. It usually presents as a slowly growing intradermal or subcutaneous nodule on the face. Treatment involves local excision with a cuff of normal tissue to prevent recurrence. A rare case of chondroid syringoma arising from the external auditory canal is reported. The clinical features, histology, treatment and follow-up are discussed.     

The use of two pedicled skin flaps in the surgical treatment of acquired atresia of the outer ear canal 1

Surgical treatment of acquired atresia of the outer ear canal remains in some cases troublesome. Based on previous experience, we have refined the existing surgical technique to obtain better results. In four patients we used two pedicled skin flaps for the treatment of total mature post-inflammatory atresia of the outer ear canal. We raised two well-vascularized pedicled skin flaps with the distal 1.5–2 cm thinned to the level of a full-thickness skin graft. All patients showed complete primary healing with stable coverage and near to complete air-bone gap closure.