翼腭窝鼻内镜临床解剖学研究

目的研究翼腭窝鼻内镜下临床解剖,为内镜下翼腭窝手术提供解剖学依据。方法10例(20侧)中国成人干性颅骨,用0°、25°Wolfe鼻内镜,在监视器下,分别从翼上颌裂、鼻腔以及底部不同角度观察翼腭窝结构。结果翼腭窝是一狭窄裂隙,由蝶骨体、蝶骨翼突和腭骨垂直板、上颌窦后壁共同围成,大小为(21.4±0.8)mm×(5.2±0.3)mm×(3.2±0.3)mm,从上面观察似三棱锥体型,上宽下窄。鼻内镜从翼上颌裂置入翼腭窝,可以观察到翼腭窝顶部眶下裂与位于其外侧3mm的圆孔,向下可见翼腭窝底部腭大孔与腭小孔。将鼻内镜置入鼻腔观察,咬除上颌窦骨性开口后方腭骨垂直部骨质并咬除上颌窦后内侧骨壁,0°鼻内镜可以窥及整个翼腭窝以及后壁全貌,后壁呈上宽下窄的梯形,见其内下方之翼管开口以及外上角之圆孔,二者之间有一明显的纵形骨嵴分隔。结论经鼻内镜下去除上颌窦口后部骨质以及部分上颌窦后内侧壁,可以完整显露整个翼腭窝的结构,表明翼腭窝范围的疾病可以采用鼻内镜处理。

Anatomic study of pterygopalatine fossa under endoscope

OBJECTIVE: To provide endoscopic anatomic bony structures of pterygopalatine fossa for skull base surgery. METHODS: The bony structures of the pterygopalatine fossa were observed in ten dry skulls under endoscope. RESULTS: The pterygopalatine fossa showed a long and narrow cleft composed of the body and pterygoid process of sphenoid bone, the lamina perpendicularis of palatine bone, and the posterior wall of maxillary sinus. The pterygopalatine fossa is (21.4 +/- 0.8) mm x (5.2 +/- 0.3) mm x (3.2 +/- 0.3) mm, with seven paths communicating with nasal cavity, mouth cavity, pharynx, orbit, infratemporal fossa and middle cranial fossa. Under endoscope,the whole pterygopalatine fossa could be observed. CONCLUSIONS: Endoscopic anatomic study of the pterygopalatine fossa is important to endoscopic endonasal skull base surgery. Under endoscope,the whole pterygopalatine fossa can be observed.