蝶窦前壁的外科解剖学研究

目的　探讨蝶窦前壁区的解剖特征及其在经蝶窦入路手术中的意义。 方法　用15例（30侧）成人头部标本及20例（40侧）成人头骨标本，在手术显微镜下对蝶窦前壁骨质、蝶腭动脉及其分支等结构进行观察和测量。 结果 蝶窦前壁的基本形态酷似鸟头，正中线棱状高起，两侧为鸟眼样的蝶窦口，下方为鸟喙样的蝶嘴。蝶窦口距上鼻道末端（14.5±1.1）mm，距后鼻孔上缘（12.2±1.0）mm，距鼻后中隔动脉上支（8.2±0.5)mm。自鼻孔伸入探条探测蝶窦前壁时，所探及的“最浅点”大致位于蝶窦口与后鼻孔之间的中点附近。蝶腭孔位于蝶窦口的外下方和中鼻甲的后端区域，与蝶窦口间距(6.9±1.3)mm，两侧蝶腭孔内侧缘间距(18.2±2.5)mm。 结论 蝶窦前壁具有特征性的形态，蝶窦口大致位于蝶窦前壁的上中1/3交界处，其下方的骨质向前方突起。蝶腭孔位于蝶窦口下外侧方约7 mm处，经蝶窦入路手术中可以依此定位蝶腭孔。

Surgical anatomy of the anterior sphenoid sinus wall

Objective　To investigate the anatomy of anterior sphenoid sinus wall and its significance for the transsphenoidal surgery.　Methods　Fifteen cases (30 sides) of adult cadaveric skulls and 20 cases (40 sides) of bleached adult dry skulls were observed under microscope. The bone structure of anterior sphenoid sinus wall and the sphenopalatine arteries and their branches were measured.　Results　The anterior sphenoid sinus wall resembled a bird head, with midline prismatic protrusion. The sphenoid ostia on both sides were in shape of bird-eyes, and the sphenoidal rostrum below was like the beak. The sphenoid sinus ostium was (14.5±1.1) mm from the terminal of upper nasal meatus, (12.2±1.0 )mm from the posterior choanae, and (8.2±0.5)mm (6.6~12.2 mm) from the upper branch of nasal septum artery. A straight probe was stretched from the nostril to the anterior sphenoid sinus wall to determine the nearest point on this wall, which was defined as the "shallowest point". This point was at about the middle point between the sphenoid sinus ostium and the posterior choanae. Sphenopalatine foramen was located inferolateral to the sphenoid sinus ostium and at the rear of middle turbinate, with a distance of (6.9±1.3) mm to the sphenoid sinus ostium. The distance between the medial edges of sphenopalatine foramen on both sides was (18.2±2.5) mm. Conclusions The anterior sphenoid sinus wall has its own morphological characteristics. The sphenoid sinus ostium was located at the junction of the upper and middle thirds of the anterior sphenoid sinus wall. There is a protuberance bellow the ostium. The sphenopalatine foramen was inferior-lateral to the sphenoid sinus ostium, with about 7 mm from each other. This data should be useful for positioning the sphenopalatine foramen in the transsphenoidal surgery.