咽旁颞下区显微解剖学研究
|
摘要
目的
为详尽了解咽旁颞下区及其手术入路的相关显微解剖关系,并为临床手术提供详尽的解剖参数。
方法
1.观测20例(40侧)成人头颅骨性标本,对咽旁颞下区手术有重要临床意义的骨性标志相互间距离及有关夹角进行解剖学测量。
2.选取10%福尔马林固定的成人头颅标本10例(20侧),应用颞下-耳前-颞下窝入路、下颌骨外旋入路,在手术显微镜下模拟手术入路逐层解剖,仔细观测了咽旁颞下区及毗邻结构。
结果
1 茎突根部至卵圆孔、棘孔、舌下神经管外口、颈动脉外口、颈静脉窝的距离分别为25.25±4.38mm、17.90±2.54mm、17.88±2.52mm、10.25±2.34mm、3.32±1.75mm,夹角分别为149.48±6.85°、154.00±4.83°、85.48±5.78°、119.95±10.78°、86.05±4.52°。关节结节至卵圆孔、棘孔、舌下神经管外口、颈动脉外口、颈静脉窝的距离分别为29.88±3.78mm、28.02±3.01mm、48.12±3.71mm、32.86±4.21mm、3.75±3.74mm。
2.面神经出茎乳孔处位于耳屏软骨尖内侧,最短距离为10.80±2.10mm。面神经颞支分为三支,越过颧弓时距耳屏前方距离:后支16.32±2.43mm,中支21.50±2.51mm,前支31.30±2.64mm,走行于颞浅筋膜深面,颞浅血管行于颞浅筋膜中。
郑州大学医学院2004届硕士研究生毕业论文
咽旁颖下区显微解剖学研究
3.下领神经为三叉神经最大的一支,主要分支有颊神经、颗深神经、咬肌神
经、耳颗神经、舌神经、下牙槽神经。颖深前神经60%与颊神经共干穿翼外肌
两头间折转向前进入颖肌深面。颖深后神经55%与咬肌神经共干沿颖下窝顶部
行向外,然后越过颗下晴后部进入颖肌深面。颖深动脉与额深神经伴行于骨膜与
颖肌深面之间,参与颖肌血供。
4.后四对颅神经及颈内动静脉位于茎突隔深面,行于茎突与之间的狭小间隙
内,后四对颅神经于寰椎横突的前方开始分开走行,舌咽神经行向前下,舌下神
经稍向前下,迷走神经继续下行,副神经行向后下。
5.舌咽神经出颅后行于茎突根部深面,绕茎突咽肌后缘至其浅面,继续前行
进入舌骨舌肌后缘深面,位于舌下神经上方19.45士4.54fnln。
6.舌神经由领下腺导管的上方到其外侧,经下方到管的内侧,呈螺旋样旋绕
导管,与导管形成两次交叉。
结论
1.茎突根部、关节结节可作为咽旁颗下区侧方手术入路的指引标志。
2.外耳道软骨尖是寻认面神经干的可靠标志。面神经颜支行于颖浅筋膜深
面,颖浅动静脉位于颗浅筋膜中,在颗深筋膜深层与颖肌之间分离颖肌可保护面
神经颜支免受损伤。
3.颖深动脉及颖深神经行于骨膜与颖肌之间,术中应从骨膜下分离颖肌,以
免颖肌萎缩。
4.利用茎突隔、寰椎横突可识别并保护咽旁后间隙重要神经血管结构。
5.茎突根部、茎突咽肌、舌骨舌肌后缘处舌下神经上方是寻找颈段舌咽神经
的标志。
6.切断术侧领下腺导管并切除同侧领下腺可保留舌神经功能,同时增大了暴
露范围。
Objective To understand the microsurgical anatomy of the parapharyngeal
space(PPS) and infrotemporal fossa(ITF) and to provide anatomical basis for the operation of the region.
Methods (1) Direct foraminal measurements were made in twenty dry skulls (40 sides),and the relationship of these foramina to each other and various landmarks were determined in the the parapharyngeal space and infrotemporal fossa.(2) Ten adult cadaveric heads (20 sides) fixed in 10% formalin were examined using microsurgical techniques and instruments, including the operating microscope.Subtemporal preauricular infratemporal fossa and mandibular swing approaches were selected to study.The anatomic relationships of the muscles, nerves, arteries, and veins were carefully recorded, with special emphasis regarding the relative relationship of these structures.
Results (1) The distances from the root of styloid process to the foramen oval,foramen lacerum,exocranial entrance to the hypoglossal canal,exocranial entrance to the carotid canaljugula rfossa were 25.25?.38mm,17.90?.54mm, 17.88 ?.52mm,10.25?.34mm,3.32?.75mm;and the angles were!49.48?.85? 54.00?4.83?85.48?.780,119.95?0.780,86.05?.52?respectiveiy.The distances from the articular tubercle to them were 29.88?.78mm,28.02?.01 mm, 48.12?.71mm,32.86?.21mm,3.75?.74mm,respectively.(2) The shortest distance from the tragal pointer to the trunk of facial nerve was 10.80?.10mm.The temporal branches of facial nerve had three rami.They crossed the zygomatic arch to the temporal region,and ran between the superficial temporal fascia and the superficial
layer of the deep temporal fascia .The superficial temporal vessels were enwarpped with the superficia temporal fascia.The anterior temporal branch of the facial nerve crossed zygomatic arch at the distance of 31.30?.64mm before the tragus,the middle temporal branch 21.50?.51mm,and the posterior temporal branch 16.32?.43mm.(3) The mandibular nerve was the largest branch of the trigeminal.Its main branches included masseteric,deep temporal,buccal,auriculotemporal,lingual and inferior alveolar nerve.60% of the anterior deep temporal nerve had a common trunk with the buccal nerve.They crossed between the superior and inferior head of lateral pterygoid before entering the deep layer of temporal muscle.The posterior deep temporal nerve accompanying the masseteric nerve accounted for 55%,and they ran laterally on the roof of the ITF before they passed posterior to the infrotemporal crest and entered the deep layer of temporal muscle.The deep temporal artery accompanying with nerve ran between temporal muscle and periosteum,and supplied temporal muscle.(4) The lower cranial nerves(IX-XII), internal jugular vein, internal carotid artery sat medial to the styloid diaphragm,and ran between the styloid process and the transverse process of the atlas(TPA).The lower cranial nerves fanned out at front of the TPA.The glossopharyngeal nerve and the hypoglossal nerve coursed anteriorly .The vagus nerve continued its vertical course.and the spinal accessory nerve coursed posteriorly.(5) After the glossopharyngeal nerve exited jugular foramen,it coursed medial to the styloid process.lt curved around the posterior border of the stylopharyngeal muscle(SPM)and traveled over its lateral surface.Then it ran anteriorly to enter medial to the posterior border of the hyoglossus,At which the distance from the hypoglossal nerve was 19.45?.54mm.(6) The lingual nerve ran inferolateraly to cross the submandibular duct,and curved around it to travel medial to it so that two crossings were formed.
Conclusions (1) The root of styloid process and the articular tubercle are two reference guides during the operation of the PPS and the ITF.(2) The tragal pointer is a key landmark to find the extratemporal portion of the facial nerve. The temporal branch of the facial nerve lies between the superficial temporal fascia and the superficial layer of the deep temporal fascia in the temporal region It is safe to dissect
in the plane between the deep layer of the deep temporal fascia and the
为详尽了解咽旁颞下区及其手术入路的相关显微解剖关系,并为临床手术提供详尽的解剖参数。
方法
1.观测20例(40侧)成人头颅骨性标本,对咽旁颞下区手术有重要临床意义的骨性标志相互间距离及有关夹角进行解剖学测量。
2.选取10%福尔马林固定的成人头颅标本10例(20侧),应用颞下-耳前-颞下窝入路、下颌骨外旋入路,在手术显微镜下模拟手术入路逐层解剖,仔细观测了咽旁颞下区及毗邻结构。
结果
1 茎突根部至卵圆孔、棘孔、舌下神经管外口、颈动脉外口、颈静脉窝的距离分别为25.25±4.38mm、17.90±2.54mm、17.88±2.52mm、10.25±2.34mm、3.32±1.75mm,夹角分别为149.48±6.85°、154.00±4.83°、85.48±5.78°、119.95±10.78°、86.05±4.52°。关节结节至卵圆孔、棘孔、舌下神经管外口、颈动脉外口、颈静脉窝的距离分别为29.88±3.78mm、28.02±3.01mm、48.12±3.71mm、32.86±4.21mm、3.75±3.74mm。
2.面神经出茎乳孔处位于耳屏软骨尖内侧,最短距离为10.80±2.10mm。面神经颞支分为三支,越过颧弓时距耳屏前方距离:后支16.32±2.43mm,中支21.50±2.51mm,前支31.30±2.64mm,走行于颞浅筋膜深面,颞浅血管行于颞浅筋膜中。
郑州大学医学院2004届硕士研究生毕业论文
咽旁颖下区显微解剖学研究
3.下领神经为三叉神经最大的一支,主要分支有颊神经、颗深神经、咬肌神
经、耳颗神经、舌神经、下牙槽神经。颖深前神经60%与颊神经共干穿翼外肌
两头间折转向前进入颖肌深面。颖深后神经55%与咬肌神经共干沿颖下窝顶部
行向外,然后越过颗下晴后部进入颖肌深面。颖深动脉与额深神经伴行于骨膜与
颖肌深面之间,参与颖肌血供。
4.后四对颅神经及颈内动静脉位于茎突隔深面,行于茎突与之间的狭小间隙
内,后四对颅神经于寰椎横突的前方开始分开走行,舌咽神经行向前下,舌下神
经稍向前下,迷走神经继续下行,副神经行向后下。
5.舌咽神经出颅后行于茎突根部深面,绕茎突咽肌后缘至其浅面,继续前行
进入舌骨舌肌后缘深面,位于舌下神经上方19.45士4.54fnln。
6.舌神经由领下腺导管的上方到其外侧,经下方到管的内侧,呈螺旋样旋绕
导管,与导管形成两次交叉。
结论
1.茎突根部、关节结节可作为咽旁颗下区侧方手术入路的指引标志。
2.外耳道软骨尖是寻认面神经干的可靠标志。面神经颜支行于颖浅筋膜深
面,颖浅动静脉位于颗浅筋膜中,在颗深筋膜深层与颖肌之间分离颖肌可保护面
神经颜支免受损伤。
3.颖深动脉及颖深神经行于骨膜与颖肌之间,术中应从骨膜下分离颖肌,以
免颖肌萎缩。
4.利用茎突隔、寰椎横突可识别并保护咽旁后间隙重要神经血管结构。
5.茎突根部、茎突咽肌、舌骨舌肌后缘处舌下神经上方是寻找颈段舌咽神经
的标志。
6.切断术侧领下腺导管并切除同侧领下腺可保留舌神经功能,同时增大了暴
露范围。
Objective To understand the microsurgical anatomy of the parapharyngeal
space(PPS) and infrotemporal fossa(ITF) and to provide anatomical basis for the operation of the region.
Methods (1) Direct foraminal measurements were made in twenty dry skulls (40 sides),and the relationship of these foramina to each other and various landmarks were determined in the the parapharyngeal space and infrotemporal fossa.(2) Ten adult cadaveric heads (20 sides) fixed in 10% formalin were examined using microsurgical techniques and instruments, including the operating microscope.Subtemporal preauricular infratemporal fossa and mandibular swing approaches were selected to study.The anatomic relationships of the muscles, nerves, arteries, and veins were carefully recorded, with special emphasis regarding the relative relationship of these structures.
Results (1) The distances from the root of styloid process to the foramen oval,foramen lacerum,exocranial entrance to the hypoglossal canal,exocranial entrance to the carotid canaljugula rfossa were 25.25?.38mm,17.90?.54mm, 17.88 ?.52mm,10.25?.34mm,3.32?.75mm;and the angles were!49.48?.85? 54.00?4.83?85.48?.780,119.95?0.780,86.05?.52?respectiveiy.The distances from the articular tubercle to them were 29.88?.78mm,28.02?.01 mm, 48.12?.71mm,32.86?.21mm,3.75?.74mm,respectively.(2) The shortest distance from the tragal pointer to the trunk of facial nerve was 10.80?.10mm.The temporal branches of facial nerve had three rami.They crossed the zygomatic arch to the temporal region,and ran between the superficial temporal fascia and the superficial
layer of the deep temporal fascia .The superficial temporal vessels were enwarpped with the superficia temporal fascia.The anterior temporal branch of the facial nerve crossed zygomatic arch at the distance of 31.30?.64mm before the tragus,the middle temporal branch 21.50?.51mm,and the posterior temporal branch 16.32?.43mm.(3) The mandibular nerve was the largest branch of the trigeminal.Its main branches included masseteric,deep temporal,buccal,auriculotemporal,lingual and inferior alveolar nerve.60% of the anterior deep temporal nerve had a common trunk with the buccal nerve.They crossed between the superior and inferior head of lateral pterygoid before entering the deep layer of temporal muscle.The posterior deep temporal nerve accompanying the masseteric nerve accounted for 55%,and they ran laterally on the roof of the ITF before they passed posterior to the infrotemporal crest and entered the deep layer of temporal muscle.The deep temporal artery accompanying with nerve ran between temporal muscle and periosteum,and supplied temporal muscle.(4) The lower cranial nerves(IX-XII), internal jugular vein, internal carotid artery sat medial to the styloid diaphragm,and ran between the styloid process and the transverse process of the atlas(TPA).The lower cranial nerves fanned out at front of the TPA.The glossopharyngeal nerve and the hypoglossal nerve coursed anteriorly .The vagus nerve continued its vertical course.and the spinal accessory nerve coursed posteriorly.(5) After the glossopharyngeal nerve exited jugular foramen,it coursed medial to the styloid process.lt curved around the posterior border of the stylopharyngeal muscle(SPM)and traveled over its lateral surface.Then it ran anteriorly to enter medial to the posterior border of the hyoglossus,At which the distance from the hypoglossal nerve was 19.45?.54mm.(6) The lingual nerve ran inferolateraly to cross the submandibular duct,and curved around it to travel medial to it so that two crossings were formed.
Conclusions (1) The root of styloid process and the articular tubercle are two reference guides during the operation of the PPS and the ITF.(2) The tragal pointer is a key landmark to find the extratemporal portion of the facial nerve. The temporal branch of the facial nerve lies between the superficial temporal fascia and the superficial layer of the deep temporal fascia in the temporal region It is safe to dissect
in the plane between the deep layer of the deep temporal fascia and the
引文