侧颅底区舌咽神经及其毗邻结构的临床应用解剖
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摘要
目的
本研究的目的是获得关于舌咽神经的详细解剖学资料,明确其与周围结构的空间定位关系,为侧颅底手术中舌咽神经及其分支的定位和保护提供形态学和局部解剖学依据。
方法
1.选取国人成人头颅标本10具(20侧),经福尔马林固定,其中3具红色乳胶灌注。应用侧方经颞—蝶进路,显露舌咽神经颅外部分的全程。在解剖过程中,仔细观测颞下窝、咽旁间隙、茎突隔、颈静脉孔、侧颅底区肌肉、血管、神经的解剖关系。测量了舌咽神经、迷走神经、副神经及舌下神经的最大直径。解剖过程中所有解剖步骤均照相记录。
2.在30例(60侧)国人成人头颅骨标本上,对侧颅底区与舌咽神经相关的有重要临床意义的骨性标志相互间距离进行解剖学测量。
结果
1、通过对尸头进行解剖发现舌咽神经在颅底茎突和茎突诸肌的中后部与迷走神经、副神经一起自颈静脉孔出颅。舌咽神经干在颈动脉鞘的前内侧易与颈动脉鞘分离,在近颈静脉孔处膨大形成下神经节。其鼓室支(Jacobson’s神经)自下神经节发出经鼓室小管进入中耳,第二个小分支在舌咽神经出颅后即离开主干
郑州大学2004届硕士毕业论文侧颅底区舌咽神经及其毗邻结构的临床应用解剖
进入颈动脉体。后四组颅神经和颈内静脉,行走于寰椎横突和茎突之间的狭窄间
隙。舌咽神经主干继续向下、向前走行于颈内动脉的表面、颈内静脉、颈外动脉
及茎突的深面,横过茎突咽肌深面,绕该肌中部下缘弯向前行,并发出分支支配
该肌,穿过茎突咽肌后,舌咽神经的分支一咽支脱离主干,向下向前走行于颈内
动脉及颈外动脉分叉处,与迷走神经的分支及颈交感神经的分支一起组成咽丛,
咽丛位于舌骨水平的咽中缩肌上。而主干则继续弯曲走行于茎突咽肌的内侧,
于舌骨舌肌的深面,向舌背方向走行,至此舌咽神经分成其终末支:舌支及扁
桃体支。
2.乳突尖端与下领角之间的连线的中点至颈静脉孔的距离,左侧为21.犯
士2.03~,右侧为21 .42士2.05~。测量茎突根部至颈静脉孔外缘的距离,
左侧为4.70士1.83~,右侧为3.67士2.12rn们n;至颈动脉管外口外缘的距离
左为9.97士2.23 n1Jll,右为10.03
离,左侧为21.88士2.20~,
士1.74111111。测量乳突尖至颈静脉孔外缘的距
右为
右为
20.64士2.00~;距颈动脉管外口后
缘的距离左为30.68士2.43~
30.97士2.36 Inrn。
3.茎突隔将咽旁间隙分割为茎突前间隙和茎突后间隙,并保护颈内动脉、
颈内静脉及后组颅神经。
4.舌咽神经在茎突咽肌的深面距颈动脉分叉的距离为23一47m五1,距离乳突
尖的距离为7一巧nun。测得舌咽神经的最大直径为1.2r以刀n。
结论
1.在手术中,侧颅底区的骨性解剖标志可作为重要结构的定位参照。侧
颅底区相关解剖数据的测量有利于术中掌握解剖定位及安全范围。
2.在颗下窝区,茎突根部、鼓板下缘、寰椎横突、乳突尖以及下领角等可
作为舌咽神经颅外部分的参考标志。
3在乳突尖到下领角轴线区,切除二腹肌后腹时应注意区别和保护舌咽神
经。二腹肌后腹亦可作为术中辨认舌咽神经的解剖标志。
The study were to obtain more useful detailed microanatomic information of the Glossopharyngeal nerve in the lateral skull base and the spatial relationships of surrounding structures, to provide some special information about the morphology and topography of the Glossopharyngeal Nerve (GphN) and its branches ,for the location and protection in surgery of lateral skull base.
Methods
1. Ten cadaver heads (20 sides) were used for microsurgical dissection , among these three heads injected with colored latex . Microsurgical anatomy and measurement were performed by lateraltranstemperal-sphenoid approach . Then exposed the whole length on the extracranial course of the GphN . During our dissection , the infratemporal fossa , parapharyngeal space , styloid diaphragm ?jugular foramen , the anatomic relationships of the muscles , arteries , veins and nerves were obtained .The greatest diameters of Glossopharyngeal Nerve (GphN )> Vagus Nerve , Accessory Nerve and Hypoglossal Nerve were measured . All stages of the dissections were photoghaphed .
2. The distance between bony landmarks and foramina in the lateral skull base was determined through measurement of 30 (60 sides) dry adult skulls .
Results
1 , The glossopharyngeal nerve exits the skull through the jugular foramen posteromedial to the styloid process and the styloid muscle with Vagus Nerve and Accessory Nerves. The glossopharyngeal nerve can be easily separaed from the carotid sheath at the anterolateral surface .The inferior ganglion is formed near the jugular foramen by glossopharyngeal nerve . The tympanic branch (Jacobson's nerve) emerged from the inferior ganglion of the GphN and enters the middle ear through the tympanic canaliculus . A second small branch , this one to the carotid body , leaves Glossopharyngeal Nerve soon after it exits the skull .The last four cranial nerves and the internal jugular vein pass through a narrow space between the transverse process of the atlas(cl) and the sryloid process . Continuing inferiorly and anteriorly , the main trunk runs superficial to the internal carotid artery but deep to the jugular vein , external carotid artery , and styloid process to the deep surface of the stylopharyngeus muscle , which it innervates . The glossopharyngeal branch to the pharyngeal plexlus leaves the nerve trunk by the time it has crossed the stylopharyngeus muscle , and passes anteriorly and inferiorly between the internal and external carotid arteries to the main trunk to join branches of the Vagus Nerve and the cervical sympathetic nerves to form the pharyngeal plexus on the middle constrictor muscle at the level of the hyoid bone . Continuing , the main nerve trunk curves around the lateral border of the stylopharyngeus muscle , traveling toward the tongue base . Deep to the hyoglossus muscle , it divides into its terminal lingual and tonsillar branches .
2. The distance from the midpoint of mastoid process and the angle of the mandible to the jugular foramen was 21.68 1.77 mm in left side and 21.44?.11 mm in the right side . We also measured the distance from the root of the sryloid process to the lateral border of the jugular foramen is 4.701.83 mm in the left and 3. 67 ?. 12 mm in the right ; to the lateral border of the carotid canal is 9.97 2.23 mm (left) and 10.03 + 1.74 mm (right) . The distance from the tip of the mastoid process to the lateral border of jugular foramen was 2 1.88 ?.20 mm (left) and 20.64?.00 mm (right) ; to the back border of the carotid canal is 30.68 2.43
mm (left) and 30.97?.36 mm (right) .
3. The styloid diaphragm devides the parapharyngeal space into prestyloid and retrostyloid regions and protects Internal Jugular Vein (IJV) , Internal Carotid Artery (1C A) and Glossopharyngeal Nerve, Vagus Nerve . Accessory Nerve and Hypoglossal Nerve .
4. Glossopharyngeal Nerve crosses the deep surface of the stylopharyngeus muscle 23 to 47 mm cephalic to the bifurcation of the carotid artery and 7 to 15 mm from the tip of the styloid process . The greatest diameter of Glossopharyngeal Nerve was 1 .2 mm .
本研究的目的是获得关于舌咽神经的详细解剖学资料,明确其与周围结构的空间定位关系,为侧颅底手术中舌咽神经及其分支的定位和保护提供形态学和局部解剖学依据。
方法
1.选取国人成人头颅标本10具(20侧),经福尔马林固定,其中3具红色乳胶灌注。应用侧方经颞—蝶进路,显露舌咽神经颅外部分的全程。在解剖过程中,仔细观测颞下窝、咽旁间隙、茎突隔、颈静脉孔、侧颅底区肌肉、血管、神经的解剖关系。测量了舌咽神经、迷走神经、副神经及舌下神经的最大直径。解剖过程中所有解剖步骤均照相记录。
2.在30例(60侧)国人成人头颅骨标本上,对侧颅底区与舌咽神经相关的有重要临床意义的骨性标志相互间距离进行解剖学测量。
结果
1、通过对尸头进行解剖发现舌咽神经在颅底茎突和茎突诸肌的中后部与迷走神经、副神经一起自颈静脉孔出颅。舌咽神经干在颈动脉鞘的前内侧易与颈动脉鞘分离,在近颈静脉孔处膨大形成下神经节。其鼓室支(Jacobson’s神经)自下神经节发出经鼓室小管进入中耳,第二个小分支在舌咽神经出颅后即离开主干
郑州大学2004届硕士毕业论文侧颅底区舌咽神经及其毗邻结构的临床应用解剖
进入颈动脉体。后四组颅神经和颈内静脉,行走于寰椎横突和茎突之间的狭窄间
隙。舌咽神经主干继续向下、向前走行于颈内动脉的表面、颈内静脉、颈外动脉
及茎突的深面,横过茎突咽肌深面,绕该肌中部下缘弯向前行,并发出分支支配
该肌,穿过茎突咽肌后,舌咽神经的分支一咽支脱离主干,向下向前走行于颈内
动脉及颈外动脉分叉处,与迷走神经的分支及颈交感神经的分支一起组成咽丛,
咽丛位于舌骨水平的咽中缩肌上。而主干则继续弯曲走行于茎突咽肌的内侧,
于舌骨舌肌的深面,向舌背方向走行,至此舌咽神经分成其终末支:舌支及扁
桃体支。
2.乳突尖端与下领角之间的连线的中点至颈静脉孔的距离,左侧为21.犯
士2.03~,右侧为21 .42士2.05~。测量茎突根部至颈静脉孔外缘的距离,
左侧为4.70士1.83~,右侧为3.67士2.12rn们n;至颈动脉管外口外缘的距离
左为9.97士2.23 n1Jll,右为10.03
离,左侧为21.88士2.20~,
士1.74111111。测量乳突尖至颈静脉孔外缘的距
右为
右为
20.64士2.00~;距颈动脉管外口后
缘的距离左为30.68士2.43~
30.97士2.36 Inrn。
3.茎突隔将咽旁间隙分割为茎突前间隙和茎突后间隙,并保护颈内动脉、
颈内静脉及后组颅神经。
4.舌咽神经在茎突咽肌的深面距颈动脉分叉的距离为23一47m五1,距离乳突
尖的距离为7一巧nun。测得舌咽神经的最大直径为1.2r以刀n。
结论
1.在手术中,侧颅底区的骨性解剖标志可作为重要结构的定位参照。侧
颅底区相关解剖数据的测量有利于术中掌握解剖定位及安全范围。
2.在颗下窝区,茎突根部、鼓板下缘、寰椎横突、乳突尖以及下领角等可
作为舌咽神经颅外部分的参考标志。
3在乳突尖到下领角轴线区,切除二腹肌后腹时应注意区别和保护舌咽神
经。二腹肌后腹亦可作为术中辨认舌咽神经的解剖标志。
The study were to obtain more useful detailed microanatomic information of the Glossopharyngeal nerve in the lateral skull base and the spatial relationships of surrounding structures, to provide some special information about the morphology and topography of the Glossopharyngeal Nerve (GphN) and its branches ,for the location and protection in surgery of lateral skull base.
Methods
1. Ten cadaver heads (20 sides) were used for microsurgical dissection , among these three heads injected with colored latex . Microsurgical anatomy and measurement were performed by lateraltranstemperal-sphenoid approach . Then exposed the whole length on the extracranial course of the GphN . During our dissection , the infratemporal fossa , parapharyngeal space , styloid diaphragm ?jugular foramen , the anatomic relationships of the muscles , arteries , veins and nerves were obtained .The greatest diameters of Glossopharyngeal Nerve (GphN )> Vagus Nerve , Accessory Nerve and Hypoglossal Nerve were measured . All stages of the dissections were photoghaphed .
2. The distance between bony landmarks and foramina in the lateral skull base was determined through measurement of 30 (60 sides) dry adult skulls .
Results
1 , The glossopharyngeal nerve exits the skull through the jugular foramen posteromedial to the styloid process and the styloid muscle with Vagus Nerve and Accessory Nerves. The glossopharyngeal nerve can be easily separaed from the carotid sheath at the anterolateral surface .The inferior ganglion is formed near the jugular foramen by glossopharyngeal nerve . The tympanic branch (Jacobson's nerve) emerged from the inferior ganglion of the GphN and enters the middle ear through the tympanic canaliculus . A second small branch , this one to the carotid body , leaves Glossopharyngeal Nerve soon after it exits the skull .The last four cranial nerves and the internal jugular vein pass through a narrow space between the transverse process of the atlas(cl) and the sryloid process . Continuing inferiorly and anteriorly , the main trunk runs superficial to the internal carotid artery but deep to the jugular vein , external carotid artery , and styloid process to the deep surface of the stylopharyngeus muscle , which it innervates . The glossopharyngeal branch to the pharyngeal plexlus leaves the nerve trunk by the time it has crossed the stylopharyngeus muscle , and passes anteriorly and inferiorly between the internal and external carotid arteries to the main trunk to join branches of the Vagus Nerve and the cervical sympathetic nerves to form the pharyngeal plexus on the middle constrictor muscle at the level of the hyoid bone . Continuing , the main nerve trunk curves around the lateral border of the stylopharyngeus muscle , traveling toward the tongue base . Deep to the hyoglossus muscle , it divides into its terminal lingual and tonsillar branches .
2. The distance from the midpoint of mastoid process and the angle of the mandible to the jugular foramen was 21.68 1.77 mm in left side and 21.44?.11 mm in the right side . We also measured the distance from the root of the sryloid process to the lateral border of the jugular foramen is 4.701.83 mm in the left and 3. 67 ?. 12 mm in the right ; to the lateral border of the carotid canal is 9.97 2.23 mm (left) and 10.03 + 1.74 mm (right) . The distance from the tip of the mastoid process to the lateral border of jugular foramen was 2 1.88 ?.20 mm (left) and 20.64?.00 mm (right) ; to the back border of the carotid canal is 30.68 2.43
mm (left) and 30.97?.36 mm (right) .
3. The styloid diaphragm devides the parapharyngeal space into prestyloid and retrostyloid regions and protects Internal Jugular Vein (IJV) , Internal Carotid Artery (1C A) and Glossopharyngeal Nerve, Vagus Nerve . Accessory Nerve and Hypoglossal Nerve .
4. Glossopharyngeal Nerve crosses the deep surface of the stylopharyngeus muscle 23 to 47 mm cephalic to the bifurcation of the carotid artery and 7 to 15 mm from the tip of the styloid process . The greatest diameter of Glossopharyngeal Nerve was 1 .2 mm .
引文