额颧角入路上颌神经阻滞的相关影像解剖测量
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摘要
目的:CT定位下测量经额颧角入路上颌神经阻滞相关影像学解剖结构数据,为临床安全开展此路径上颌神经阻滞提供依据。方法:对140例成年人进行颌面部MSCT扫描检查,并进行图像后处理,包括多平面重建(multiplanar reformation, MPR)和三维容积显示(volume rendering, VR),分别在横断位和斜矢状位上测量额颧角至蝶骨大翼及圆孔外口的距离和角度,在斜矢状位上测量额颧角至颞肌后缘距离,在三维图像上观察额颧角并通过测量参数描述其相对位置,并进行统计学分析。结果:横断位上额颧角至蝶骨大翼及斜矢状位上额颧角至圆孔外口距离分别是(34.18±3.99) mm及(58.51±3.67) mm;相对额颧角所在冠状面和水平面,额颧角至圆孔外口需向前(15.19±2.20)°,向下(8.76±2.01)°。结论:CT定位准确、直观,为额颧角入路上颌神经阻滞的操作提供影像解剖依据。
Objective: The anatomical data of the maxillary nerve block related to the frontozygomatic angle approach were measured by CT, which provided a basis for the clinical safety of the maxillary nerve block.Methods: The maxillofacial MSCT scans were performed in 140 adults, the images post-processing including multiplanar reformation(MPR) and volume rendering(VR) were used to measure the distances and angles from the frontozygomatic angle to the great wing of the sphenoid and to the foramen rotundum area in the axial planes, the distances and angles from the frontozygomatic angle to the great wing of the sphenoid and to the foramen rotundum area and distances between the right angle and the posterior edge of temporal muscle in the oblique planes. The frontozygomatic angle was observed and described by measuring parameters on 3 D images, and statistical analysis was performed. Results: The distances from the frontozygomatic angle to the greater wing of the sphenoid in the axial plane and to the foramen rotundum in the oblique plane were 34.18±3.99 mm and 58.51±3.67 mm, respectively. On the coronal and the horizontal plane of the frontozygomatic angle, the direction from the frontozygomatic angle towards the foramen rotundum was oriented 15.19±2.20 degrees forward and 8.76±2.01 degrees downward. Conclusion: CT scan provides anatomical basis for the operation of maxillary nerve block via frontozygomatic angle approach, accurately and directly.
Objective: The anatomical data of the maxillary nerve block related to the frontozygomatic angle approach were measured by CT, which provided a basis for the clinical safety of the maxillary nerve block.Methods: The maxillofacial MSCT scans were performed in 140 adults, the images post-processing including multiplanar reformation(MPR) and volume rendering(VR) were used to measure the distances and angles from the frontozygomatic angle to the great wing of the sphenoid and to the foramen rotundum area in the axial planes, the distances and angles from the frontozygomatic angle to the great wing of the sphenoid and to the foramen rotundum area and distances between the right angle and the posterior edge of temporal muscle in the oblique planes. The frontozygomatic angle was observed and described by measuring parameters on 3 D images, and statistical analysis was performed. Results: The distances from the frontozygomatic angle to the greater wing of the sphenoid in the axial plane and to the foramen rotundum in the oblique plane were 34.18±3.99 mm and 58.51±3.67 mm, respectively. On the coronal and the horizontal plane of the frontozygomatic angle, the direction from the frontozygomatic angle towards the foramen rotundum was oriented 15.19±2.20 degrees forward and 8.76±2.01 degrees downward. Conclusion: CT scan provides anatomical basis for the operation of maxillary nerve block via frontozygomatic angle approach, accurately and directly.
引文
[1]胡玉婷,韩卉,孟庆玲,等.上颌神经阻滞麻醉的应用解剖学基础[J].四川解剖学杂志, 2003, 11(4):15-17.
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[7]Radder K, Shah A, Fatima S, et al. Ef?cacy and feasibility of frontozygomatic angle approach for extra maxillary nerve block in oral surgery:A descriptive clinical trial[J]. J Maxillofac Oral Surg, 2014, 13(3):231-237.
[8]Mesnil M, Dadure C, Captier G, et al. Anewapproach forperi-operativeanalgesiaofcleftpalaterepairin infants:thebilateralsuprazygomaticmaxillarynerve block[J]. Pediatric Anesthesia, 2010, 20:343-349.
[9]Chiono J, Raux O, Bringuier S, et al. Bilateral suprazygomatic maxillary nerve block for cleft palate repair in children[J]. Anesthesiology, 2014, 120:1362-1369.
[10]Prigge L, Albert-Neels van Schoor, Marius C, et al. Clinical anatomy of the maxillary nerve block in pediatric patiens[J]. Pediatric Anesthesia, 2014, 24:1120-1126.
[11]邓彬华,彭玉成,范静平,等.翼腭窝CT三维重建的临床应用[J].解剖学杂志, 2005, 28(6):682-684.
[12]郭强,麻瑞晨,党彩艳.两种穿刺入路射频热凝治疗原发性三叉神经痛的临床比较[J].中国疼痛医学杂志, 2017, 23(8):613-615.
[13]杨巨顺,崔磊,何玉泉,等.正常成人圆孔骨性通道相关参数的多层螺旋CT研究[J].中华解剖与临床杂志, 2017, 22(2):94-98.
[14]纪荣明,彭旭,钟启胜,等.上颌神经应用解剖学研究[J].解剖学杂志, 1998, 21(6)558-560.
[15]Stoj?ev Staj?i?L, Ga?i?B, Popovi?N, et al. Anatomical study of the pterygopalatine fossa pertinent to the maxillary nerve block at the foramen rotundum. Int[J].J Oral Maxillofacial Surg, 2010, 39:493-496.
[16]Bratbak DF, Folvik M, Nordg?rd S. Depicting the pterygopalatineganglionon3 Teslamagneticresonance images[J].SurgicalandRadiologic Anatomy,2017,DOI:10.1007/s00276-017-1960-6.
[2]Captier G, Dadure C, Leboucq N, et al. Anatomic study using Three-Dimensional computed tomographic scan measurement for truncal maxillary nerve blocks via the suprazygomaticrouteininfants[J]. AnatomicStudy,2009, 20:224-228.
[3]Zarembinski C, Graff-Radford S. An unusual challenge inperformingsphenopalatineganglionblockwith enlargedcoronoidprocess:Jacob'sDisease[J].Pain Medicine, 2014, 15:329-332.
[4]韩影,王然,陆丽娟. 3D重建在三叉神经第二支射频治疗穿刺路径选择中的作用[J].中国疼痛医学杂志, 2016, 22(12):903-907.
[5]佐伯茂,张勤功,丛寿耆,译.蝶腭神经节阻滞[J].疼痛, 1999, 7(4):183-185.
[6]樊扬诗,沈梅媛,雷广平.翼腭窝穿刺进路解剖测量[J].北京军区医药, 1995, 7(4):245-247.
[7]Radder K, Shah A, Fatima S, et al. Ef?cacy and feasibility of frontozygomatic angle approach for extra maxillary nerve block in oral surgery:A descriptive clinical trial[J]. J Maxillofac Oral Surg, 2014, 13(3):231-237.
[8]Mesnil M, Dadure C, Captier G, et al. Anewapproach forperi-operativeanalgesiaofcleftpalaterepairin infants:thebilateralsuprazygomaticmaxillarynerve block[J]. Pediatric Anesthesia, 2010, 20:343-349.
[9]Chiono J, Raux O, Bringuier S, et al. Bilateral suprazygomatic maxillary nerve block for cleft palate repair in children[J]. Anesthesiology, 2014, 120:1362-1369.
[10]Prigge L, Albert-Neels van Schoor, Marius C, et al. Clinical anatomy of the maxillary nerve block in pediatric patiens[J]. Pediatric Anesthesia, 2014, 24:1120-1126.
[11]邓彬华,彭玉成,范静平,等.翼腭窝CT三维重建的临床应用[J].解剖学杂志, 2005, 28(6):682-684.
[12]郭强,麻瑞晨,党彩艳.两种穿刺入路射频热凝治疗原发性三叉神经痛的临床比较[J].中国疼痛医学杂志, 2017, 23(8):613-615.
[13]杨巨顺,崔磊,何玉泉,等.正常成人圆孔骨性通道相关参数的多层螺旋CT研究[J].中华解剖与临床杂志, 2017, 22(2):94-98.
[14]纪荣明,彭旭,钟启胜,等.上颌神经应用解剖学研究[J].解剖学杂志, 1998, 21(6)558-560.
[15]Stoj?ev Staj?i?L, Ga?i?B, Popovi?N, et al. Anatomical study of the pterygopalatine fossa pertinent to the maxillary nerve block at the foramen rotundum. Int[J].J Oral Maxillofacial Surg, 2010, 39:493-496.
[16]Bratbak DF, Folvik M, Nordg?rd S. Depicting the pterygopalatineganglionon3 Teslamagneticresonance images[J].SurgicalandRadiologic Anatomy,2017,DOI:10.1007/s00276-017-1960-6.