额颞眶颧入路的显微解剖学研究.DOCVIP

临床医学论文-额颞眶颧入路的显微解剖学研究 ????????????? 作者：杨军 张庆林 于春江 石祥恩 高秀来 【摘要】 目的 为额颞眶颧手术入路提供显微外科解剖学基础。方法 10例经福尔马林固定的国人成人尸头共20侧，15例头颅干标本共30侧，对额颞眶颧手术入路相关解剖标志进行了详细地显微解剖、观察、拍摄、测量和统计。结果 面神经额支与颧支、眶上孔或眶上切迹出入眶的眶上神经及血管均存在变异的可能，离断颧弓的断端间距约30mm，颅骨外板外缘至颧骨前后根夹角处距离约25mm，前后根交点与中颅窝底的夹角为-0.03±2.83（-5.0～4.0）°。结论 额颞眶颧入路适用于起源于蝶骨嵴或眶内且向前颅窝延伸及颅内部分主要集中位于中颅窝底的巨大颅眶沟通瘤;入路的手术空间和视角较理想，是眶尖区联合手术入路中复杂的手术类型之一，应根据手术需要酌情采用。 　　关键词 额颞眶颧 手术入路 颅底 显微解剖 　　Study on the microsurgical anatomy of the frontotemporal-orbitozygomatic approach?????? 　　【Abstract】 Objective To study the microsurgical anatomy of the frontotemporal-orbitozygomatic approach and provide anatomical basis for operative approach.Methods 10cases（20sides）of Chinese adult cadaver heads fixed by10%formalin and15cases（30sides）of dry skull samples were studied.The relative anatomical landmarks of the frontotemporal-orbitozygomatic approach were dissected under microscope，observed，photographed，measured and analyzed.Results The frontal and zygomatic branches of the facial nerves and the supraorbital nerves and vessels via the supraorbital foramen or incisure had variations.The spacing between the broken tips of the broken zygomatic arch was about30mm.The distance from the outer border of the skull to the intersecting point of the anterior and the posterior root of the zygomatic bone was about25mm.The angle between the intersecting point of the anterior and the posterior root and the middle skull base was0.03±2.83（-5.0～4.0）°.Conclusion The Frontotemporal-orˉbitozygomatic approach is applicable to the great cranio-orbital tumors which originate from the sphenoid wing or within the orbit，extend to the anterior skull fossa，and mainly lie in the middle skull fossa.The operative space and visual angle of this approach are satisfactory.However，this approach might damage the varied structures and is one of the most complex operations among the combined approaches in the orbital apex region.This approach should be used with discretion according to the operative need.??