上颌骨掀翻入路之相关解剖学研究

发布时间：2018-05-30 08:59

本文选题：上颌骨 + 掀翻　；参考：《山西医科大学》2011年硕士论文

【摘要】：[目的] (1)研究上颌骨掀翻入路所能暴露的全部解剖结构、相互毗邻关系及所受到的限制,为采用该术式处理相应解剖部位的病变提供系统直观的解剖学资料；(2)研究上颌骨掀翻入路所涉及的由浅至深的全部层次及每一层与手术入路相关的重要解剖结构及标志；(3)研究变异血管对手术入路及术后的影响。 [方法]对20例40侧固定的男性成人尸头利用局部解剖法分别进行逐层解剖,外侧出面神经五大分支层次至翼腭窝及内侧出鼻中隔层次至翼腭窝的各层解剖；研究上颌骨掀翻入路所暴露的咽旁间隙、海绵窦、颞下窝及翼腭窝等重要解剖结构；利用红色乳胶灌注后对于血管的清晰显示研究此手术入路所涉及的重要血管及其血供；利用自然腐蚀法对头面部重要血管网进行更加直观的显示,为手术后防止上颌骨坏死提供解剖学资料；在尸头上模拟上颌骨掀翻入路观察暴露的解剖区域及相关的重要动脉走行。 [结果] (1)明确了鼻腔外侧壁、蝶筛区、颅底、海绵窦、翼腭窝、颞下窝、咽旁间隙等重要解剖结构的详细形态、界限、毗邻及走行的神经血管；(2)明确了上颌骨掀翻入路所经过的重要解剖层次；(3)明确了上颌骨掀翻入路所涉及的重要血管的具体走行及其支配区域,同时观察了相邻区域的交通血管及血管网。(4)发现一例有关面动脉的变异。[结论] 本研究通过对上颌骨掀翻入路之相关解剖进行全面系统的研究后得出以下结论： 1、上颌骨掀翻入路所能暴露的解剖结构有：鼻腔外侧壁、蝶筛区、中颅底及前颅底、海绵窦、鼻咽部、咽旁间隙、翼腭窝、颞下窝。 2、颞下窝与颅底通过卵圆孔及其走行的下颌神经交通；翼腭窝与颅底通过圆孔及其走行的上颌神经交通,故颞下窝与翼腭窝的病变容易侵入颅底。 3、上颌骨掀翻的切口会损伤鼻翼动脉,但对于发出鼻翼动脉之前的面动脉没有影响,故面动脉可作为上颌骨掀翻术后的一重要面部供血动脉。 4、眶下动脉在上颌骨掀翻的整个过程中可以保留,如果病变区域不需要掀翻角度太大可以保留眶下动脉作为面部一供血动脉,如若病变需要掀翻角度大,可以先找到眶下动脉结扎,避免掀翻过程中大的出血。 5、蝶腭动脉分为两支,其中鼻中隔后动脉在掀翻过程中必然会损伤,而鼻后外侧动脉在掀翻后可以完整保留,故可以作为术后鼻腔外侧壁的供血动脉,若手术破坏太大,可在掀翻前先找到此动脉结扎,避免掀翻过程出血量过大。 6、上颌动脉从颈外动脉发出后,在下颌骨颏突上方发出颊动脉,向前外下走行,支配颊肌。此动脉位于上颌骨外侧,不受掀翻的影响,故可以作为术后面部的供血动脉。 7、在头面部的血管铸型中可以看到下颌骨浅面有一丰富的血管网,此区域紧邻上领骨,同时处于上颌骨外侧,不受掀翻的影响,可以作为术后一重要的面部供血区域；在颧弓上方,即颞窝处,还有一丰富的血管网,距离上颌骨近,可在上颌骨掀翻术后作为供血动脉区域。 8、发现一例红色乳胶灌注的尸头右侧颈外动脉在发出面动脉之后,面横动脉之前,在两支动脉之间发出一支新的动脉,向下走行至下颌角上方处水平向前至颏孔稍外侧发出数支分别支配颊肌、口轮匝肌下部、颏肌,并与眶下动脉、面动脉之间有一丰富的交通支吻合。而面动脉在绕过下颌角后,上行至颏孔处,支配该区域的肌肉,并无继续上行。左侧面动脉发出的上唇动脉一直沿着上唇上方水平向右走行,止于右侧口角附近,右侧上唇动脉缺如。
[Abstract]:[Objective] (1) to study the total anatomical structure, the adjacent relationship and the limitations of the maxillary dissection approach, to provide systematic and visual anatomical data for the surgical treatment of the diseased parts of the anatomy, and (2) to study the all levels of the upper jaw and the depth of the upper jaw and the surgical approach. Related important anatomical structures and signs; (3) to study the effects of variant vessels on operative approaches and postoperative outcomes.
[Methods] 20 male adult cadaver heads with 40 sides were anatomically dissected by local anatomy. The five branches of the lateral outlining nerve were dissected to the pterygopalatine fossa and the medial septum to the pterygopalatine fossa. The parapharyngeal space, the cavernous sinus, the infratemporal fossa and the pterygopalatine fossa were studied. Structure; the clear display of blood vessels after perfusion of red latex studies the important blood vessels and blood supply involved in the surgical approach; the natural corrosion method is used to display the important vascular network of the head and face more intuitively, to provide anatomical data for the prevention of maxillary necrosis after operation; and to simulate the approach of the upper jaw on the head of the corpse. Observe the anatomic area and related important arteries.
[results] (1) the detailed anatomy of the important anatomical structures, such as the lateral wall of the nasal cavity, the butterfly sieves, the skull base, the cavernous sinus, the pterygopalatine fossa, the infratemporal fossa, the parapharyngeal space and other important anatomical structures, and the adjacent and walking nerve vessels; (2) (3) the important vessels involved in the upper jaw opening approach were clearly defined. We also observed the traffic vessels and vascular network in the adjacent area. (4) a variant of the facial artery was found. [Conclusion]
In this study, a comprehensive and systematic study of the anatomy of the maxillary overturn approach was carried out.
1, the anatomical structures of the upper jaw open approach include the lateral wall of the nasal cavity, the butterfly sieve area, the middle skull base and the anterior skull base, the cavernous sinus, the nasopharynx, the parapharyngeal space, the pterygopalatine fossa, and the infratemporal fossa.
2, the infratemporal fossa and the skull base through the oval orifice and the moving of the mandibular nerve; the pterygopalatine fossa and the skull base through a circular hole and its moving maxillary nerve, so the lesions of the infratemporal fossa and pterygopaltine fossa are easily intruded into the skull base.
3, the incision of the maxillary bone can damage the alar artery, but it does not affect the facial artery before the alar artery is emitted, so the facial artery can be used as an important facial blood supply artery after the maxillofacial overturn.
4, the suborbital artery can be retained during the entire process of the maxillofacial upturn. If the lesion does not need to be overturned, the suborbital artery can be retained as a blood supply on the face. If the lesion needs to be turned over a large angle, the suborbital artery ligation can be found to avoid overturning Cheng Zhongda's bleeding.
5, the sphenopalatine artery is divided into two branches, of which the posterior nasal septum artery is bound to be damaged during the overturn, and the posterior lateral nasal artery can be retained completely after overturning, so it can be used as a blood supply artery for the lateral wall of the nasal cavity after operation. If the operation is too large, the artery ligation can be found before the overturn, so as to avoid excessive bleeding.
6, after the maxillary artery is sent out from the external carotid artery, the buccal artery is sent out of the mandibular chin process and moves forward and down to dominate the cheek muscles. This artery is located outside the maxilla and is not affected by overturn, so it can be used as the blood supply artery for the postoperative face.
7, in the vascular cast of the head and face, we can see a rich vascular network on the shallow surface of the mandible. This area is close to the upper collar bone and is at the lateral of the maxilla. It is not affected by the overturn. It can be used as an important area of facial blood supply after the operation. Above the zygomatic arch, the temporal fossa, and a rich vascular net near the maxilla, can be in the upper jaw. Bone turnover was used as a blood supply artery area.
8, we found that one case of the right external carotid artery of the head of the corpse of the corpse filled with red latex was given a new artery between the two arteries before the surface of the facial artery, and a few branches of the buccal muscle, the lower part of the orbicularis orbicularis muscle, the chin muscle, the facial artery, and the inferior orbitalis, and the facial artery. There is a rich anastomosis between the traffic branches, and the facial artery goes up to the chin and does not continue to go up after the mandibular angle. The upper lip artery from the left lateral artery goes straight along the upper lip to the right, close to the right corner, and the right upper lip artery is absent.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R322

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