A vidian neurectomy approach with the sphenoid process of the palatine bone as a landmark
-
摘要: 目的 探索一种以腭骨蝶突为标志，能够安全有效定位翼管神经并将其切断的手术方式。方法 通过尸头解剖确认可有效定位翼管外口的手术标志，并验证利用确定的解剖标志在术中定位翼管神经的可行性。结果 通过对5例(10侧)尸头解剖研究确定腭鞘管前口、腭鞘管后口、腭鞘管及翼突根部延续至鼻咽顶的骨嵴几个解剖标志可作为定位翼管神经的重要标志。应用以上解剖标志在10例难治性变应性鼻炎及血管运动性鼻炎患者中成功定位翼管神经并将其切断，1例患者术后出现短期单侧硬腭麻木的不良反应。结论 腭鞘管前口、腭鞘管后口、腭鞘管及翼突根部延续至鼻咽顶的骨嵴可作为以腭骨蝶突为标志的翼管神经切断术的手术标志。Abstract: Objective To explore a safe and effective surgical approach to locate and cut the vidian nerves with the sphenoid process of the palatine bone as a landmark. Methods The landmarks of locating the external opening of the vidian canal were confirmed by the dissection of the cadaveric heads, and the feasibility of locating the vidian nerves with the determined landmarks was verified during operation.Results The anatomical landmarks, which are the anterior opening of palatovaginal canal, the posterior opening of palatovaginal canal, palatovaginal canal and the nasal pharyngeal crest of the root of the pterygoid process can be used as the important landmarks of locating vidian nerve. In the cases of 10 patients with refractory allergic rhinitis and vasomotor rhinitis, the vidian nerves were successfully located and sectioned, and one patient was complicated with short-term unilateral palatal numbness after surgery.Conclusion The anterior opening of palatovaginal canal, the posterior opening of palatovaginal canal, palatovaginal canal and the nasal pharyngeal crest of the root of the pterygoid process can be used as surgical markers for vidian neurectomy with the sphenoid process of the palatine bone as landmarks.
-
-
[1] 中华耳鼻咽喉头颈外科杂志编辑委员会鼻科组, 中华医学会耳鼻咽喉头颈外科学分会鼻科学组. 中国变应性鼻炎诊断和治疗指南(2022年, 修订版)[J]. 中华耳鼻咽喉头颈外科杂志, 2022, 57(2): 106-109 https://www.cnki.com.cn/Article/CJFDTOTAL-YRBH202202017.htm
[2] Marshak T, Yun WK, Hazout C, et al. A systematic review of the evidence base for vidian neurectomy in managing rhinitis[J]. J Laryngol Otol, 2016, 130 Suppl 4: S7-S28.
[3] Pinheiro-Neto CD, Fernandez-Miranda JC, Rivera-Serrano CM, et al. Endoscopic anatomy of the palatovaginal canal(palatosphenoidal canal): a landmark for dissection of the vidian nerve during endonasal transpterygoid approaches[J]. Laryngoscope, 2012, 122(1): 6-12. doi: 10.1002/lary.21808
[4] Meng QG, Lu YT, Wang CX, et al. Visualisation of the vomerovaginal canal during endonasal transpterygoid approaches and CT imaging diagnosis[J]. J Anat, 2019, 235(2): 246-255. doi: 10.1111/joa.13009
[5] 余少卿, 王向东, 徐睿, 等. 变应性鼻炎的外科手术治疗专家共识(2022, 上海)[J]. 中国耳鼻咽喉颅底外科杂志, 2022, 28(1): 7-17. https://www.cnki.com.cn/Article/CJFDTOTAL-ZEBY202201002.htm
[6] el Shazly MA. Endoscopic surgery of the vidian nerve. Preliminary report[J]. Ann Otol Rhinol Laryngol, 1991, 100(7): 536-539. doi: 10.1177/000348949110000703
[7] Zhao C, Ji Y, An Y, et al. An Alternative Methodsof Endoscopic Intrasphenoidal Vidian Neurectomy[J]. OTO Open, 2018, 2(1): 2473974X18764862.
[8] 刘婷, 李鹏, 孟庆翔, 等. 腭鞘管及蝶腭动脉在翼管神经切断术中定位翼管的作用[J]. 临床耳鼻咽喉头颈外科杂志, 2020, 34(7): 606-609. http://www.cnki.com.cn/Article/CJFDTotal-LCEH202007008.htm
[9] Meng Q, Lu Y, Shi L, et al. The posterior groove as a landmark for location of the palatovaginal canal in axial computed tomography[J]. Surg Radiol Anat, 2016, 38(7): 825-833.
-
下载:
图(2)
计量
- 文章访问数: 1048
- PDF下载数: 475
- 施引文献: 0