Study on the consistency between CBCT image features of sphenopalatine foramen and those seen in nasal endoscopy
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摘要: 目的 通过在翼管神经分支切断术术中解剖蝶腭孔，探讨蝶腭孔的临床解剖。再将解剖与蝶腭孔锥形束CT(cone beam computed tomography，CBCT)的影像结合分析，以实现通过蝶腭孔CBCT影像导航临床手术。 方法 收集2017年10月至2023年9月行翼管神经分支切断术患者84例(168侧)，根据术中蝶腭孔的解剖进行临床总结，同时提取患者术前鼻窦CBCT研究蝶腭孔的影像学表现。 结果 蝶腭孔临床解剖可分为4中类型，中鼻道型占1.19%，跨鼻道型占62.29%，上鼻道型占33.33%，双孔型占1.19%。筛嵴出现率为98.81%。蝶腭孔-鼻后孔距离(SP)和蝶腭孔下缘位角(∠a)分别为左侧(14.63±2.66) mm、右侧(14.65±2.63) mm和左侧(62.36±10.05)°、右侧(61.51±11.82)°。轴位CT影像可将蝶腭孔层面分为5个层面：蝶腭孔上缘层面，翼管神经层面，基板交互层面，蝶腭孔下缘层面以及翼腭管层面。蝶腭孔内镜解剖与影像学导航契合度为100%。 结论 蝶腭孔具有多种解剖类型，术前导航般蝶腭孔CBCT阅片可有效的了解蝶腭孔的解剖，为选择手术方式及避免严重并发症发生提供参考，临床有一定应用价值。Abstract: Objective To study the clinical anatomy of the sphenopalatine foramina by dissecting the sphenopalatine foramina during Vidian nerve branch neurotomy. The anatomy and CBCT images of sphenopalatine foramen were analyzed to facilitate the navigational of clinical operation using CBCT images. Methods From October 2017 to September 2023, 84 cases(168 sides) of Vidian nerve branch neurotomy in our department were collected. The clinical summary was made according to the anatomy of sphenopalatine foramen during the operation. Preoperative CBCT imaging findings of the sphenopalatine foramina were also studied. Results The clinical anatomy of sphenopalatine foramen could be divided into four types: middle meatus type(1.19%), trans-meatus type(62.29%), superior meatus type(33.33%) and double foramen type(1.19%). The incidence of ethmoidal ridge was 98.81%. The distance from sphenopalatine foramina to posterior nasal canal were(14.63±2.66) mm to left and(14.65±2.63) mm to right, The position Angle ∠a of lower margin of sphenopalatine foramina were(62.36±10.05)° to left and(61.51±11.82)° to right, respectively. Axial CT images can be used to divide the sphenopalatine foramen into five levels: the upper edge of the sphenopalatine foramen level, the Vidian nerve level, the basal plate interaction level, the lower edge of the sphenopalatine foramen level and the pterygopalatine canal level. The agreement between endoscopic anatomy of sphenopalatine foramen and imaging navigation was 100%. Conclusion The sphenopalatine foramina exhibit various anatomical types. The preoperative navigational CBCT reading can effectively identify the type of sphenopalatine foramina, guide the choice of surgical method, and help avoid serious complications. This has significant clinical application value.
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表 1 不同类型蝶腭孔EF及∠a的数据统计
项目 侧别 中鼻道型 跨鼻道型 上鼻道型 双孔型 总计 例数(侧数) 1(2) 54(108) 28(56) 1(2) 84(168) SP/mm 左侧 15 15.75±1.96 15.89±1.73 13 14.63±2.66 右侧 15 14.04±2.85 13.96±2.83 14 14.65±2.63 ∠a/° 左侧 40 63.05±10.23 62.07±9.14 56 62.36±10.05 右侧 40 62.91±10.31 59.78±13.99 56 61.51±11.82 
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