本文選題：上頜骨 + 掀翻��； 參考：《山西醫(yī)科大學(xué)》2011年碩士論文

【摘要】：[目的] (1)研究上頜骨掀翻入路所能暴露的全部解剖結(jié)構(gòu)、相互毗鄰關(guān)系及所受到的限制,為采用該術(shù)式處理相應(yīng)解剖部位的病變提供系統(tǒng)直觀的解剖學(xué)資料；(2)研究上頜骨掀翻入路所涉及的由淺至深的全部層次及每一層與手術(shù)入路相關(guān)的重要解剖結(jié)構(gòu)及標(biāo)志；(3)研究變異血管對(duì)手術(shù)入路及術(shù)后的影響。 [方法]對(duì)20例40側(cè)固定的男性成人尸頭利用局部解剖法分別進(jìn)行逐層解剖,外側(cè)出面神經(jīng)五大分支層次至翼腭窩及內(nèi)側(cè)出鼻中隔層次至翼腭窩的各層解剖；研究上頜骨掀翻入路所暴露的咽旁間隙、海綿竇、顳下窩及翼腭窩等重要解剖結(jié)構(gòu)；利用紅色乳膠灌注后對(duì)于血管的清晰顯示研究此手術(shù)入路所涉及的重要血管及其血供；利用自然腐蝕法對(duì)頭面部重要血管網(wǎng)進(jìn)行更加直觀的顯示,為手術(shù)后防止上頜骨壞死提供解剖學(xué)資料；在尸頭上模擬上頜骨掀翻入路觀察暴露的解剖區(qū)域及相關(guān)的重要?jiǎng)用}走行。 [結(jié)果] (1)明確了鼻腔外側(cè)壁、蝶篩區(qū)、顱底、海綿竇、翼腭窩、顳下窩、咽旁間隙等重要解剖結(jié)構(gòu)的詳細(xì)形態(tài)、界限、毗鄰及走行的神經(jīng)血管；(2)明確了上頜骨掀翻入路所經(jīng)過的重要解剖層次；(3)明確了上頜骨掀翻入路所涉及的重要血管的具體走行及其支配區(qū)域,同時(shí)觀察了相鄰區(qū)域的交通血管及血管網(wǎng)。(4)發(fā)現(xiàn)一例有關(guān)面動(dòng)脈的變異。[結(jié)論] 本研究通過對(duì)上頜骨掀翻入路之相關(guān)解剖進(jìn)行全面系統(tǒng)的研究后得出以下結(jié)論： 1、上頜骨掀翻入路所能暴露的解剖結(jié)構(gòu)有：鼻腔外側(cè)壁、蝶篩區(qū)、中顱底及前顱底、海綿竇、鼻咽部、咽旁間隙、翼腭窩、顳下窩。 2、顳下窩與顱底通過卵圓孔及其走行的下頜神經(jīng)交通；翼腭窩與顱底通過圓孔及其走行的上頜神經(jīng)交通,故顳下窩與翼腭窩的病變?nèi)菀浊秩腼B底。 3、上頜骨掀翻的切口會(huì)損傷鼻翼動(dòng)脈,但對(duì)于發(fā)出鼻翼動(dòng)脈之前的面動(dòng)脈沒有影響,故面動(dòng)脈可作為上頜骨掀翻術(shù)后的一重要面部供血?jiǎng)用}。 4、眶下動(dòng)脈在上頜骨掀翻的整個(gè)過程中可以保留,如果病變區(qū)域不需要掀翻角度太大可以保留眶下動(dòng)脈作為面部一供血?jiǎng)用},如若病變需要掀翻角度大,可以先找到眶下動(dòng)脈結(jié)扎,避免掀翻過程中大的出血。 5、蝶腭動(dòng)脈分為兩支,其中鼻中隔后動(dòng)脈在掀翻過程中必然會(huì)損傷,而鼻后外側(cè)動(dòng)脈在掀翻后可以完整保留,故可以作為術(shù)后鼻腔外側(cè)壁的供血?jiǎng)用},若手術(shù)破壞太大,可在掀翻前先找到此動(dòng)脈結(jié)扎,避免掀翻過程出血量過大。 6、上頜動(dòng)脈從頸外動(dòng)脈發(fā)出后,在下頜骨頦突上方發(fā)出頰動(dòng)脈,向前外下走行,支配頰肌。此動(dòng)脈位于上頜骨外側(cè),不受掀翻的影響,故可以作為術(shù)后面部的供血?jiǎng)用}。 7、在頭面部的血管鑄型中可以看到下頜骨淺面有一豐富的血管網(wǎng),此區(qū)域緊鄰上領(lǐng)骨,同時(shí)處于上頜骨外側(cè),不受掀翻的影響,可以作為術(shù)后一重要的面部供血區(qū)域；在顴弓上方,即顳窩處,還有一豐富的血管網(wǎng),距離上頜骨近,可在上頜骨掀翻術(shù)后作為供血?jiǎng)用}區(qū)域。 8、發(fā)現(xiàn)一例紅色乳膠灌注的尸頭右側(cè)頸外動(dòng)脈在發(fā)出面動(dòng)脈之后,面橫動(dòng)脈之前,在兩支動(dòng)脈之間發(fā)出一支新的動(dòng)脈,向下走行至下頜角上方處水平向前至頦孔稍外側(cè)發(fā)出數(shù)支分別支配頰肌、口輪匝肌下部、頦肌,并與眶下動(dòng)脈、面動(dòng)脈之間有一豐富的交通支吻合。而面動(dòng)脈在繞過下頜角后,上行至頦孔處,支配該區(qū)域的肌肉,并無繼續(xù)上行。左側(cè)面動(dòng)脈發(fā)出的上唇動(dòng)脈一直沿著上唇上方水平向右走行,止于右側(cè)口角附近,右側(cè)上唇動(dòng)脈缺如。
[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.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2011
【分類號(hào)】：R322

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