耳内镜手术相关面神经解剖

Endoscopic anatomical study of facial nerve

摘要:

摘 要： 目的 为安全实施耳内镜手术，避免面神经损伤提供解剖依据。方法 对12例24侧成人尸头样本进行解剖，暴露面神经全程，对面神经进行相关解剖测量，从外耳道、鼓窦、迷路（乙状窦）后径路用耳内镜对面神经进行观察。结果 所有标本均能通过上述径路在耳内镜下完整观察面神经全程，且清晰显露面神经隐窝以及咽鼓管鼓口周围结构。面神经垂直段恰位于骨迷路中轴线位置，面神经水平段介于外半规管和镫骨头之间；面神经鼓室段和上半规管顶、外半规管上缘距离分别为（8.59±1.75）mm和（3.83±1.11）mm，面神经乳突段距后半规管下缘距离为（3.13±1.53）mm；面神经乳突段和外耳道前、后壁距离分别为（10.50±1.91）mm和（3.85±0.99）mm；鼓索神经出外耳道后壁处和面神经鼓室段之间垂直距离为（2.21±0.76）mm，鼓索神经和面神经乳突段间夹角为27.30°±5.97°，内耳门外侧距乳突骨质表面水平距离为（33.82±2.80）mm，内耳门上缘距岩骨上缘距离为（4.96±1.40）mm。结论 耳内镜可以清晰显示显微镜难以暴露的手术区域，能清晰分辨并避免损伤面神经，在耳显微外科有广阔的应用前景。

Abstract:

Abstract: Objective To provide anatomic data of facial nerve for damnification avoidance in the otoendoscopic surgery. Methods 12 fomalinfixed adult cadaver specimens (24 sides) were anatomized, the entire facial nerve was exposed and related anatomic parameters were measured with endoscopy. Results All facial nerves were observed entirely with endoscopy; the facial recess and the tympanic orifice were also exposed clearly. Mastoid segment lied on the midline of the ossseous labyrinth.The distance from temporal bone surface to internal acoustic porus was (33.82±2.80) mm, that from the internal acoustic porus to superior edge of petrous was (4.96±1.40) mm.The distances from mastoid segment to front and back wall of external acoustic meatus were (10.50±1.91) mm and (3.85±0.99) mm respectively,while that to posterior semicircular canal was (3.13±1.53) mm. The distances from tympanic segment to lateral and superior semicircular canal were (3.83±1.11) mm and (8.59±1.75) mm. The length from chorda tympani nerve to tympanic segment of facial nerve was (2.21±0.76) mm, and the angle between chorda tympanic nerve and mastoid segment of facial nerve was 27.30°±5.97°. Conclusion The areas which could not exposed microscopically can be observed clearly by endoscopy. Owing to advantages of clear identification and damnification avoidance of the facial nerve, endoscopic surgery will be promising in otology.