Applied Medical Research Centre, St Vincent's Hospital, University of New South Wales, and Macquarie University, Darlinghurst, Sydney, Australia.
Am J Rhinol Allergy. 2013 May-Jun;27 Suppl 1:S3-6. doi: 10.2500/ajra.2013.27.3888.
An understanding of paranasal sinus anatomy based on important fixed landmarks rather than variable anatomy is critical to ensure safe and complete surgery. The concept of the paranasal surgical box defines the anatomic limits of dissection. The boundaries of the surgical box include the middle turbinate medially, orbital wall laterally, and skull base superiorly. The "vertical component" of the surgical box defines the boundaries of the frontal recess and includes the middle turbinate and intersinus septum medially, medial orbital wall and orbital roof laterally, nasofrontal beak anteriorly, and skull base and posterior table of frontal sinus posteriorly. The paranasal sinuses are divided into anterior, posterior, and sphenoidal functional cavities based on their distinct drainage pathways into the nose. The ultimate goal of surgery is to create a functional sinus cavity. Application of the paranasal surgical box and its vertical component enables the surgeon to view the limits of dissection with a single position of the endoscope. This will ensure complete dissection of the functional sinonasal compartments and effectively avoid leaving behind disconnected cells from the surgical cavity, mucocele formation, mucous recirculation, overcome obstructive phenomenon and enable maximal delivery of topical therapy in the post-operative setting. This article reviews the structure and function of the nasal cartilages and turbinates. It also describes the concept of the paranasal surgical box, key anatomical landmarks and limits of dissection. Normal anatomy and common variants of normal anatomy are discussed.
基于重要的固定标志而不是可变的解剖结构来理解鼻窦解剖结构对于确保手术的安全和完整至关重要。鼻窦手术盒的概念定义了解剖的界限。手术盒的边界包括中鼻甲在内侧，眼眶壁在外侧，颅底在上侧。手术盒的“垂直部分”定义了额窦的前界，包括中鼻甲和窦间隔在内侧，内侧眼眶壁和眼眶顶在外侧，鼻额缝在前侧，额窦的颅底和后板在后侧。根据其通向鼻腔的不同引流途径，鼻窦分为前、后和蝶窦功能腔。手术的最终目标是创建一个功能性鼻窦腔。鼻窦手术盒及其垂直部分的应用使外科医生能够通过内窥镜的单个位置观察到解剖的范围。这将确保对功能性鼻窦腔进行彻底的解剖，并有效地避免在手术腔中留下未连接的细胞、黏液囊肿形成、黏液再循环、克服阻塞现象，并在术后环境中最大限度地输送局部治疗。本文回顾了鼻软骨和鼻甲的结构和功能。还描述了鼻窦手术盒的概念、关键解剖标志和解剖界限。讨论了正常解剖结构和正常解剖结构的常见变异。
