Ference Elisabeth H, Smith Stephanie S, Conley David, Chandra Rakesh K
Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Laryngoscope. 2015 Jun;125(6):1296-300. doi: 10.1002/lary.25089. Epub 2015 Jan 13.
OBJECTIVES/HYPOTHESIS: To assess relevant variations in the anatomical course of the infraorbital nerve (ION). This understanding may reduce the risk of surgical injury.
A total of 100 consecutive computed-tomography sinus studies obtained in a tertiary referral center were reviewed, and measurements were made of the 200 IONs. Anatomic variants were classified into three types based on the degree to which (if any) the nerve's course descended from the maxillary roof into the sinus lumen.
A total of 60.5% of IONs were entirely contained within the sinus roof. In 27.0%, the nerve canal descended below the roof but remained juxtaposed to it. In 12.5%, the ION descended into the sinus lumen. The proportion of IONs descending into the sinus significantly increased to 27.7% when an infraorbital ethmoid cell was present (chi-square P < 0.001) and to 50% when the nerve was contained within a lamella of such a cell (chi-square P < 0.001). Descended nerves terminated in a foramen located an average of 11.9 ± 2.5 mm below the infraorbital rim, significantly further below the orbit than nondescended nerves (t test P < 0.001). Descended nerves were located a mean distance of 8.6 ± 2.9 mm below the sinus roof and traversed the sinus lumen diagonally for a mean length of 15.4 ± 3.1 mm.
Descent of the ION into the maxillary sinus is a common anatomic variant that is more prevalent in the setting of an ipsilateral infraorbital ethmoid cell. Descended nerves are associated with the foramen significantly further below the inferior orbital rim than those of nondescended nerves. These observations may help surgeons avoid iatrogenic ION injury.
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目的/假设：评估眶下神经（ION）解剖走行的相关变异情况。了解这些情况可能会降低手术损伤风险。
回顾了在一家三级转诊中心连续获取的100份鼻窦计算机断层扫描研究资料，并对200条眶下神经进行了测量。根据神经走行从上颌窦顶下降至窦腔内的程度（若有），将解剖变异分为三种类型。
共60.5%的眶下神经完全包含在窦顶内。27.0%的神经管道下降至窦顶以下但仍与之相邻。12.5%的眶下神经下降至窦腔内。当存在眶下筛窦气房时，下降至窦腔内的眶下神经比例显著增加至27.7%（卡方检验P<0.001），当神经包含在这种气房的一层中时，这一比例增加至50%（卡方检验P<0.001）。下降的神经终止于一个平均位于眶下缘下方11.9±2.5mm的孔，明显比未下降的神经更靠眶下（t检验P<0.001）。下降的神经平均位于窦顶下方8.6±2.9mm处，以对角线方式穿过窦腔，平均长度为15.4±3.1mm。
眶下神经下降至上颌窦是一种常见的解剖变异，在同侧眶下筛窦气房的情况下更为普遍。下降的神经与孔的关联明显比未下降的神经更靠眶下缘下方。这些观察结果可能有助于外科医生避免医源性眶下神经损伤。
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