Açar Gülay, Özen Kemal Emre, Güler İbrahim, Büyükmumcu Mustafa
Necmettin Erbakan University, Meram Faculty of Medicine, Department of Anatomy, Konya, Turkey.
İzmir Kâtip Çelebi University, Faculty of Medicine, Department of Anatomy, İzmir, Turkey.
Braz J Otorhinolaryngol. 2018 Nov-Dec;84(6):713-721. doi: 10.1016/j.bjorl.2017.08.009. Epub 2017 Sep 8.
The course of the infraorbital canal may leave the infraorbital nerve susceptible to injury during reconstructive and endoscopic surgery, particularly when surgically manipulating the roof of the maxillary sinus.
We investigated both the morphometry and variations of the infraorbital canal with the aim to show the relationship between them relative to endoscopic approaches.
This retrospective study was performed on paranasal multidetector computed tomography images of 200 patients.
The infraorbital canal corpus types were categorized as Type 1: within the maxillary bony roof (55.3%), Type 2: partially protruding into maxillary sinus (26.7%), Type 3: within the maxillary sinus (9.5%), Type 4: located anatomically at the outer limit of the zygomatic recess of the maxillary bone (8.5%). The internal angulation and the length of the infraorbital canal, the infraorbital foramen entry angles and the distances related to the infraorbital foramen localization were measured and their relationships with the infraorbital canal variations were analyzed. We reported that the internal angulations in both sagittal and axial sections were mostly found in infraorbital canal Type 1 and 4 (69.2%, 64.7%) but, there were commonly no angulation in Type 3 (68.4%) (p<0.001). The length of the infraorbital canal and the distances from the infraorbital foramen to the infraorbital rim and piriform aperture was measured as the longest in Type 3 and the smallest in Type 1 (p<0.001). The sagittal infraorbital foramen entry angles were detected significantly smaller in Type 3 and larger in Type 1 than that in other types (p=0.003). The maxillary sinus septa and the Haller cell were observed in 28% and 16% of the images, respectively.
Precise knowledge of the infraorbital canal corpus types and relationship with the morphometry allow surgeons to choose an appropriate surgical approach to avoid iatrogenic infraorbital nerve injury.
眶下管的走行可能使眶下神经在重建手术和内镜手术过程中易受损伤，尤其是在对上颌窦顶进行手术操作时。
我们研究了眶下管的形态测量和变异情况，旨在揭示它们与内镜入路之间的关系。
对200例患者的鼻旁多排螺旋计算机断层扫描图像进行了这项回顾性研究。
眶下管主体类型分为：1型：位于上颌骨骨顶内（55.3%）；2型：部分突入上颌窦（26.7%）；3型：位于上颌窦内（9.5%）；4型：解剖学上位于上颌骨颧隐窝的外限处（8.5%）。测量了眶下管的内角和长度、眶下孔入口角度以及与眶下孔定位相关的距离，并分析了它们与眶下管变异的关系。我们报告称，矢状面和轴状面的内角大多见于眶下管1型和4型（分别为69.2%和64.7%），但3型通常无角度（68.4%）（p<0.001）。眶下管长度以及眶下孔到眶下缘和梨状孔的距离测量结果显示，3型最长，1型最短（p<0.001）。3型矢状面眶下孔入口角度明显小于其他类型，1型则大于其他类型（p=0.003）。分别在28%和16%的图像中观察到上颌窦隔和哈勒气房。
精确了解眶下管主体类型及其与形态测量的关系，有助于外科医生选择合适的手术入路，避免医源性眶下神经损伤。
