Zhang Lu, Fang Dongliang, Jiang Dawei, Xu Zhixian, Guo Mengmeng, Chen Lihe, Lin Peijun
Department of Acupuncture and Moxibustion, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, China.
Morphology Department, Capital Medical University.
Zhongguo Zhen Jiu. 2016 Nov 12;36(11):1171-1176. doi: 10.13703/j.0255-2930.2016.11.018.
To identify the feasibility and safety of fossa infratemporalis approach for blind-needle at sphenopalatine ganglion so as to provide anatomical evidence for the operation and the prevention of non-immediate adverse reaction.
The variations of pterygopalatine fossae in sixty dry skulls were observed by selecting measuring points for facial skull width. The brains of six wet skulls were taken out,then acupuncture of fossa infratemporalis approach was applied. Sphenopalatine ganglion was separated accurately with the pterygopalatine segment of maxillary arteria retained in the pterygopalatine fossa after its paries posterior was opened. We detected whether the needle was inserted into pterygopalatine fossa. Measurements showed needle inserted depth, facial skull width,the distance between the needle and sphenopalatine ganglion,the distance between the needle and the pterygopalatine segment of maxillary arteria,the distance between the pterygopalatine segment of maxillary arteria and the crotaphitic nerve in pterygopalatine fossa.
The distance between the slight hollow under bilateral arcus superciliaris was selected as skull width, and 3 dry skulls showed the variation of pterygopalatine fossa. Needles were inserted into the pterygopalatine fossae of the wet skulls (12 times). The proportion of the inserting depth to the distance between the slight hollow under bilateral arcus superciliaris was 44%-54%. Only twice did the needle contact sphenopalatine ganglion. The average distances between the sphenopalatine ganglion and the needle were (5.88±3.70) mm in the left side and (6.43±5.54) mm in the right side. The average distances between the needle and the pterygopalatine segment of maxillary arteria were (2.77±3.99) mm left and (2.53±3.10) mm right. The average distances between the pterygopalatine segment of maxillary arteria and the crotaphitic nerve in pterygopalatine fossa were (2.83±4.05) mm left and (2.67±4.95) mm right. The mean data between the two sides had no statistic significance about all the above indices (all >0.05).
Fossa infratemporalis approach is feasible for blind-needle at sphenopalatine ganglion with less possibility to contact it. The effect of treating nasitis may achieved by little distance to nerve. Pricking at the pterygopalatine segment of maxillary arteria may induce non-immediate adverse reaction. The safety and efficacy should be comprehensively considered. There is a proportional relationship between the width of the skull and the insertion depth of the needle. The inserting depth of 44 percent may appropriate accounted for skull width.
探讨颞下窝进路行翼腭神经节盲穿的可行性及安全性，为手术操作及预防非即时不良反应提供解剖学依据。
选取60具干燥颅骨，测量面部颅骨宽度的测量点，观察翼腭窝的变异情况。取6具湿性颅骨的脑标本，采用颞下窝进针法进行针刺。打开翼腭窝后壁后，保留翼腭窝内上颌动脉翼腭段，准确分离翼腭神经节。检测针是否刺入翼腭窝。测量针的刺入深度、面部颅骨宽度、针与翼腭神经节的距离、针与上颌动脉翼腭段的距离、翼腭窝内上颌动脉翼腭段与颧神经的距离。
选取双侧眉弓下浅凹间距离作为颅骨宽度，3具干燥颅骨显示翼腭窝变异。针均刺入湿性颅骨的翼腭窝（共12次）。刺入深度与双侧眉弓下浅凹间距离的比例为44% - 54%。仅2次针接触到翼腭神经节。左侧翼腭神经节与针的平均距离为(5.88±3.70)mm，右侧为(6.43±5.54)mm。针与上颌动脉翼腭段的平均距离左侧为(2.77±3.99)mm，右侧为(2.53±3.10)mm。翼腭窝内上颌动脉翼腭段与颧神经的平均距离左侧为(2.83±4.05)mm，右侧为(2.67±4.95)mm。上述各项指标两侧的均值比较差异均无统计学意义（均P>0.05）。
颞下窝进路行翼腭神经节盲穿是可行的，接触翼腭神经节的可能性较小。近距离接触神经可能达到治疗鼻炎的效果。针刺上颌动脉翼腭段可能引发非即时不良反应。应综合考虑其安全性和有效性。颅骨宽度与针插入深度之间存在比例关系，插入深度占颅骨宽度的44%可能较为合适。
