Li Lifeng, London Nyall R, Prevedello Daniel M, Carrau Ricardo L
Department of Otolaryngology-Head and Neck Surgery, 117902Beijing Tongren Hospital, Capital Medical University, Beijing, China.
Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, Ohio.
Am J Rhinol Allergy. 2023 May;37(3):291-297. doi: 10.1177/19458924221139019. Epub 2022 Nov 13.
Caudal pneumatization of the pterygoid process may impact endonasal exposure of the lateral recess of sphenoid sinus (LRSS).
This study aims to explore the implications of a pneumatized pterygoid process for an endonasal transpterygoid approach to the LRSS and to define strategies regarding the preservation or sacrifice of the vidian nerve.
Dissection of the LRSS (11 sides) was performed on 6 cadaveric specimens, preselected for the radiographic presence of an LRSS. In addition, the dimensions of the LRSS were measured on the deidentified CT images of 120 patients (240 sides). The sphenoid sinus was subdivided into 3 categories: Type 1 (no identifiable LRSS), Type 2 (lateral pneumatization of the greater wing above the vidian canal), and Type 3 (pneumatization of both the greater wing and the pterygoid process).
On the cadaveric specimens, a Type 2 pneumatization often allowed access to the LRSS above the level of the vidian canal; thus, sparing the vidian neurovascular bundle. In Type 3 pneumatization, a frontal corridor through the pterygoid base could be created to reach the LRSS with preservation of the vidian nerve. Extreme Type 3 pneumatization, however, required the transposition or sacrifice of the vidian nerve to facilitate a full direct access to the superolateral LRSS. Measurements on CT images revealed that the extent of caudal pneumatization of the pterygoid process had no statistically significant correlation with the superolateral extension of the lateral recess in patients with Type 3 LRSS ( > .05).
Pneumatization of the LRSS toward a caudal or superolateral direction may develop independent from each other. Caudal pneumatization of the pterygoid process seems to variably impact the endonasal exposure of the LRSS.
翼突的尾侧气化可能会影响蝶窦外侧隐窝（LRSS）的鼻内暴露。
本研究旨在探讨气化的翼突对经鼻经翼突入路至LRSS的影响，并确定有关保留或牺牲翼管神经的策略。
在6具尸体标本上进行LRSS（11侧）的解剖，这些标本因影像学上存在LRSS而预先选定。此外，在120例患者（240侧）的去识别CT图像上测量LRSS的尺寸。蝶窦分为3类：1型（无可识别的LRSS），2型（翼管上方大翼的外侧气化）和3型（大翼和翼突均气化）。
在尸体标本上，2型气化通常允许在翼管水平上方进入LRSS；因此，可保留翼管神经血管束。在3型气化中，可通过翼突基部创建一个额侧通道以在保留翼管神经的情况下到达LRSS。然而，极端的3型气化需要移位或牺牲翼管神经以利于完全直接进入LRSS的上外侧。CT图像测量显示，在3型LRSS患者中，翼突的尾侧气化程度与外侧隐窝的上外侧延伸无统计学显著相关性（>0.05）。
LRSS向尾侧或上外侧方向的气化可能相互独立发展。翼突的尾侧气化似乎对LRSS的鼻内暴露有不同程度的影响。
