Sugisaki M, Ikai A, Tanabe H
Department of Dentistry, Jikei University School of Medicine, Tokyo, Japan.
J Oral Maxillofac Surg. 1995 Jul;53(7):803-10. doi: 10.1016/0278-2391(95)90337-2.
Several reports have suggested a risk of injury to the middle cranial fossa and middle ear during arthroscopic procedures in the superior joint space of the temporomandibular joint (TMJ). However, there has been no anatomic study of directions and distances of the TMJ from the posterior portal in relation to the risk of mandibular fossa injury. In this study, the angles and depths at which the risk is greatest for injury to the deepest point of the mandibular fossa (DP) and to the middle ear during arthroscopy were analyzed.
Three-dimensional measurements of 96 mandibular fossae in 48 dry skulls were made.
It was found that the distance from the lateral rim of the fossa to DP and Hugier's canal was 9.50 +/- 2.07 mm and 17.04 +/- 3.09 mm, respectively. The most dangerous angle for DP injury in the Frankfort horizontal plane (FH plane) was an inclination of the instrument base of -8 degrees dorsad and 17 and 19 degrees caudad in the frontal plane. The most dangerous angle for Hugier's canal injury was a tilting of the instrument base of 15 degrees ventrad in the FH plane and -2 degrees craniad in the frontal plane. However, these values showed a wide range.
It was concluded that great care must be exercised in manipulation of instruments near the DP and Hugier's canal to avoid injury to the middle ear or penetration into the middle cranial fossa.
多项报告提示，在颞下颌关节（TMJ）上关节腔进行关节镜手术时，存在中颅窝和中耳损伤风险。然而，关于TMJ与后入路的方向和距离与下颌窝损伤风险的关系，尚未有解剖学研究。在本研究中，分析了关节镜检查期间下颌窝最深点（DP）和中耳损伤风险最大时的角度和深度。
对48个干燥颅骨中的96个下颌窝进行三维测量。
发现从窝的外侧边缘到DP和胡吉尔管的距离分别为9.50±2.07mm和17.04±3.09mm。在法兰克福水平面（FH平面）中，DP损伤最危险的角度是器械底座向背侧倾斜8度，在额平面中向尾侧倾斜17度和19度。胡吉尔管损伤最危险的角度是器械底座在FH平面中向腹侧倾斜15度，在额平面中向头侧倾斜-2度。然而，这些值显示出较大范围。
得出结论，在DP和胡吉尔管附近操作器械时必须格外小心，以避免中耳损伤或穿透进入中颅窝。
