Yu Q, Wang P, Shi H, Luo J, Sun D
Department of Radiology, Ninth People's Hospital, School of Stomatology, Shanghai Second Medical University, People's Republic of China.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998 Jun;85(6):742-51. doi: 10.1016/s1079-2104(98)90045-2.
The purpose of this study was to categorize the computed tomography features of lesions affecting the pterygopalatine fossa and infratemporal fossa and thus aid in the diagnosis of these lesions.
Eighty-six patients with lesions of the pterygopalatine fossa and infratemporal fossa were examined with computed tomography; the lesions were confirmed by both surgery and biopsy. The patients were divided into three groups: group I consisted of patients in whom the lesions had originated in one or both fossae; group II, of patients in whom the lesions originated in other oral and maxillofacial regions but showed extension into the pterygopalatine and infratemporal fossae; and group III, of patients in whom the lesions had multicentric origins.
Of the 11 cases in group I, demarcation was confined to both fossae in 4 patients, and involvement of the adjacent structures was shown on computed tomography images in 7 patients. Involved structures included the maxillary sinus (4 sides), nasal cavity (3 sides), mandibular ramus (6 sides), buccal space (2 sides), base of the skull (5 sides), palate (3 sides), and parapharyngeal space (5 sides). In the 70 cases in group II, computed tomography images showed that lesions had invaded both fossae via following routes: (1) 40 lesions in the maxillary sinus had infiltrated posterolaterally into 26 pterygopalatine and 39 infratemporal fossae; (2) two nasal cavity and three nasopharynx tumors had infiltrated laterally or lateroanteriorly into five pterygopalatine and one infratemporal fossae; (3) lesions originating in mandibular rami (9 lesions), buccal regions (4 lesions), parapharyngeal spaces (1 lesion) and parotid glands (1 lesion) had intruded medially into 15 infratemporal fossae; (4) two temporal bone tumors had encroached inferiorly on two infratemporal fossae; (5) four palate tumors had led to involvement of three pterygopalatine and four infratemporal fossae; and (6) four inflammatory diseases of the facial spaces involved two pterygopalatine and four infratemporal fossae. Group III lesions (5 cases) affecting one pterygopalatine and five infratemporal fossae were hemangiomas; one was a malignant lymphoma.
Group I lesions may involve the adjacent anatomic structures of both pterygopalatine and infratemporal fossae in every direction. Group II lesions that correspond to the various origins of the maxillofacial region have different pathways of infiltration into the pterygopalatine or infratemporal fossae. Computed tomography examination is very important in the evaluation of lesions involving the pterygopalatine and infratemporal fossae.
本研究旨在对累及翼腭窝和颞下窝的病变的计算机断层扫描特征进行分类，从而有助于这些病变的诊断。
对86例翼腭窝和颞下窝病变患者进行了计算机断层扫描检查；病变经手术和活检确诊。患者分为三组：第一组由病变起源于一个或两个窝的患者组成；第二组由病变起源于其他口腔颌面部区域但向翼腭窝和颞下窝扩展的患者组成；第三组由病变有多中心起源的患者组成。
在第一组的11例病例中，4例患者的界限局限于两个窝，7例患者的计算机断层扫描图像显示相邻结构受累。受累结构包括上颌窦（4侧）、鼻腔（3侧）、下颌支（6侧）、颊间隙（2侧）、颅底（5侧）、腭（3侧）和咽旁间隙（5侧）。在第二组的70例病例中，计算机断层扫描图像显示病变通过以下途径侵入两个窝：（1）上颌窦的40个病变向后外侧浸润至26个翼腭窝和39个颞下窝；（2）两个鼻腔和三个鼻咽部肿瘤向外侧或外前侧浸润至5个翼腭窝和1个颞下窝；（3）起源于下颌支（9个病变）、颊部区域（4个病变）、咽旁间隙（1个病变）和腮腺（1个病变）的病变向内侧侵入15个颞下窝；（4）两个颞骨肿瘤向下侵犯两个颞下窝；（5）四个腭部肿瘤导致3个翼腭窝和4个颞下窝受累；（6）四个面部间隙的炎症性疾病累及2个翼腭窝和4个颞下窝。第三组病变（5例）累及1个翼腭窝和5个颞下窝，均为血管瘤；1例为恶性淋巴瘤。
第一组病变可向各个方向累及翼腭窝和颞下窝的相邻解剖结构。与颌面部不同起源相对应的第二组病变向翼腭窝或颞下窝浸润的途径不同。计算机断层扫描检查在评估累及翼腭窝和颞下窝的病变中非常重要。
