咽旁颞下区的外科解剖钥匙———茎突

目的 研究茎突毗邻关系，为咽旁颞下区手术提供外科解剖基础。方法 测量颅骨。结果 茎突根部深面有颈静脉孔，两者相距约３ｍｍ。颈静脉孔前有动脉管外口，分隔两者间的骨板下缘厚约１．８７ｍｍ。在颈动脉管外口前外方有蝶骨角棘，二者相距约６．５ｍｍ。角棘之外侧有颞下颌关节窝，之前方为棘孔。棘孔之前内侧有卵圆孔。结论 茎突可作为咽旁颞下区的外科解剖钥匙。     

咽旁颞下区颈部血管体表标志及临床意义

目的 :研究确定咽旁颞下区重要结构的体表标志及对临床的指导作用。方法 :解剖新鲜尸头 6具 ,观测 12例咽旁颞下区的体表解剖标志及文献复习。结果 :骨性外耳道下内 ( 11.5± 2 .0 )mm为颈内静脉孔外壁 ,髁状突内缘距颈内动脉管外口为 ( 10 .0± 1.3 )mm ,下颌角后缘 ( 12 .0± 3 .0 )mm有颈内动脉经过 ,第一颈椎横突前 ( 5 .0± 2 .0 )mm为颈内静脉后壁。结论 :以骨性外耳道下点为A ,髁状突前点为B ,下颌角点为C ,第一颈椎横突点为D ,组成的四边形为咽旁颞下区后部重要结构的体表标志。BC线可作为咽旁颞下区前、后部的分界线。此标志对该区病变的诊断、治疗有指导意义     

颅底结构螺旋CT影像的三维定量测量

目的　分析健康成人当下颌骨处在正常牙尖交错位时 ,髁突与颅底颈内动脉管外口、颈静脉窝、卵圆孔、棘孔、破裂孔等之间的空间位置关系 ,为术中对其他重要结构的位置评估提供依据。方法　选择健康成人 10 0名 ,在正常牙尖交错位时 ,用螺旋CT扫描、颅底三维影像重建 ,测量各结构间的最短距离和空间角度。 12个定点 ,测量 2 8项距离和空间角度以极坐标表示 ,髁突内缘点为中心点 ,髁突长轴为 0°轴作为参照系。结果　颌下入路能顺利显露髁突内缘点和髁突长轴的方向 ,以此为参照系 ,确定颈内动脉管外口外缘点为 12 0 1± 2 71mm ,5 14± 1 2 2° ,颈静脉窝外缘点为 15 11±2 72mm ,- 5 6 2 7± 14 0 5°。结论　以髁突内缘点为中心点 ,髁突长轴为 0°轴参照系有助于为颌下入路颅底手术的术中定位及颅底解剖教学提供参考。     

咽旁颞下间隙肿瘤的手术进路探讨(附55例分析)

咽旁颞下间隙位于颅底骨性结构的外侧面,其内有颈内动、静脉,翼静脉丛、迷走神经、舌咽神经、腮腺等重要组织结构,解剖复杂,良恶性肿瘤种类较多,部位深在隐蔽,手术进路和术野暴露难度较大．本文拟就我们自１９８５年以来收治的５５例咽旁颞下区肿瘤的手术方法作一总...     

CT在诊断咽旁颞下区肿瘤上的临床应用

咽旁颞下区是口腔颌面部解剖部位深在、组织结构复杂的区域。该部位肿瘤隐蔽,不易发现,难以定位,因而给诊断和治疗带来一定困难。自1982年来我们先后对9例咽旁颞下区肿瘤的患者做了CT检查。结果表明:它能清晰地显示该部位肿瘤的准确部位和范围及其与毗邻组织的关系,为该区肿瘤诊断和选择治疗方案提供了可靠的依据。从而减少了患者的痛苦,提高了手术的成功率。     

咽旁颞下区肿瘤的手术治疗探讨

目的探讨咽旁颞下区肿瘤的有效诊治途径。方法回顾2003—2006年我科手术治疗咽旁颞下区肿瘤11例。手术采用颌下进路和耳前颌下进路,恶性肿瘤术后行放疗或化疗。结果11例患者10例手术患者肿瘤肉眼下全切除,1例放弃手术。术后病检:良性肿瘤2例,恶性肿瘤9例。结论①CT扫描和术中冰冻活检可有效指导手术治疗咽旁颞下区肿瘤。②颌下进路是该区肿瘤较好的手术途径,在累及腮腺、下颌升支的恶性咽旁颞下区肿瘤切除术中采用耳前颌下进路联合下颌升支切除中效果好。     

颞下咽旁区及颅底肿瘤的手术入路分析

目的：探讨咽旁颞下区及颅底肿瘤的手术治疗。方法：总结58例咽旁颞下区及颅底肿瘤切除的手术径路及优缺点、适用范围。结果：颞下咽旁区及颅底肿瘤58例中，良性肿瘤37例，恶性肿瘤21例。58例中采用侧方手术入路51例，前方手术入路7例。结论：根据肿瘤的原发部位、体积、侵犯范围、有无颈淋巴结转移等情况确定手术入路。     

35例茎突综合征临床分析

茎突综合征（ｓｔｙｌｏｉｄｓｙｎｄｒｏｍｅ）又称Ｅａｇｌｅ综合征，茎突过长综合征，茎突—舌骨综合征，临床上并不多见。作者对中山医科大学孙逸仙纪念医院口腔颌面外科的３５例茎突综合征作临床分析，报告如下。材料和方法１－一般资料：本组病例中男性９例，女性２６例；其中左侧１４例，右侧１９例，双侧２例；年龄最小２５岁，最大６４岁。平均４２．３岁，病程５个月～５年，均无家族史。临床表现为咽痛、咽不适感、耳颞部痛，下颌后凹或颈部痛、偏头痛等，但各有侧重，其中以咽部症状为主的占２０例，以头颈痛为主的占１５例。有…     

侵及咽旁间隙的腮腺深叶肿瘤的诊断和外科治疗

侵及咽旁间隙的腮腺深叶肿瘤的诊断和外科治疗皖南医学院附属弋矶山医院口腔科鞠远福腮腺深叶有一咽侧突，经下颌骨升枝后缘向内侧伸入，因此发生于腮腺深叶的肿瘤往往向抵抗力小的内侧经茎突下颌漏斗进入咽旁间隙．咽旁间隙及其周围解剖复杂，手术野显露困难，术中易发生...     

成人颅下颌骨解剖测量分析

目的: 应用三维CT对成人颞下颌关节解剖学数据进行初步测量分析,为标准型全颞下颌关节假体研发提供依据。方法: 选取无颞下颌关节疾病的受试者400例,应用螺旋CT扫描头颅骨（层厚0.625 mm,Dicom格式）,利用Simplant Pro 11.04软件对颞下颌关节相关解剖结构进行三维重建并测量,应用SAS 8.02软件包进行统计学分析。结果: 在三维重建头颅上测得颧弓宽度、颧弓弯曲弧度、关节窝内外径、关节窝前后径、关节窝前后斜面角度、髁突内外径、髁突前后径、髁突前后斜面角度、髁突颈部宽度、下颌孔距下颌支后缘距离、下颌角距下牙槽神经距离等相关数据。结论: 颞下颌关节相关解剖数据的测量及分析结果,可为标准型全颞下颌关节假体的研发提供数据支持。     

Morphometric study of the apical anatomy of C-shaped root canal systems in mandibular second molars

AIM: To investigate the apical anatomy of C-shaped canal systems in mandibular second molars by micro-computerized tomography (microCT) and stereomicroscopy. METHODOLOGY: Forty-four permanent mandibular second molars with a C-shaped root canal systems from a native Chinese population were scanned at 100 microm intervals by microCT at a resolution of 30 x 30 microm. The apical 5 mm of each tooth was reconstructed three-dimensionally for visualization and classification of the canal configuration using Vertucci's criteria. The main and auxiliary (accessory) foramina were examined under a stereomicroscope. RESULTS: Type IV and VIII canal configurations were most often found in the apical 5 mm of these canal systems. The prevalence of accessory canals, lateral canals, inter-canal communications and apical delta were 41%, 25%, 27% and 11%, respectively. Approximately 80% of C-shaped canals had 1-3 apical foramina; the prevalence of accessory foramina was about 48%. The mean distance between the main foramen and the anatomic root apex was 0.84 mm, and that between the accessory foramen and the apex was 1.61 mm. The mean (shortest and longest) diameters of major and accessory foramina were 0.19 - 0.32 mm and 0.07 - 0.10 mm, with a mean form factor of 0.73 and 0.82, respectively. CONCLUSION: The apical anatomy of C-shaped root canal systems in mandibular second molars is extremely complex with many anatomical variations.     

下颌骨颏孔前区解剖结构的锥形束CT研究

目的 通过锥形束CT（CBCT）分析下颌骨颏孔前区颌骨内的重要解剖结构,提出下颌颏孔前区种植相关手术的安全区域。方法 选取104例患者的CBCT图像资料,观察颏管、下颌切牙管、下颌舌侧管和舌侧孔。对数据进行描述性分析,计算均数和标准差。采用SPSS 19.0软件包对数据进行统计学分析。结果 颏管的发生率为55.29%,平均长度为1.12 mm。舌侧孔及舌侧管的发生率为94.23%,直径平均值为1.77 mm。从下颌第二前磨牙至中切牙,下颌切牙管距唇（颊）侧骨板的距离均小于距舌侧骨板的距离。结论 建议在颏孔前区种植手术或者颏部取骨时,以双侧颏孔前缘6 mm以上,唇侧骨厚度（取骨时）3 mm以内为安全界限;而在下颌前牙区种植时,种植体长度不超过14 mm。     

第一恒磨牙根尖孔解剖及其与初锉的关系

目的探讨上、下颌第一恒磨牙根尖孔的解剖及其与初锉尖端的适合性。方法上、下颌离体第一恒磨牙各30颗,冠方预展后确定初锉号数,立体显微镜下观察根尖孔的数目、根尖表面主根尖孔的位置和形态,测量主根尖孔和距根尖孔1mm、2mm、3mm处根管横断面的最大径及最小径。结果78.1%的根管有一个根尖孔;主根尖孔54.8%位于根尖顶,呈椭圆形者占92.5%;主根尖孔和距根尖孔1mm处管径相当,距根尖孔1mm、2mm、3mm处根管的最大径和最小径依次递增;初锉尖端直径比距根尖孔1mm处根管最小径稍小,比最大径平均小三个锉号。结论以根尖狭窄部最小径确定的初锉为基线进行根管机械预备,根管壁的清创质量可能受到影响。     

正常人群颞骨茎突的锥形束CT研究

目的研究正常人群颞骨茎突的形态,为临床诊断茎突综合征提供理论依据。方法挑选20~30岁无茎突综合征患者1000例(男女各500例),使用锥形束CT(cone beam computed tomography,CBCT)扫描,测量左右两侧颞骨茎突长度、体积、前倾角、内倾角,研究正常颞骨茎突的各项指标和特点。结果正常成人茎突的参数指标:双侧茎突长度分别为26.202±5.771mm和26.751±6.183mm (P>0.05);双侧茎突前倾角分别为31.721±4.495°和30.204±8.602°(P>0.05);双侧茎突内倾角分别为19.883±6.645°和22.605±6.334°(P<0.05);双侧茎突体积分别为202.966±13.826mm~3和224.489±14.746mm~3(P<0.05)。不同性别的双侧茎突长度与前倾角无明显差异(P>0.05),而双侧茎突内倾角和体积与性别有关(P<0.05)。结论 CBCT可清晰显示颞骨茎突影像,用于建立正常人群茎突的长度、角度、体积及对称性等参考数据,依此对临床诊断茎突综合征具有重要指导意义。     

上颌第二恒磨牙近中颊根第二根管的离体牙研究

目的研究上颌第二恒磨牙近中颊根第二根管（MB2）的发生情况,为提高上颌第二恒磨牙根管治疗的成功率提供解剖学基础。方法于山东地区收集离体上颌第二恒磨牙118颗,采用斜方型开髓洞型开髓,利用小号C型锉探查并疏通根管,记录MB2的发现率及扩通率;拍摄X线牙片,记录近中颊根的根管数目、形态和类型;在根管显微镜下观察并应用数显卡尺测量近中颊根主根管和MB2根管口之间的距离,确定根管口的位置;记录近中颊根的根尖孔数目,并测量解剖根尖孔至解剖根尖的距离。结果118颗上颌第二恒磨牙中,有58颗发现MB2,发现率为49.15%;其中48颗牙齿的MB2被扩通,扩通率为82.76%。108颗3根牙中,近中颊根的根管形态为Ⅰ型者有50颗,占46.30%;Ⅱ型及Ⅲ型者分别为14和34颗,占12.96%和31.48%。近中颊根主根管口与MB2根管口的平均距离为1.26 mm;近中颊根解剖根尖孔至解剖根尖的距离平均值为1.13 mm。结论山东地区上颌第二恒磨牙MB2的发现率较高,临床治疗中采用改良的斜方型开髓孔有利于发现MB2,用X线片确定工作长度时需要结合临床综合判断根尖孔的位置。     

Histomorphometric study of the root apex of mandibular premolar teeth: an attempt to correlate working length measured with electronic and radiograph methods to various anatomic positions in the apical portion of the canal

One aim of this study was to attempt to relate the position of the cementodentinal junction (CDJ) and the apical constriction to that of the apical foramen in mandibular premolars, as well as to measure the canal diameter at these various points. Another aim was to evaluate how electronic working length determination by Root ZX and radiographic method of working length determination correlated to the location of these various positions. The results showed that CDJ was detected at average distance of 0.3 mm from apical foramen with average canal diameter of 0.32 mm, whereas the apical constriction was detected at average distance from apical foramen of 1.2 mm with canal diameter of 0.22 mm. There was a statistically significant difference between file-tip position from apical foramen in group I working length measured by Root ZX and group II working length measured radiographically. Also this significant difference was found between file-tip position in both groups and CDJ and apical constriction. The average canal diameter at 0.5, 1, and 1.5 mm from apical foramen was 0.33 +/- 0.11, 0.28 +/- 0.06, and 25 +/- 0.05 mm, respectively.     

茎突过长症的诊断和手术治疗5例报告

目的总结茎突过长症的临床表现和手术方式。方法对5例茎突综合征病例进行螺旋CT或x线平片茎突检查,对其临床表现和手术方式进行分析。结果3例患者CT检查显示患侧茎突长分别40mm、42．8mm、84．0mm、85．6mm（1例患者为双侧患病）;2例患者x线平片显示患侧茎突长度为40．0mm和37．0mm,较正常人明显增长。其中4名患者行口外或口内手术入路茎突截短术,手术效果良好。结论CT容积漫游技术（volume rendering technique,VRT）较x线平片更能直观准确地显示茎突形态和长度。茎突截短术是茎突综合征有效的治疗方法。     

Evaluation of the visibility and the course of the mandibular incisive canal and the lingual foramen using cone‐beam computed tomography

Objectives: To assess the visibility and the course of the incisive canal and the visibility and the location of the lingual foramen using cone‐beam computed tomography (CBCT). Methods: In total, 100 CBCT examinations of patients for preoperative planning were used for this study. The examinations were taken using the NewTom 3G CBCT unit, applying a standardized exposure protocol. Image reconstruction from the raw data was performed using the NewTom software. Three experts were asked to assess the visibility of the incisive canal using a four‐point rating scale. The position of the incisive canal was recorded in relation to the lower, buccal and lingual border of the mandible using the application provided by the CBCT software. Results: The incisive canal was definitely visible in 83.5% of the scans and the mean endpoint was approximately 15 mm anterior to the mental foramen. The mean distance from the lower border of the mandible was 11.5 mm and its course was closer to the buccal border of the mandible in 87% of the scans. The lingual foramen was definitely visible in 81% of the scans. Conclusions: The high detection rate of the incisive canal and the lingual foramen in the anterior region of the mandible using CBCT indicates the potentional high preoperative value of CBCT scan for surgical procedures in the anterior mandible. To cite this article :
Makris N, Stamatakis H, Syriopoulos K, Tsiklakis K, van der Stelt PF. Evaluation of the visibility and the course of the mandibular incisive canal and the lingual foramen using cone‐beam computed tomography.
Clin. Oral Impl. Res. 21 , 2010; 766–771.
doi: 10.1111/j.1600‐0501.2009.01903.x     

100例下颌骨下颌管形态及其至牙槽嵴距离的观测研究

目的:观测下颌管形态结构及其周围的关系,为临床下颌骨手术、种植牙手术的进路、深度提供参考数据。方法:采用100个人体下颌骨,对其下颌管上缘至各牙槽嵴顶的间距和颏孔至下颌孔的间距进行观察与测量,根据吴汝康《人类骨学测量方法》规定的年龄估计及性别的标准加以分析。结果:下颌管均值长男性62.30mm,女性57.69mm;下颌管上缘至第二前磨牙牙槽嵴距离:男性14.79mm,女性15.14mm;下颌管上缘至第一磨牙牙槽嵴距离男性14.69mm,女性14.23mm;下颌管上缘至第二磨牙牙槽嵴距离男性14.68mm,女性14.21mm;下颌管呈圆形68例,卵圆形32例。结论:男女牙槽嵴至下颌管距离无显著性差异,P>0.05,但男女下颌管长度有显著性差异,男性大于女性,P<0.01。提示,在进行种植牙手术和下颌骨手术时,应留意下颌管与周围组织的关系。