Sectional And Applied Anatomy Of Frontonasal Area

Objective:The frontonasal area is superior to the nose, lateral to the visual organ, and inferior to the brain and the blood vessel of brain. Mainly, it can be divide into frontal sinus, nasofrontal duct(isthmus), and frontal recess. Its communication is extensive. It’s not easy to acquire the tumor and xenome which betide this region, and the operation is not easy to exposed sufficiently and removed thoroughly. With the development and improvement of medical science, many native and abroad scholars carried out a great quantity of reports from macroscopy to imageology, but the reports with continuous thin section technique research has not be seen. Accordingly, we use the technique of improved celloidin embedding thin section (0.25mm) and the way of applied anatomy, to carry out the sectional and applied anatomy research to the frontonasal region, to provid the evidence of the morphology and clinical applied anatomy for the operative approach of frontonasal region.Methods:To take30examples of the fixed adult dead bodies’heads, to obtain the base of skull anterior region. The examples traverse20%HC1decalcification; gradient deaquation (in the liquid of70%alcohol、80%alcohol、95%alcohol、 absolute alcohol and ethylether alcohol in order); gradient bathing in the collodion (bathing in the5%collodion8%collodion and15%collodion in order); embedding; welding; inciding thin section0.25mm on the horizontal plane, sagittal plane and coronal plane (3D), with the JUNGAG type cerebrum slicer; surveying the appearance and adjoin of frontonasal region, localization and courser of the chief structure, and the surrounding structure. And using80sides of arid bones of skull and the20sides decalcificated dead head to survey frontonasal region, and to obtain some data.Results:To describe the different sections of the horizontal, sagittal and coronal planes, the amount of nasal morphology is diverse. The shape and position of this region are asymmetry. The stucture of frontonasal area is like a hourglass:the frontal sinus is the the upper part of the hourglass, the amount of nasal tube (isthmus) is the narrow part, and the frontal recess is the lower half of the hourglass. In the horizontal sections, the shape of the frontal sinus can beriangle-shaped, pistal-shaped. horn-shaped, arc-shaped, sickle-shaped, short-bar-shaped and hump-shaped; the superior opening of the nasofrontal duct is round-shaped, oval-shaped, spindle-shaped and even a slit; the frontal recess are pear-shaped, rectangular and flat, narrow shape of fissure. In coronal sections, the frontal sinus can be triangle-shaped, butterfly-shaped and quadrangle-shaped; the nasofrontal duct is arc-shaped; the frontal recess are rectangular or triangular. In sagittal sections, frontal sinus are conical-shaped, bugle-shaped and oval-shaped; the nasofrontal duct can be "S"-shaped, linear-shaped and oblique narrow shape.Conclusion:To combine the horizontal, sagittal and coronal sections, is more effectively to diagnose the disease in frontonasal region. By using sectional and applied anatomy, we design a new operative approach, namely, an approach to frontonasal region through the natural nasal cavity. The instrument should enter from middle nasal meatus. Find ethmoid bulla and semimunar hiatus and make them as a mark. Extend the instruments superoanteriorly, and we will see the inferior opening of the nasofrontal duct. We extend the instruments through the nasofrontal duct from inferior to superior in order to reach the frontal sinus. Then, we can do the drainage or tumor removal of the frontal sinus. Approaching from here, the operation wound is smaller, the blood loss is less, the coefficient of resistance is higher, and the postoperative complication is less. So in preoperative period we should do the imageology examination in order to increase achievement ratio of the operation.