Anatomical Structure Study In Piercing Into Foramen Rotundum In The Anterior Approach

Objective:Through analysis of the data of the measurement around the foramen rotundum’s structure in CT three-dimensional,we explore a line of piercing path which can be based on and design puncture needle,improve the rate of successful puncture and put forward the potential risk factors.Method:111 cases of trigeminal neuralgia patients with jaw CT 3D reconstruction from selection November 2012 to December 2014 in stomatology in Nantong l’st people hospital,222 cases foramen rotundum’s(FR)pipe were observed at the horizontal and sagittal position,FR’s diameter and pipe length measured,the width of pterygopalatine fossa(PPF)at the lateral and inferior of FR.We measure the distance between the FR and the supraorbital fissure(SOF),design puncture needle,set to point B,which is the parallel line 2 cm lateral of the center line and along 8 mm away from the infraorbital margin;set to point A,which is the points of the straight line of puncture needle cross with the zygomatic(percutaneous puncture is the cross point which is the vertical line 1 cm lateral to the outer canthus and the horizontal line of the base of the nose).Assuming that the line with A and B point is as the reference line of the puncturing,which is validated by 21 cases of adult head specimens of bone.After the curved needle is punctured into the FR.then fix the skull in Frankfort plane,take photoes in the positive,measure in the picture.AC is the needle’s ray.AD is the needle’s reverse ray.The angle is between AB line and the needle’s reverse ray AD(∠BAD).And AB line is applied to 10 patients in stomatology in Nantong l’st people hospital,10 positive photographs were taken and measured the angle of the∠BAD.Results:3-line-types of the FR’s pipes compared with the midline show from front to back at the horizontal position in CT,the FR’s pipes close the midline from front to back have 139 cases(62.61%)、close to parallel have 59 cases(26.58%)、stay away from the midline from front to back have 24 cases(10.81%);3 types of FR’s pipes were found in the sagittal position in CT,go up line(compared to the plane of the hard palate)、the basic parallel and go down line,respectively accounted for 21 cases(9.46%)、89 cases(40.09%)and 112 cases(50.45%).FR’s diameter is 2.54±0.56 mm,which is no statistical difference about FR’s diameter of left and right side.There is no statistical difference about FR’s diameter in the coronary position and sagittal position;FR’s pipe length is 5.02±1.49 mm,which are statistical differences between the left and right side of the FR’s pipe length;The PPF width at the FR’s lateral is 4.10± 1.00 mm.the PPF width at FR’s inferior is 4.32±1.26 mm.the PPF width at FR’s lateral and inferior between the right side and the left side are no statistical differences;The linear vertical distance is 7.93±2.15 mm between the FR’s external and the line of the orbital bottom,which is no statistical difference in the comparison of the left and right side and the age and the gender,P>0.05;The distance is 19.91 ± 1.92 mm between the FR and the M line(the line which is connected dorsum midpoint with ethmoid vertical plate edge point).There is no statistical difference in the comparison of the left and right side and the age,P>0.05.There are statistically significant differences in the gender comparison,P<0.01.The distance between FR with the supraorbital fissure(SOF)is 3.85±1.34mm.There are statistical differences between the left with the right of the distance which is between the FR and the SOF.The angle is showed AB line and the needle’s reverse ray ∠BAD is 2.38°±4.84 °in the positive pictures.There is no statistical difference in the angle of left and right side.10 cases are applied in clinic,It is showed ∠BAD is 0.08 °±4.05 °in the positive pictures.Conclusion:FR and PPF are diverce which is necessary of the preoperative CT examination,the puncture point A which is the straight line of puncture needle cross with the zygomatic and point B which was set in front of the maxillary are connected that can be provided a reference in piercing into FR in the anterior approach.