| Objective: To observe the anatomical structure of the cranioorbital communication area and analyze the anatomical structure of the cadaveric head by simulating frontotemporal orbitozygomatic approach under microscope,so as to provide anatomical basis and reference for clinical treatment of the lesions in this area.Methods: This study performed Ten(20 sides)Chinese adult dry skull specimens to observe and measure the morphological characteristics and anatomical data of the importa-nt bone structures in the cranio-orbital communication area,such as supraorbital fissure and optic nerve canal.Application of frozen fresh Chinese wet resin head specimens in 5 patients(10 sides),with red latex perfusion artery after dredging vessels,blue latex into veins,soaked in 70% ethanol,the microscopic simulation frontotemporal orbital zygom-atic approach to anatomy,step by step and photograph cranial orbital communication the important anatomical structures(including 2 d and 3 d images),analysis of data relevant to the prime minister after accurate measurement.The data were processed with statistical software,and the results were presented as Mean ±SDmm,(Min – Max)mm.Results:1.The temporal branch of facial nerve starts at a deep position and gradually becomes shallow during ascending process.After crossing the zygomatic arch,it runs close to the bottom of superficial temporal fascia in the interfascial fat pad.The distance between the superior margin of zygomatic arch and the frontal branch of superficialtemporal artery is 7.6 ± 0.2 mm,(6.3-8.0)mm.2.The key foramen of frontotemporal-orbitozygomatic approach were different when different bone flaps were used to enter the skull(single bone flap,two bone flaps,three bone flaps).Dandy's key foramen is located above the zygomatic-frontal suture of the frontal bone,below the supratemporal line,and behind the zygomatic process.The key foramen of Mac Carty were located on the frontal-sphenoid suture behind the frontal,zygomatic and sphenoid junctions,5.5 mm ± 0.5 mm posterior to the junctions,about 5-10 mm from the key foramen of Mac Carty.3.The supraorbital nerve is one of the branches of frontal nerve,which is large in shape.The supraorbital notch(foramen)is located in the skin of forehead.The distance between the supraorbital notch(foramen)and the center of eyebrow is 25.5 ± 2.6mm(21.9-29.1 mm).4.The length of superior wall,lateral wall and medial wall of supraorbital fissure were 17.75 ± 1.78mm(12.32-21.14)mm,18.71 ± 2.92mm(16.23-22.54)mm,8.22 ± 1.69mm(6.10-8.50 mm)respectively.The supraorbital fissure can be divided into three regions: lateral region,central region and inferior region according to the position of the Zinn tendon ring and its posterior extending connective tissue.Lacrimal gland nerves trochlear nerves frontal nerves(trigeminal ophthalmic branches)and ophthalmic veins pass through the lateral upper part of the ring.The superior and inferior branches of the oculomotor nerve,the nasociliary nerve(the ocular branch of the trigeminal nerve),and the abducens nerve pass through the ring.The inferior ophthalmic vein runs under the ring.The lacrimal gland nerve is located on the superior wall of the supraorbital fissure,The distance between lateral wall and medial wall was 1.05 ± 0.65 mm,4.07±1.75 mm,10.48±1.68 mm,The frontal nerve is distant from the superior wall of the supraorbital fissure,The distances of lateral wall,medial wall were 0.49 ± 0.26 mm,9.39 ± 1.72 mm,4.80 ± 1.62 respectively.The distances of trochlear nerve from superior wall,lateral wall,medial wall of superior orbital fissure were 0.32 ± 0.13 mm,11.14 ± 1.95 mm,3.57 ± 0.64 mm respectively.The distances of oculomotor nerve from superior wall,lateral wall,medial wall of superior orbital fissure were 0.38 ± 0.23 mm,12.24 ± 2.15 mm,1.84 ± 0.63 mm respectively.The distances from the nasociliary nerve to the superior,lateral and medial walls of the superior orbital fissure were 1.76 ± 1.42 mm,11.30 ± 2.89 mm and 2.84 ± 0.99 mm,respectively.The distances from the abducent nerve to the superior,lateral and medial walls of the superior orbital fissure were 2.81 ± 1.05 mm,12.15 ± 2.50 mm and 2.17 ± 0.86 mm,respectively.The distances between frontal nerve and trochlear nerve,abducens nerve and nasociliary nerve were 2.56 ± 0.69 mm,1.86 ± 0.82 mm,1.35 ± 0.86 mm and 1.44 ± 0.82 mm,respectively.5.The optic canal is divided into cranial segment and orbital segment.The canal is composed of superior,inferior,medial and lateral walls,cranial orifice and orbital orifice.The cross section of the canal is elliptical.The optic canal became narrower and the wall became stiffer as the optic canal moved from the intracranial to the orbital region.The medial wall of the optic canal became thicker and thicker as the optic ring.The narrowest part is the central optic canal.The length of lateral wall,medial wall,superior wall and inferior wall of optic canal were 8.77 ± 1.41 mm,11.67 ± 1.59 mm,10.67 ± 1.66 mm and 6.96 ± 0.88 mm,respectively.The transverse diameters of optic canal and optic nerve were 6.42 ± 0.99 mm and 4.95 ± 0.69 mm,the vertical diameters were 3.88 ± 0.75 mm and 2.90 ± 0.68 mm,the cross-sectional areas were 19.16 ± 4.82 mm 2 and 10.72 ± 2.44 mm 2,respectively.The transverse diameters of optic canal and optic nerve were 4.76 ± 0.56 mm and 3.36 ± 0.56 mm in orbital orifice,5.85 ± 0.68 mm and 3.45 ± 0.70 mm in vertical channel,22.15 ± 3.57 mm and 9.60 ± 1.91 mm 2 in cross-sectional area,4.66 ± 0.46 mm and 3.66 ± 0.36 mm in middle channel and optic nerve,4.65 ± 0.58 mm and 3.15 ± 0.20 mm in vertical channel,17.45 ± 3.87 mm and 9.60 ± 1.81 mm 2 in cross-sectional area,respectively.6.The ophthalmic artery begins at the C2 segment of the anterior clinoid process of the internal carotid artery from the cavernous sinus,travels in the optic canal between thedura maters beneath the optic nerve and always accompanies the optic nerve into the orbit.The external diameter of ophthalmic artery was 1.66 ± 0.43 mm(0.9-2.34 mm)at the origin and 1.51 ± 0.35 mm(0.8-1.83 mm)at the orbital opening of optic canal.7.The frontotemporal-orbitozygomatic approach combined with medial approach(the space between superior oblique muscle and superior rectus muscle,levator palpebrae superioris muscle)can expose 34 ° ± 4 °(26 °-37 °),The exposure angle of frontotemporal-orbitozygomatic approach combined with middle approach(space between superior rectus and levator palpebrae superioris)was 21 ° ± 9 °(10 °-33 °).The exposure angle of frontotemporal-orbitozygomatic approach combined with lateral approach(space between lateral rectus and superior rectus,levator palpebrae superioris)was 107 ° ± 9 °(93 °-118 °).8.The anterior clinoid process is tapered in shape,with a total length of 9.71±1.09 mm,a median length of 5.55±1.17 mm,a root width of 12.42±1.39 mm,and a median width of 6.45±1.14 mm.The visual column length is 5.14±0.87 mm,and the visual column width is 2.51 ±0.56 mm.9.The bed protrusion gap is a cavity formed after the anterior bed protrusion is removed.The width of the bottom is 5.09±1.02 mm,the depth of the bottom is 7.65±1.36 mm,the length of the inner side is 7.79±1.43 mm,the length of the outer side is 10.42±1.22 mm,the length of the lower side is 10.24±1.12 mm,and the width of the top side is 2.15±0.69 mm.Conclusion: 1.Familiar with the anatomical features of the cranioorbital communication area,for the lesions located in the orbit,the selection of the appropriate orbital space is the key to deal with the lesions in the cranioorbital communication area.2.When dealing with the intracranial part of the lesions in the cranio-orbital communication region,by grinding out the anterior clinoid process,the important nerves,blood vessels and other tissues in the clinoid process space can be fully exposed,so that the surgical field of vision is wide and safe.3.Supraorbital fissure and optic nerve are important passageways to communicate the intracranial and orbital parts,and their anatomical structures are relatively complex,and there are important blood vessels and nerves in their internal shape. |
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