해면정맥동의 측삼각: 방인두 공간의 접근을 위한 통로

초록

Surgeons dealing with lesions involving both spaces above and below the middle fossa floor must be knowledgeable about the complex anatomy of the floor of the middle cranial fossa and its exocranial space. In this study, we describe the surgical anatomy of roof of the prestyloid parapharyngeal space (PPS) in subtemporal middle fossa appraoch with special reference of surgical landmarks for drilling of cavernous sinus (CS) lateral triangle. The osseous anatomy related with the upper part of the prestyloid PPS was observed in 10 dry skulls. The upper portion of the prestyloid PPS was dissected through subtemporal middle fossa approach in 20 specimens obtained from 10 formalin-fixed human cadaver heads for the evaluation of the practical operative anatomy. The bony floor of the CS lateral triangle by Dolenc corresponds to the scaphoid foss and the pterygoid fossa at the exocranial surface. The pterygoid canal corresponds to the medial limit of the bony floor. By drilling the bony floor of the CS lateral triangle, the prestyoid PPS can be reached. The nasopharyngeal wall can be exposed by drilling a triangular area formed by 3 points: the posterior opening of the pterygoid canal; the anterior opening of the pterygoid canal; and the anterior apex of the scaphoid fossa. The auditory tube cartilage and the pterygopalatine fossa are posterior and anterior to this triangle, respectively. This triangle may be named as the middle fossa nasopharyngeal triangle. Understanding of the anatomy of the bony floor of the CS lateral triangle and the middle fossa nasopharyngeal triangle can help surgeons enter to the prestyloid PPS and nasopharynx or avoid entering into the nasopharynx depending on the pathology and goal of operation.