The Applied Anatomy of Operative Therapy of Pterygopalatine Fossa Neoplasms through Posterior Wall of the Maxillary Sinus Approach

Objective:To provide anatomical evidence for the operative therapy of pterygopalatine fossa neoplasms through posterior wall of maxillary sinus approach by observing the shape of maxillary sinus posterior wall and the data from measurement of the neighboring structures.Methods:Thirty samples of dry skull were selected randomly,which including 15 sagittal plane sections and 15 horizon plane sections.The height and thickness of the posterior partes post-lateral wall of maxillary sinus,the thickness of the junction between maxillary sinus hanging wall and posterior wall were measured in the 15 sections of sagittal plane.The shape and size of sphenopalatine foramen,the distance from sphenopalatine foramen lateral wall to the junction and the width of the posterior part of poster-lateral wall of maxillary sinus were observed and measured on the 15 horizon plane sections.The position,pathway,length of branch and diameter of maxillary artery in pterygopalatine fossa were observed by surgical operative microscope in 30 samples of median sagittal plane adult skull.The position,pathway,length of branch and diameter of maxillary nerve in pterygopalatine fossa,the position,shape and size of pterygopalatine ganglion were also observed and measured.Rusults:The mean value of the height of posterior part poster lateral wall maxillary sinus was 19.21±3.42 mm,the mean value of its thickness was 0.74±0.42 mm,the mean value of thickness of the juncture between maxillary sinus hanging wall and posterior wall 0.63±0.31mm.The above data were obtained from the 15 sections of sagittal plane.The results from 15 horizon plane sections of as follows,round shape in sphenopalatine foramen's accounted for 66.7 percent,orbicular-ovate accounted for 20 percent,irregular shape accounted for 13.3 percent.The mean distance from sphenopalatine foramen lateral wall to the junction was 2.45±1.33 mm.the mean width post-lateral wall of posterior part of maxillary sinus was 7.52±2.08 mm.The position variation of the position of maxillary artery in pterygopalatine fossa was obvious.Its main branches included sphenopalatine artery,posterior superior alveolar artery,infraorbital artery,descending palatine artery,circular aperture artery and canalis pterygoideus artery.The mean value of diameter of maxillary nerve in pterygopalatine fossa was 3.65±0.54 mm.It included three branches,sphenopalatine nerve,infraorbital nerve,and posterior superior alveolar nerve.The mean value of distance from pterygopalatine ganglion to the inferior extremity of maxillary nerve was 3.57±1.39 mm,it from pterygopalatine ganglion to posterior part of maxillary sinus lateral wall was 3.17±1.08mm.The results of the shape of pterygopalatine ganglion showed that oval-shape accounted for 43.3 percent,irregular shape accounted for 40 percent and round shape accounted for 16.7 percent.Its mean value of diameter was 4.19±1.01 mm.Conclusions:When opening maxillary sinus posterior wall to operate pterygopalatine fossa neoplasm,the approach was limited.The junction between maxillary sinus and posterior wall medial wall could not be exceeded,the junction between maxillary sinus hanging wall and the posterior wall could not be exceeded upward.Handle branches of maxillary artery and maxillary nerve shoud be very carefal when removed the neoplasm.