摘要
目的对腭咽部肌肉、肌纤维之间的关系进行探讨,以更好地指导腭裂修复中的肌肉重建,理解腭裂病理语音的形成。方法无人认领的1具诊断为Ⅱ度腭裂的28周流产胎儿尸体,截取头部眶底平面至口角-下颌角平面之间部分,4%甲醛固定8 h,3.75%碘碘化钾浸泡染色7 d,进行微米CT扫描,并根据扫描所得DICOM图像描绘肌纤维,重建肌肉解剖结构的三维模型,观察标本腭咽部肌肉解剖结构。结果由微米CT扫描图像及三维重建模型可发现腭咽部主要肌肉:腭帆提肌、腭帆张肌、腭咽肌、腭舌肌、咽上缩肌上部。此例腭裂标本的肌肉局部解剖结构特点:(1)腭帆张肌发出分支止于咽侧壁;(2)咽上缩肌与腭咽肌、腭帆提肌和腭帆张肌交叉或延续;(3)腭裂软腭内部肌肉之间没有发现明显的交叉关系,未见腭垂肌。结论在腭裂标本中,腭咽部主要功能肌肉均与咽上缩肌存在肌纤维的交叉、延续等关联。腭部和咽部肌肉相互关联,构成了一个立体的"腭咽肌肉复合体"。
Objective The cadaveric specimens stained with iodine-potassium iodide can show the fine structure of muscles by Micro-CT scanning. A specimen with cleft palate was scanned using this technique to explore the relationship between the muscle fibers of pharyngeal muscles in order to guide the muscle reconstruction in cleft palate repair, so as to understand the lingual pathology secondary to cleft palate. Methods One unclaimed 28-week aborted stillbirth, diagnosed as Ⅱ-degree cleft palate, was dissected.The anatomic structure between orbital floor plane and mouth bottom plane was saved, and soaked in 4% for maldehyde for 8 hours. Thereafter, the subject was soaked in 3.75% iodine-potassium iodide for 7 days for staining. The stained specimens were scanned with Micro-CT. The muscle fibers were drawn in the exported DICOM images, for three-dimensional muscle reconstruction. Results The main muscles of velopharynx were located in the tomographic image and the three-dimensional reconstructed model, including: the levator muscle of palatine velum, the tensor velipalatini, the palatopharyngeus muscle, the palatoglossus muscle, and the upper part of the superior pharyngeal constrictor. Some local anatomical features of the muscles were also found: (1)The tensor velipalatini has a branch ended at the lateral pharyngeal wall.(2)The superior pharyngeal constrictor has multiple connections with the levator muscle of palatine velum, the tensor velipalatini, the palatopharyngeus muscle.(3)There was no obvious muscle fiber crossing between the internal muscles of the cleft palate. The muscle of uvula was not found either. Conclusions With the application of high-resolution Micro-CT technology, new branches of pharyngeal muscles and crossings of muscles can be recognized. In the cleft palate specimen, the main functional muscles of pharyngeal are mainly associated with superior pharyngeal constrictor. The muscles in the palate and the pharynx are interrelated and form a three-dimensional " velopharyngeal muscle complex" .
作者
赵久丽
麻恒源
尹宁北
吴镝
Zhao Jiuli;Ma Hengyuan;Yin Ningbei;Wu Di(Plastic Surgery Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100144, China)
出处
《中华整形外科杂志》
CAS
CSCD
北大核心
2019年第1期17-22,共6页
Chinese Journal of Plastic Surgery
基金
国家自然科学基金面上项目(81471887).
