Applied Anatomic Study On The Sphenopalatine Ganglion By Puncturing Differ Acupoints In Treating Allergic Rhinitis

Objective: To discuss the entry route of puncturing sphenopalatineganglion through Xiaguan point (ST7), Die e point and Quanliao point (SI18)for allergic rhinitis by regional anatomy, as combining with clinical effectsto analyse puncturing advantages and disadvantages and summary the best entrypoint for clinical application of three acupoints.Methods:1. Study on anatomic application: 15 corpses (30 sides) of adult malewithout any facial deformity were fixed by 10% formalin. The lateral areas offace were dissected by dissecting instruments from superficial to profoundaafter marking the body surface of three acupoints by dyeing in order to separatesphenopalatine ganglion and the important blood vessel around. In addition, theelectric drill with the kirschner wire puncturing the sphenomaxillary ganglionand extended to the contralateral areas according to different directions ofpuncturing sphenomaxillary ganglion from the acupoints. The correspondingpuncturing points were measured through the coordinate setting. Observing itemswere as follows:①correlated datas of surface location among three acupoints:the distance between SI18 and Die e point, the distance between ST7 and Die epoint, the distance between the highest point of zygomatic arch and the lowestpoint of sigmoid notch and the distance between mandibular coronoid process andcondyle;②anatomic layers of puncturing three acupoints;③inserting depth fromevery acupoint to sphenomaxillary ganglion;④the locations of the correspondingpunctured points and the general puncturing direction of the acupoints;⑤the relation between inserting route and maxillary artery as well as its arterybranches:⑥taking pictures of the observing samples to place on file.2. Verifying study on clinical application: Based on the strict diagnosticcriteria,the exclusion and inclusion criteria, 30 cases of allergic rhinitiswere selected and randomize into three groups. They were the group of puncturingST7 (n=10), the group of puncturing die e point (n=10) and the group of puncturingSI18 (n=10). Needles (2.5 cun) were inserted to sphenopalatine ganglionaccording to the program of the anatomic study until the obvious needle sensationof local distention and numbness occurred, lt was best to generate the sensationof spraying in nose or electric discharge on homolateral face. The treatmentswere underwent once every other day for a total of 10 times as one course.Oberseving items were as follows: (1) scoring according to the effective tablewhen the course finished; (2) analyzing the advantages and disadvantages of thepuncturing project of every acupoint according to the clinical effect, the needlesensation and the records of side-effect; (3) summary the best entry point ofpuncturing sphenomaxillary ganglion due to the result of anatomic study.Results:1. Correlated datas of surface location among three acupoints were as follows:the left distance between SI18 and Die e point was 21.17±3.53mm and the rightwas 21.21±3.49mm; the left distance between ST7 and Die epoint was 17.73±0.14mmand the right was 17.80±0.13mm; the left distance between the highest pointof zygomatic arch and the lowest point of sigmoid notch was 18.06±3.28mmandthe right was 18.04±3.29mm; the left distance between mandibular coronoidprocess and condyle was 26.65±3.57mm and the right was 26.65±3.56mm.2. Anatomic layers of every acupoint were as follows:①the layers of ST7from superficial to profounda were derm→hypoderma→masseter muscle→theposterior temporal muscle→sigmoid notch→medial pterygoid muscle→lateralpterygoid muscle→pterygoid venous plexus→upper jaw's artery and vein→sphenopalatine ganglion;②the layers of Die e point from superficial toprofound were derm→hypoderma→zygomatic muscle→masseter muscle→theforward of temporal muscle→pterygoid venous plexus→upper jaw's artery and vein→sphenopalatine ganglion;③the layers of SI18 from superficial to profoundwere derm→hypoderma→zygomatic muscle→masseter muscle→the forward oftemporal muscle→pterygoid venous plexus→infraorbital artery and vein→sphenopalatine ganglion.3. Inserting depths of every acupoint were as follows: the left depth of ST7was 49.93±2.69mm while the right was 49.97±2.83mm; the left depth of Die e pointwas 46.93±3.63mm while the right was 46.94±3.57mm; the left depth of SI18 was46.58±3.04mm while the right was 46. 72±2.88mm.4. The locating survey of every corresponding inserting point were as follows:①the left and right distances between the corresponding inserting point of ST7and Sizhukong point(SJ23) were 17.58±3.57mm and 17.59±3.57mm respectively;②the left and right distances between the corresponding inserting point of Diee point and contralateral horizontal line of zygomatic arch were 33.93±10.14mm and 33.85±10.13mm respectively; the left and right distances between thecorresponding inserting point of Die e point and contralateral vertical lineof eyest s outer canthus were 42.13±8.61mm and 42.14±8.62mm respectively;③the left and right distances between the corresponding inserting point of SI18and contralateral line of bilateral external acoustic pore were 28.31±9.71mmand 28.22±9.49mm respectively; the left and right distances between thecorresponding inserting point of SI18 and median line of head were 62.15±10.73and 62.15±10.69 respectively. The general directions of puncturing everyacupoint were as follows:the puncturing direction of ST7 were ento-forward and.upper, and focused around the contralateral outer canthus; the puncturingdirection of Die e point were ento-post and upper, and focused on the area ofcontralateral temporal bone; the puncturing direction of SI18 were ento-postand upper, and focused on the area of contralateral postero-bregmatic bone.5. Both the inserting route of ST7 and Die e point were near to theptero-palate section of arteria maxillaris. And the inserting route of SI18 wasnear to the arteria infraorbitalis.6. The scores of patients' symptoms all declined with 100% improving rateafter treating by puncturing the acupoints. The sensation of electric discharge on cheeks or spraying in nose occurred easily when puncturing Die e point withlittle side-effects. The sensation of distension and numbness of superior teethoccurred easily when puncturing ST7 and SI18 with frequent side-effects suchas the regional pain or stagnant blood, etc.Conclusion:1. The optimal inserting point on surface to sphenomaxillary ganglion wasDie e point, and the next was ST7 and SI18.2. It must avoid to impair the important structure adjacently mainly focuson arteria meningea media, arteria maxillaris and arteria infraorbitalis, etc,when puncturing the acupoints.3. The patients of the allergic rhinitis were validately treated using theinserting route that the subject designed, and the main symptoms were improved.4. It could be a treatment by puncturing Die e point for other facial diseaseswhich were dominated by sphenomaxillary ganglion such as epileptiform neuralgia,faical paralysis, etc.