Microanatomical Studies Of Anterolateral Approach To The Upper Cervical Vertebra

Objective:The simulated by the anterior lateral approach for microsurgical anatomy, surgery of anterior lateral approach to locate signs, and measure the relevant anatomical data, to provide anatomical basis to guide clinical surgery.Method:1. Materials and specimen samples:4 patients (8 sides) were fixed in formalin for people with neck head wet adult specimens, are reserved to the level above c4, can not exactly determine the sex and age of specimens and materials provided by the Medical School of Zhengzhou. In order to accurately distinguish between arteries and veins, all specimens were moist skull infusion in the arterial system of latex mixed with red dye, and in the vein infusion of latex mixed with blue dye.2. Empirical procedure:Imitated the submandiblar and retropharyngeal approach for the microsurgical anatomys, hot the process of anatomy by numeral camera and measured some relative anatomic data. From the point of anatomical view, the submandiblar and retropharyngeal approach could be divided into three parts:(1)superficial lamella(from the beginning of cutting open the skin to opening the retropharyngeal space); (2)deep lamella(from the beginning of opening the retropharyngeal space to exposing the osseous structures completely); (3)Bone, ligament and dura mater (from the beginning of stripping the anterior arch of atlas to cutting open the dura and exposing the anatomical structures on the ventral craniocervical junction area).3. Measurement of this approach and its surrounding location mark an important anatomical structure of the data between.Results:1. superficial lamella:The important anatomical structures in the superficial fascia were all in their own fascial layer, and we could i6jntify each fascial layer by regarding those structures as anatomic makers, which could also conduct the operation. Those structures including skin, platysma muscle, submandibular gland, digastric muscle and it's tendon, cranial nerve and hyoid bone. Hyoid cornu or the coordinates for the location mark, the specimens were measured carotid bifurcation, the superior thyroid artery, lingual artery, hypoglossal nerve and superior laryngeal nerve to the hyoid cornu distance:Carotid bifurcation and the hyoid horn tip distance of the vertical shaft 9.7～11.4mm, the horizontal axis distance of 6.4～8.5mm; thyroid artery and the hyoid horn tip distance of the vertical axis 7.8～12.4mm, the horizontal axis distance of 2.5～4.7mm; lingual artery side horn tip and the hyoid bone vertical axis distance of 1.8～ 2.6mm, the horizontal axis distance of 2.7～4.1mm; lingual artery and the hyoid horn tip end of the vertical axis distance of 4.6～5.9mm, the horizontal axis distance of 4.5-5.2mm.2. Deep lamella:lamella:Including retropharyngeal space and retrocardiac space. In the retropharyngeal space, we should keep our operation in the fat layer, and there was no need to cut any muscle, blood vessel or nerve. The first lateral approach, the important mark of a neck bone nodules and pharyngeal tubercle before 1, enter the retropharyngeal space is a former judge on the cervical surface after the middle of an important symbol, is a former arch neck width of the reference removed signs.3. Bone, ligament and dura mater:Worn out before the arch of atlas and odontoid process can clearly see that after the great occipital foramen. The atlas and axis were ground under the scope of bilateral atlantoaxial, atlanto occipital joint, mouth hypoglossal canal and vertebral artery anatomy and other restrictions. Experiment measured the level of atlas anterior lateral groove on both sides of the depth of 2.5～3.1mm (left) and 2.7～3.4mm (right), the level of the axis measured on both sides of the depth of anterior lateral groove is 2.1～3.0mm (left) and 2.4～3.2mm (right). Measured at the level of atlas anterior lateral groove distance of about 17.5～21.5mm, in the axis level for the 14.6～17.4mm. In the measured level of atlas transverse process of the hole edge distance of about 27.8～32.1mm, in the axis level for the 19.7～24.3mm. May be concluded that both sides of anterior lateral groove marked groove between the two anterior cervical surgery for the security zone.Conclusion:The anterior lateral approach dealing with skull-lesions of the ventral neck junction can be eliminated through oral tradition-the pharyngeal approach the existence of potential infection. The anterior hyoid horn can be used as intraoperative lateral approach an important sign, bilateral anterior lateral channel range can be used between the anterior lateral approach through the security area operations. The anterior lateral surgical approach is a deal with skull-lesions of the ventral cervical junction practical surgical approach.