| Objective:Because the conventional acupuncture therapy is ineffective in treating trigeminal neuralgia,in recent years,the mentor has adopted the method of needling the pterygopalatine fossa of the maxillary nerve trunk to reach the main position of nerve craniotomy.As long as the needling is accurate,it not only avoids stimulating the trigger point,but also has a strong sense of needling,which will produce obvious "qi to the sick place"effect and achieve better pain relief effect.However,the pterygopalatine fossa of the maxillary nerve trunk is located deep and its adjacent anatomical structure is complex.Blind needling can easily cause hematoma.If the structure of the nerve trunk is changed,multiple probes are needed to touch the nerve trunk,which is not easy to popularize.This study aims to determine the best approach of acupuncture at the pterygopalatine fossa segment of the upper and posterior maxillary nerve trunk from the anatomical location,so as to determine a simple and convenient method of treatment.Methods:Autopsy:Firstly,the left side of No.0 skull was placed in the specimen tray upward.Acupuncture needles were taken under the zygomatic arch,and the depression above the mandibular notch was inserted into the upper part of the needle point and the lower and lateral part of the canthus.The depth of the needle was about 50 mm.Next,the skin was incised along the three lines of ear and skull to outer canthus,ear and skull to Baihui,ear and skull to mandibular angle with No.23 scalpel,followed by incision along the three lines with scalpel,tweezers and hemostatic forceps.At the same time,the skin about 2cm long and 1 cm wide around the needle point was left to fix the needle(Fig.1).Then the needle point(ear side)was dissected layer by layer to the needle tip(Fig.2).Fig.3,Fig.4).This process does not destroy any bone structure.Observe whether the tip of the needle pierces the maxillary nerve trunk above and behind the pterygopalatine fossa.Then measure and record the length and angle of the needle.At the same time,measure and record the distance between the outer edge of nasal alar to the ear and the buckling to the mandibular angle,the distance between the needle and the outer edge of nasal alar,the distance between the needle and the ear and the buckling to the mandibular angle The right side of the skull in the above case was placed upwards,and the other operations were the same as above.The remaining 10 skulls were punctured with acupuncture needles according to the depth of needle insertion,the angle of needle to cross section and sagittal plane recorded after the above operations.The 10 skulls were taken CT photographs,and the needle insertion depth,cross-sectional and sagittal angles were measured(Fig.5 and 6).The average needle insertion depth and angle were recorded and calculated.Ten skulls were dissected according to operation 1 and 2 to observe whether they were stabbed at the upper and posterior maxillary nerve trunk of pterygopalatine fossa and recorded with EXCEL 2016 to calculate the success rate of acupuncture.In vivo clinical study:Six healthy subjects in our school were selected.Acupuncture approach was selected according to the data of autopsy.The discharge sensation of the subjects in the maxillary nerve distribution area was taken as the criterion.The depth,angle and success rate of needling were recorded and calculated by EXCEL 2016.Results:1.Autopsy:The average distance between the left and right alar edge of the skull to the ear and the skull to the mandibular angle,the needle to the alar edge of the nose,the needle to the ear and the skull to the mandibular angle,the needle to the alar edge to the ear and the skull to the mandibular angle were7.34 cm,8.3 cm,4.69 cm,3.84 cm,3.83 cm,0.73cm,0.44cm,respectively;the depth of the left and right needle to the transverse and sagittal plane.The mean values were48.43mm 546.3mm,37.29 degrees,31.3 degrees,52.71 degrees and 58.7 degrees,respectively.After dissection,10 cases(20sides)were successfully punctured in 9 cases(14sides),which were right side of No.2,bilateral side of No.3,bilateral side of No.4,bilateral side of No.5,right side of No.6,left side of No.7,bilateral side of No.8,left side of No.9 and bilateral side of No.10.The success rate was 14 sides/20 sides*100%=70%.2.Clinical study in vivo:The range of the needling points on the left and right sides to the outer edge of nasal alar and the line from ear to mandibular angle was(4.80(+0.90)cm and(4.69(+0.21)cm,respectively.The fluctuation range of the needling points from the outer edge of nasal alar to the line from ear to mandibular angle was within 1.2cm.The depth of needling was within the range of(48.43 11.70)cm and(46.30 13.70)cm,respectively.The angles of needle and sagittal plane,needle and transverse section in left and right coronal position were within the range of(52.71 3.29),(58.70 8.30),(37.29 4.29)and(31.305.30)degrees,respectively.The success rate of puncture was 71.4%.Conclusions:Acupuncture was performed in the range of autopsy and in vivo clinical research results,that is,the range of the connection between the left and right insertion points and the outer edge of nasal alar,ear and calf to mandibular angle was(4.80(+0.90)cm,(4.69(+0.21)cm,(3.84(+0.96)cm,(3.83(+0.83)cm respectively,while the fluctuation range of the insertion points from the outer edge of nasal alar to the outer edge of ear and calf to the mandibular angle was within 1.2cm.The lateral needling depth is within the range of(41.83+7.17)mm and(39.00 +9.00)mm respectively.The angle of needle and sagittal plane,the angle of needle and cross-section in the left and right coronal position are within the range of(59.92 +9.98)degrees and(62.40 +11.30)degrees,(30.08 +10.52)degrees and(27.56+11.34)degrees,respectively,which can not only increase the success rate of needling,but also further reduce the risk of needling,and provide a reliable basis for popularizing this needling method.According to.In clinical practice,the depth of needle insertion can be adjusted around 50mm,and the angle of needle insertion can be about 60 degrees between needle and sagittal plane,which is also about the angle between needle and skin. |
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