Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4512_Библиотеки_им_академика_М_И_Перельмана
.pdf
Acknowledgments
https://t.me/med1917
The editors would like to acknowledge the help of all
the people involved in this project and, more specifically, the contributors who took part in the process.
Without their support, this book would not have
become a reality. We would like to thank our fellows
for their feedback, cooperation, and, of course, friendship. We thank Mr. Stephan Konnry and his team for
supporting this project.
xix
https://t.me/med1917
Contributors
https://t.me/med1917
Juan Ramón Gras Albert, MD, PhD
Professor
Department of Otolaryngology-Head and
Neck Surgery
Hospital Universitario de Alicante
Universidad Miguel Hernandez
Alicante, Spain
Isam Alobid, MD, PhD
Professor
Rhinology and Skull Base Unit
Department of Otolaryngology
Hospital Clinic, University of Barcelona
Barcelona, Spain
Huseyin Altun, MD
Consultant
Department of ENT
Yunus Emre Hospital
Istanbul, Turkey
Tareck Ayad, MD, FRCSC
Associate Professor
Department of Otolaryngology and Head
Neck Surgery
Université de Montréal
Montréal, Canada
Leonardo Balsalobre, MD
PhD Student
Department of Otolaryngology and Head
Neck Surgery
Federal University of Sao Paulo
ENT Center of Sao Paulo
Sao Paulo, Brazil
Ilyes Berania, MD
Consultant
Department of Otolaryngology and Head
Neck Surgery
Université de Montréal
Montréal, Canada
Eugenio Cárdenas, MD, PhD
Neurosurgeon
Department of Neurosurgery
Hospital Universitario Virgen del Rocío y
Virgen Macarena
Sevilla, Spain
Michele Cassano, MD
Consultant
Department of ENT
University of Foggia
Foggia, Italy
Paolo Castelnuovo, MD, FRCSEd, FACS
Full Professor and Chairman
Division of Otorhinolaryngology
Department of Biotechnology and Life Sciences
Head and Neck Surgery & Forensic Dissection
Research Center (HNS & FDRC)
University of Insubria
ASST Sette Laghi
Ospedale di Circolo e Fondazione Macchi
Varese, Italy
Arturo Cordero Castillo, MD
Consultant
Rhinology and Skull Base Unit
Department of Otolaryngology
Hospital Clinic, University of Barcelona
Barcelona, Spain
Mauricio López Chacón, MD
Consultant
Rhinology and Skull Base Unit
Department of Otolaryngology
Hospital Clinic, University of Barcelona
Barcelona, Spain
Giacomo Ceroni Compadretti, MD
Consultant
Department of Otorhinolaryngology
Imola Hospital
Bologna, Italy
Fabio Ferreli, MD
Consultant
Division of Otorhinolaryngology
Department of Biotechnology and Life Sciences
Head and Neck Surgery & Forensic Dissection
Research Center (HNS & FDRC)
University of Insubria
ASST Sette Laghi
Ospedale di Circolo e Fondazione Macchi
Varese, Italy
xxi
Contributors
https://t.me/med1917
Jonathon Frankel, MD
Consultant
MetroHealth Medical Center
Department of Otolaryngology
Case Western Reserve University
Cleveland, Ohio
Elena Garcia-Garrigós, MD
Consultant
Department of Radiology
Hospital Universitario de Alicante
Universidad Miguel Hernandez
Alicante, Spain
Alfonso García-Piñero, MD, PhD
Consultant
Rhinology Unit
ENT Department
HUiP La Fe.
Valencia, Spain
Juan R. Gras-Cabrerizo, MD
Consultant
Department of Otolaryngology-Head and
Neck Surgery
Hospital de la Santa Creu i Sant Pau
Universitat Autònoma de Barcelona
Barcelona, Spain
Emily Hrismalos, MD
Consultant
MetroHealth Medical Center
Department of Otolaryngology
Case Western Reserve University
Cleveland, Ohio
Francesca Jaume, MD
Consultant
Rhinology and Skull Base Unit
Department of Otolaryngology
Hospital Clinic, University of Barcelona
Barcelona, Spain
Ariel Kaen, MD, PhD
Neurosurgeon
Department of Neurosurgery
Hospital Universitario Virgen del Rocío y
Virgen Macarena
Sevilla, Spain
Jung Soo Kim, MD
Professor
Department of Otorhinolaryngology-Head and Neck
Surgery
Kyungpook National University
School of Medicine
Daegu, Republic of Korea
Deniz Hanci, MD
Consultant
Department of ENT
Okmeydani Education and Research Hospital
Istanbul, Turkey
Sung Jae Heo, MD
Assistant Professor
Department of Otorhinolaryngology-Head and
Neck Surgery
Kyungpook National University
School of Medicine
Daegu, Republic of Korea
Steven M Houser, MD, FAAOA
Director of Rhinology, Sinus and Allergy
MetroHealth Medical Center
Department of Otolaryngology
Case Western Reserve University
Cleveland, Ohio
Cristobal Langdon, MD
Associate Professor
Rhinology and Skull Base Unit
Department of Otolaryngology
Hospital Clinic, University of Barcelona
Barcelona, Spain
Philippe Lavigne, MD
Consultant
Department of Otolaryngology and Head
Neck Surgery
Université de Montréal
Montréal, Canada
José J. Letort, MD
Professor
Department of ENT
Hospital Metropolitano
Pontificia Universidad Católica del Ecuador
Quito, Ecuador
xxii
Contributors
https://t.me/med1917
Paula Mackers, MD
Consultant
Rhinology and Skull Base Unit
Department of Otolaryngology
Hospital Clinic, University of Barcelona
Barcelona, Spain
Hesham A. K. A. Mansour, MD
Professor of Ear, Nose and Throat
Cairo University
Cairo, Egypt
Humbert Massegur-Solench, MD
Consultant
Department of Otolaryngology-Head and
Neck Surgery
Hospital de la Santa Creu i Sant Pau
Universitat Autònoma de Barcelona
Barcelona, Spain
Meritxell Valls Mateus, MD
Consultant
Department of Otorhinolaryngology
Hospital Clinic, University of Barcelona
Barcelona, Spain
Pietro Palma, MD, FACS
Consultant
Division of Otorhinolaryngology
Department of Biotechnology and Life Sciences
Head and Neck Surgery & Forensic Dissection
Research Center (HNS & FDRC)
University of Insubria
ASST Sette Laghi
Ospedale di Circolo e Fondazione Macchi
Varese, Italy
Shirley Shizue Nagata Pignatari, MD, PhD
Associate Professor
Division of Pediatric Otolaryngology
Federal University of Sao Paulo
Sao Paulo, Brazil
Alfonso Santamaría, MD
Consultant
Rhinology and Skull Base Unit
Department of Otolaryngology
Hospital Clinic, University of Barcelona
Barcelona, Spain
Juan Antonio Simal-Julian, MD, PhD
Consultant
Endoscopic Skull Base Unit Coordinator
Department of Neurosurgery
HUiP La Fe
Valencia, Spain
Aldo Cassol Stamm, MD, PhD
Affiliated Professor
Department of Otolaryngology and Head and
Neck Surgery
Federal University of Sao Paulo
Director
ENT Center of Sao Paulo
Sao Paulo, Brazil
Ignazio Tasca, MD
Chief of ENT Department
Department of Otorhinolaryngology
Imola Hospital
Bologna, Italy
xxiii
https://t.me/med1917
Chapter 1
https://t.me/med1917
Nasal Anatomy
1.1 Front Door to Nasal Cavity 3
1.2 Medial Wall of Nasal Cavity:
Nasal Septum 4
1.3 Lateral Nasal Wall 5
1.4 Ceiling of Nasal Cavity: Nasal
Vault, Ethmoid Cells, and
Frontal Sinus 7
1.5 Nasal Floor 8
1.6 Back Door of Nasal Cavity 9
1
https://t.me/med1917
1 Nasal Anatomy
https://t.me/med1917
Alfonso García-Piñero, Eugenio Cárdenas, Ariel Kaen, Juan Antonio Simal-Julian
Nasal Anatomy
Summary
The nasal cavity is the space comprised in between the
external nares and the choanae. In the sagittal axis, this
space is divided into two cavities by the nasal septum. In
the coronal plane, the nasal cavities extend from the
palate to the skull base and from the nasal septum to
the lateral nasal wall.
To systematize the surgical endoscopic anatomy of
the nose, we approach each nasal cavity as a hexahedron. The anterior and posterior walls of the cube are
the nares and the choanae, respectively, the medial wall
is the nasal septum, the lateral wall is the homonymous
part of the nose, the inferior wall is the nasal floor, and
the superior wall is the nasal vault.
The paranasal sinuses are adjacent to these nasal
walls. In the roof of the nasal cavity, the frontal sinus,
the ethmoidal cells, and the sphenoid sinus are located
in an anteroposterior way. The maxillary sinuses are
located beside the lateral nasal walls.
The anatomy of the nasal cavity and the paranasal
sinuses is exposed/discussed in this chapter in a similar
way as an endoscopic approach is performed with
respect to the underlying anatomy and each nasal wall.
1.1 Front Door to Nasal Cavity
1.1.1 Piriform Aperture
The piriform aperture acts as the door to the bony structures of the nose. Its boundaries are superiorly the
inferior edge of both the nasal bones, laterally the nasal
(ascending) processes of the maxilla, and inferiorly the
horizontal processes of the maxillary bones. The junction
between the latter ones forms the anterior nasal spine, a
keel-shaped protrusion in which the nasal septum is
firmly attached (▶ Fig. 1.1).
1.1.2 Nasal Pyramid
The bony framework of the piriform aperture represents
the insertion of the cartilaginous structures supporting
the nasal pyramid: upper lateral cartilages (ULCs) and
lower lateral cartilages (LLCs). The ULCs are triangle
shaped. Its superior insertion is under the nasal bones
where they are strongly attached. Medially, its edge
merges with the nasal septum and the contralateral ULC
at the keystone area (▶ Fig. 1.2). This union with the nasal
septum shapes a decreasing angle in the nasal cavity from
Fig. 1.1 Pyriform aper ture.
Skull: 1, nasal bones; 2, ascending processes of the maxilla;
3, horizontal processes of the maxillary bones; 4, anterior nasal
spine.
Fig. 1.2 Nasal pyramid.
Open rhinoplasty approach with nasal cartilages exposed:
1, upper lateral cartilages (ULCs); 2, keystone area; 3, cruris lateralis of the lower lateral cartilages (LLCs); 4, domes of the LLC;
5, cruris medialis of the LLC; 6, nasal bones.
3
Nasal Anatomy
https://t.me/med1917
superior to inferior (from 70 to 10–15 degrees), which is
of paramount importance to determine the nasal airflow.
At this point, between the nasal septum, ULC, the head of
the middle turbinate, and the floor of the nasal cavity, the
coronal section is called “nasal valve” as it constitutes the
place of maximal resistance to nasal airflow. Values of
this valvular nasal angle under 10 degrees may result in
nasal obstruction.
laterally in the frontal process of the maxilla. The inferior
edge of the ULC is placed under the superior edge of
the LLC crus lateralis. The LLC is horseshoe shaped and
has three portions: crus medialis, crus lateralis, and
intermediate crus or dome. This cartilage is the main
support to the nasal vestibule that is the natural entry
to the nasal cavity. Because of its fibroelastic insertions
to the bony framework of the piriform aperture and to
the musculocutaneous components of the nasal pyramid, it offers a significant elasticity that facilitates the
indispensable maneuvers for the endoscopic approaches
to the nose.
1
The vertex of the ULC is inserted
1.2 Medial Wall of Nasal
8
9
2
1
4
6
Fig. 1.3 Nasal septum.
Sagittal cut of the head; view of the nasal septum: 1, septal
cartilage; 2, perpendicular plate of the ethmoid; 3, vomer;
4, septal crest of the palatine bone; 5, septal crest of the maxilla; 6, anterior nasal spine; 7, rostrum of the sphenoid; 8, frontal bone; 9, nasal bone; 10, sphenoid sinus; 11, eustachian
tube.
5
10
7
3
11
Cavity: Nasal Septum
The nasal septum is constituted by the septal cartilage
and four bones: the perpendicular plate of the ethmoid,
the vomer, septal crests of the palatine, and maxillary
bones.
Classically the septum was divided by Cottle into five
areas, corresponding to the projection of anatomical
structures located in the lateral nasal wall: area I, from
the external nostril to the nasal valve; area II, corresponding to the nasal valve; area III, from the nasal valve to the
anterior limit of the head of the turbinates; area IV, corresponding to the projection of the turbinates; and area V,
from the tail of the turbinates to the choana. This classification may be of interest to designate precisely the anatomical location of nasoseptal perforations (▶ Fig. 1.3).
1.2.1 Septal Cartilage
Its anterosuperior edge articulates with the suture
between both the nasal bones in the most superior portion; its middle part is the place of insertion of the ULCs
of the nasal dorsum and its lower third forms the “supratip” of the nose, being the main support for the nasal tip.
The anteroinferior edge hangs just over the crus medialis
of the LLCs and separated of them by the membranous
septum. The posteroinferior edge articulates with the
anterior nasal spine, the septal crests of both the maxillary bones (also named wings of the premaxilla), and
the anterior half of the vomer. Interesting in this area are
the fibrous junctions that keep the septal cartilage
firmly attached to its inferior bony insertions: direct and
crossing fibers from periosteum to perichondrium. The
posterosuperior edge of the cartilage joins the perpendicular plate of the ethmoid in an oblique line from anterior
to posterior and superior to inferior. This boundary shows
a clear change of consistency between the bone and
cartilage when surgically exposed.
1.2.2 Perpendicular Plate
of Ethmoid
Its superior edge is inserted in the cribriform plate, where
it continues inside the endocranium as the crista galli.
The anterosuperior edge of the plate is projected forward
to articulate with the nasal spine of the frontal bone and
the nasal bones. As it has been mentioned, its anteroinferior edge articulates with the septal cartilage. Its inferior
edge joins the vomer, often resulting in a bony lateral
ridge (▶ Fig. 1.4). In the posterior edge it articulates with
the vertical crest located in the middle of the rostrum
sphenoidale, in bet ween both ostia of the sphenoid
sinuses.
1.2.3 Vomer
It has a pointing forward wedge shape. Its posteroinferior
edge is the medial limit and the separation of the choanae.
Its posterosuperior limit articulates through a V-shaped
sulcus with the middle crest of the rostrum sphenoidale.Its
anterosuperior edge is firmly attached to the perpendicular
plate of the ethmoid bone and the septal cartilage. Its
inferior edge articulates with the vertical septal crests of
the maxillary and palatine bones (see ▶ Fig. 1.3).
4
Соседние файлы в папке Библиотека им академика М.И. Перельмана