Résumé
Objective To explore the localization and guidance value of infraorbital/maxillary nerve in endoscopic transmaxillary approach, and to provide anatomical data for clinical operation. Methods The eight adult cadaver heads were dissected by means of the endoscopic transmaxillary approach to expose the infraorbital/maxillary nerve, and relevant data were collected. Results In 8 cases, 16 maxillary nerves arose from the trigeminal ganglion of the trigeminal nerve and emerged from the foramen rotundum, transited to the infraorbital nerve at the infraorbital fissure, then traveled in the infraorbital canal and out of the infraorbital foramen. The infraorbital/maxillary nerve could be divided into four segments according to the foramen rotundum, infraorbital groove and infraorbital foramen: the terminal segment, the infraorbital nerve and its terminal branches to the face, distal to the infraorbital foramen; the orbitomaxillary segment and the orbitomaxillary segment of the infraorbital nerve within the infraorbital canal from the infraorbital foramen along the infraorbital groove (length 11.7 ±2.5 mm ), which was readily identified in the roof of the maxillary sinus in all specimens. The pterygopalatine segment, the pterygopalatine segment within the pterygopalatine fossa, which started at the infraorbital groove to the foramen rotundum (length 13.4±2.1 mm); The intracranial segment, the intracranial segment from the foramen rotundum to the trigeminal ganglion(length 15.2±3.9 mm). Conclusion The infraorbital nerve can serve as a anatomical landmark for endoscopic transmaxillary approach to get access to infratemporal fossa, pterygopalatine fossa, trigeminal ganglion and lateral wall of the cavernous sinus.
Résumé
Objective To evaluate the clinical application of SWI and DTI of MRI in the diagnosis and prognosis of diffuse axonal injury (DAI).Methods A retrospective case series study was conducted on the clinical data of 16 patients with DAI admitted from January 2015 to December 2017.There were nine males and seven females,aged (56.3 ± 4.1) years.According to Glasgow Coma Scale (GCS),there were seven patients with 3-8 points,eight with 9-12 points,and one with 13 points.All patients received head CT examination on admission and then received head MRI examination within one week to record the number of lesions on T1WI,T2WI,DWI,and SWI in CT and MRI examination.On the DTI sequence,five regions including the subcortical white matter,the corpus callosum,the thalamus,the cerebellum,and the brain stem were selected for measurement of the apparent diffusion coefficient (ADC) and partial fraction of anisotropy (FA) values.The Glasgow outcome scale (GOS) was evaluated 6 months after injury.The linear correlation between ADC,FA values,GCS,and GOS on admission and after 6 months were analyzed.Results The statistical analysis of CT,T1WI,T2WI,DWI and SWI in 16 patients showed that the detection rates of DAI lesions were 25.6％ (43/168),30.4％ (51/168),44.0％ (74/168),51.8％ (87/168),and 100％,respectively (P ＜0.01).The ADC values of the subcortical white matter,the corpus callosum,the thalamus,the cerebellum,and the brain stem were 0.830 ± 0.148,0.536 ± 0.169,0.838 ± 0.596,0.708 ± 0.157,and 0.713 ± 0.135,respectively,and FA values were 0.487 ± 0.103,0.142 ± 0.040,0.293 ± 0.089,0.212 ± 0.045,and 0.366 ± 0.797,respectively.The GCS on admission was (8.9 ± 3.3)points,and GOS was (4.2 ± 1.0)points six months after injury.The correlation analysis showed that the ADC value and FA value of subcortical white matter and cerebellum were not related to GCS and GOS (P ＞ 0.05).The correlation strength of ADC values in each region with the GCS score in descending order was the thalamus,the corpus callosum,and the brain stem (P ＜ 0.05 or 0.01);for ADC with the GOS score,it was the corpus callosum,the thalamus and the brain stem (P ＜0.05 or 0.01);for FA with GCS and GOS scores,it was thalamus,corpus callosum,and brainstem (P ＜ 0.05 or 0.01).Conclusion The SWI has better sensitivity to detect DAI lesions than CT and conventional MRI sequences.DTI can accurately,objectively and visually detect the integrity of cerebral white matter fibers.Both SWI and DTI can help make early diagnosis and evaluate the prognosis of DAI patients accurately.