口蓋手術における舌神経の外科解剖：どこに位置し、どのように回避するか

Surgical anatomy of the lingual nerve for palate surgery: where is located and how to avoid it.

抄録

目的:

舌神経と側中咽頭構造との解剖学的関係を説明すること。

PURPOSE: To describe the anatomic relationship of the lingual nerve with the lateral oropharyngeal structures.

方法:

新鮮凍結した4頭の死体から8つの側頭部を採取し、中咽頭側壁の解剖学的解剖を行った。小さなチタンクリップを舌神経と内側翼突筋の最前縁および内側縁に沿って留置した。最適な視覚化のために放射線学的再構成が採用され、手術位置に類似させるために冠状図が好まれた。舌神経と内側翼突筋の上下の距離をX線学的に測定した。内側翼突筋の上部と下部を結ぶクリップの間に生じたベクトルと、舌神経のクリップから生じたベクトルの交点から、翼突筋に対する舌神経の軌跡角度を求めた。

METHODS: An anatomic dissection of the lateral oropharyngeal wall was conducted in eight sides from four fresh-frozen cadaveric heads. Small titanium clips were placed along the lingual nerve and the most anterior and medial border of the medial pterygoid muscle. Radiological reconstructions were employed for optimal visualization; the coronal view was preferred to resemble the surgical position. The distance between the lingual nerve and the medial pterygoid muscle at its upper and lower portion was measured radiologically. The trajectory angle of the lingual nerve with respect to the pterygomandibular raphe was obtained from the intersection between the vector generated between the clips connecting the upper and lower portion of the medial pterygoid muscle with the vector generated from the lingual nerve clips.

結果:

内側翼突筋上部から上舌神経クリップまでの平均距離は10.16±2.18mm（平均±標準偏差）、内側翼突筋下部から舌神経までの距離は5.05±1.49mmであった。内側翼突筋の最前縁上部とその下部を結ぶベクトルに対する舌神経の軌跡角度は43.73º±11.29であった。

RESULTS: The mean distance from the upper portion of the medial pterygoid muscle and superior lingual nerve clips was 10.16 ± 2.18 mm (mean ± standard deviation), and the lower area of the medial pterygoid muscle to the lingual nerve was separated 5.05 ± 1.49 mm. The trajectory angle of the lingual nerve concerning to the vector that describes the upper portion of the most anterior and medial border of the medial pterygoid muscle with its lower part was 43.73º ± 11.29.

結論:

舌神経は中咽頭側壁の外側を上-下、側-内側に走行し、その下3分の1では中咽頭側壁に近い。

CONCLUSIONS: The lingual nerve runs lateral to the lateral oropharyngeal wall, from superiorly-inferiorly and laterally-medially, and it is closer to it at its lower third.