- 期刊
耳蝸與錐狀隆突於胎兒與成人之相對解剖位置方向之變化分析
The Difference of Anatomical Relationship between Cochlea and Pyramidal Eminence in Fetus and Adult
摘要
背景：錐狀隆突與耳蝸間的相對關係，咸信為中耳手術時定位顏面神經的指標之一。但因實際檢測困難，故無臨床相關參考數據。解析胎兒與成人之錐狀隆突與耳蝸間的位置方向變化，有助於瞭解胎兒發育至成人時内耳、中耳相對位置方向之變化，也有助於耳科醫師對顏面神經及内耳之相對位置的瞭解。方法：研究取用7名胎兒顳骨及9名成人顳骨，經處理後製成厚20 μm之連續顳骨切片。於光學顯微鏡下拍攝顳骨切片並作檢讀分析。錐狀隆突之位置方向代表線取鐙骨肌腱延伸線，内耳則以蝸軸延伸線為位置方向代表線。兩延伸線之交角可定位出耳蝸與錐狀隆突之夾角。結果做魏克生檢定，統計胎兒與成人間之耳蝸與錐狀隆突間的交角差異。結果：胎兒之耳蝸與錐狀隆突的位置方向夾角為29.9 ± 1.9°，成人之耳蝸與錐狀隆突的位置方向夾角為60.2 ± 1.4°。胎兒與成人間之耳蝸與錐狀隆突的位置方向夾角呈現有意義之差異（p ＜ 0.05）。結論：胎兒與成人間之耳蝸與錐狀隆突的夾角差異，顯示耳蝸與錐狀隆突間之相對關係由胎兒至成人大幅開離。此變化表示耳蝸與錐狀隆突之間存著大幅度的組織變化，使錐狀隆突部的顏面神經大幅遠離内耳結構。
關鍵字
cochlea ； pyramidal eminence ； fetal temporal bone ； adult temporal bone（耳蝸 ； 錐狀隆突 ； 胎兒顳骨 ； 成人顳骨）並列摘要
BACKGROUND: To understand the anatomical relation of cochlea and pyramidal eminence is important in identifying facial nerve location during ear surgery. However, only few literature review had been found discussing this issue anatomically. Analyzing the difference of anatomical relationship between cochlea and pyramidal eminence between fetus and adult may help understanding the developmental change of inner ear and facial nerve position. METHOD: Seven fetus and nine adult temporal bones were harvested and processing to 20 μm continuous slides for analyzing. The extension line of stapedial tendon represents the anatomical direction of pyramidal eminence, and that of modiolus represents the anatomical direction of cochlea. The intersection angle between two extension lines shows the basic position change between cochlea and pyramidal eminence. The difference of the angles between fetus and adult was analyzed by Wilcoxon rank-sum test. RESULTS: The intersection angle of fetal cochlea and pyramidal eminence is 29.9 ± 1.9°, while the adult revealed 60.2 ± 1.4° (P value ＜ 0.05). CONCLUSIONS: The difference of intersection angles of cochlea and pyramidal eminence in fetus and adult showed the developing of inner ear and middle ear cavity. The extending of middle ear cavity results in the leaving of pyramidal eminence, which lies over vertical portion of facial nerve, from inner ear structure while developing.