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一、咽旁间隙正常解剖咽旁间隙(parapharyngeal space , PPS)是位于咽肌环与咀嚼肌群和腮腺之间由深筋膜围成的脂肪间隙，左右各一，上自颅底，下至舌骨水平，大致呈倒置的锥形。
严格而言，咽旁间隙并非由深筋膜围绕而成，而是位于这些结构之间的为脂肪充填的一个间隙，其构成和周围结构复杂，通过组织亦较繁杂，以往文献对此的表达很多，但常有所出入。
咽旁间隙的内侧壁为颊咽筋膜，此筋膜上自颅底，包绕咽颅底筋膜和咽缩肌外侧；外侧壁为翼内外肌、腮腺和二腹肌后腹的筋膜；前界自上而下依次为蝶骨翼突内侧板后缘及其颊咽筋膜、翼内肌、腭舌肌及腭咽肌筋膜；后壁为覆盖颈锥和锥前肌的锥前筋膜；顶部为岩锥和蝶骨大翼局部；底部为二腹肌后腹和舌骨大角连接处及颌下腺的包膜。
由此可见，咽旁间隙内邻鼻、口咽侧壁，其内侧的主要结构有咽肌环、腭帆张肌、腭帆提肌、咽鼓管、咽隐窝和扁桃体等；外邻翼内外肌、下颌骨、腮腺、二腹肌后腹等；后邻颈锥横突、头长肌和头前直肌〔头长肌位于头前直肌之内侧〕；前邻翼内肌和翼内板；上起自颅底；下止于颌下腺和舌骨。
由茎突及其附着肌肉〔茎突舌骨肌、茎突咽肌和茎突舌肌〕、韧带〔茎突舌骨和茎突下颌韧带〕和茎突咽筋膜组成的隔膜将咽旁间隙分为茎突前、后两个间隙〔或称茎突前、后区〕。
茎突前间隙内主要为脂肪组织，外侧有腮腺深叶伸入，内侧有腭帆张肌和腭帆提肌通过〔腭帆张肌位前部，呈扁三角形，腭帆提肌位腭帆张肌前方，呈椭圆形〕，间隙内有许多神经和血管结构通过，包含下颌神经〔第Ⅴ颅神经第三支--Ⅴ3神经〕及其分支舌神经、下牙槽神经、颞神经，上颌动脉及其分支、咽升动脉、咽静脉丛和淋巴组织等。
茎突后间隙主要通过颈动脉鞘〔ＣＳ〕，其中包含颈内动静脉、Ⅸ-Ⅻ颅神经、颈交感干、球体组织和淋巴结等。
有人认为颈动脉鞘并不属于咽旁间隙，它是由深筋膜包裹的一个独立的间隙，下达主动脉弓，分为舌骨上区和舌骨下区。
其内贯穿全长的成份有颈内静脉、迷走和交感神经及颈深淋巴链；舌骨上区还有第Ⅸ-Ⅻ对颅神经和颈内动脉，舌骨下区为颈总动脉。
内镜口内进路咽旁间隙解剖恒定标志[摘要] 目的：观察经口入路内镜下咽旁间隙的解剖恒定标志,了解颈内动、静脉及后组颅神经等解剖结构的毗邻关系，为提高经口入路内镜下咽旁间隙病变、肿瘤切除手术成功率提供解剖依据。
方法：2015年1月~2016年3月，对10具（20侧）灌注新鲜尸头先行CT扫描及三维重建，观察咽旁间隙等咽旁结构，然后应用内镜口内径路行咽旁间隙解剖。
结果：CT图像上，咽旁间隙位于咽隐窝的外侧，呈低密度三角形，翼内肌、翼外肌、咬肌、颞肌位于咽旁间隙的外侧，呈中密度阴影，茎突位于咽旁间隙的前部阴影，咽旁间隙后部颈内动脉呈中密度阴影。
解剖发现，经口进路可以良好暴露翼内肌外侧至咽上缩肌的咽旁间隙区域。
茎突及其附着的茎突舌肌及茎突咽肌在这一解剖路径中具有关键的解剖标识作用。
在茎突舌肌及茎突咽肌的后方，咽上缩肌的外侧能清楚的暴露颈内动脉、颈内静脉及IX-XII对颅神经。
结论内镜口内进路咽旁间隙解剖中咽上缩肌、茎突、茎突舌肌、茎突咽肌是重要的解剖标志，颈内动脉位于咽上缩肌的外侧，靠近咽上缩肌内侧能够保护颈内动脉。
[关键词]咽旁间隙；经口入路；内镜辅助；解剖标志Anatomical constant sign of the endoscopic approach to the parapharyngeal spaceLi Jianxing ,Yang Dangwei, Lu Yongtian（E.N.T. Department,The Central Hospital of Longhua District,Shenzhen, Guangdong 518110, E.N.T. Department Shenzhen Second People, s Hospital,Shenzhen 518035）Abstracts: Objective:To observe anatomical constant sign of the endoscopic approach to the parapharyngeal space ,and provide evidence for the treatment of the lesions of the pharyngeal space and improve the success rate of the operation .Methods:Ten fresh dead bodies (twenty sides)were acquired from January 2015 to March 2016, CT scanning and three dimensional reconstruction were performed first,the structure of the lateral pharyngeal space was observed ,and then the endoscope was applied ,endoscopic assisted anatomical pharyngeal space in the mouth .Results: On the CT image, dispharynx of very low density extendedposterior-lateral into the pharyngeal recess ,lateral pharyngeal spacelocated in the lateral pharyngeal recess,a low density triangular shadow with a narrow of the front and width in the back , wing within muscles , wing outside muscles , masseter and temporal muscle were located in the lateral pharyngeal side clearance ,it showed a medium density shadow ,styloid process was located in the front shadow of pharynx side clearance ,the back of the internal carotid artery of pharynx side clearance , showed medium density shadow. It can expose the parapharyngeal sapce clearly from the latearl wing within muscles to the interior superior constrictor muscle through the endoscopic approach to the parapharyngeal space. The styloid process ,stylopharyngeus and styloglossus muscles were critical marks in this approach. Posterior to stylopharyngeus and styloglossus muscles and laterally to the superior constricor muscle,the internal carotid artery,internal jugular vein,and lower cranial nerves were identifiable.Conclusion:Endoscopic assisted transoral approach to the parapharyngeal space operation has the styloid process , stylopharyngeus and styloglossus muscles as the critical marks of anatomy.【key words】Parapharyngeal space; Transoral approach;Endoscopic assistance ; Anatomical sign咽旁间隙(parapharyngeal space)也称“危险间隙”（dangerous space）, 其位置深在，解剖区域隐蔽，结构细微而复杂，有重要的血管与神经穿行其中. 咽旁间隙肿瘤是头颈部常见的肿瘤之一，占头颈部肿瘤0.5%[1]，可导致咽部、颈部及其内神经症状。
螺旋CT三维重建咽旁隙的研究石小玲;陶磊;唐作华;王申江;王文忠;叶昕裴【摘要】目的探索螺旋CT扫描成人呈张口位时咽旁隙成像并行多平面重建和三维重建等后处理,为经口入路切除咽旁隙肿瘤提供解剖依据及术前指导.方法选择咽旁隙无占位性病变患者28例,放置张口器后行多层螺旋CT血管成像,应用多平面重建测量茎突长度并统计茎突末端与第一颈椎横突的关系,于颅底层面测量茎突至颈内动脉、下颌骨升支后缘的距离并进行统计学分析.利用容积重现和剪切技术对图像进行三维重建等后处理,观察颈内动静脉走行及是否存在变异移位等.结果茎突长度、茎突根部至颈内动脉、茎突根部至下颌骨升支后缘的平均距离分别为(2.50 ±0.80)、(1.09±0.26)、(2.27±0.29) cm,侧别、性别方面均无显著性差异(P＞0.05).78.6％(44/56)茎突末端位于第一颈椎横突或以下,64.3％(36/56)颈内动脉起始部位低于舌骨,12.5％(7/56)咽旁隙段颈内静脉先走行于颈内动脉前方然后再转向后外.结论咽旁隙以茎突至毗邻解剖结构的距离为参考,有助于神经血管的定位.三维重建的图像能清晰地显示颅底、下颌骨升支、茎突、颈内动静脉等咽旁隙周边及内部结构.咽旁隙段颈内动静脉均存在一定的变异率,为模拟手术入路和术中颈内动脉定位提供重要信息.%Objective To provide anatomical basis and preoperative guidance for removal of parapharyngeal space tumors via a transoral approach by multi-planar and three-dimensional (3-D) reconstructions with spiral CT scanning in healthy subjects with " mouth open" position.Methods Multi-slice spiral CT angiography was performed on 28 adults without parapharyngeal space-occupying lesions in " mouth open" position.By multi-planar reconstruction,the length of styloid process and the relationship between the end of styloid process and the transverseprocess of the first cervical vertebra were detected.At the skull base level,the distance between the styloid process and the posterior boarder of the mandibular ramus,and that from the styloid process to the internal carotid artery were measured and statistically analyzed.Volume reconstruction technique and shear technique were used to conduct 3-D reconstruction of the images to observe the courses of internal carotid artery and internal jugular and their variation and displacement.Results The average length of the styloid process,the distance from styloid process to the internal carotid artery,and that between styloid process root and mandibular ramus were (2.50 ± 0.80) cm,(1.09 ± 0.26) cm,and (2.27 ± 0.29) cm respectively.The differences of above parameters between different genders and those between different sides were all statistically insignificant (all P ＞0.05).Of them,about 78.6％ (44/56) of the ends of the styloid process were located at or below the transverse process of the first cervical vertebra.The internal carotid artery in 64.3％ (36/56) of the subjects branched at the beginning of the lower part of the hyoid bone.The internal jugular vein preceded in front of the internal carotid artery and then turned to the posterior in 12.5％ (7/56) of the subjects.Conclusions The distances between the styloid process and other anatomical structures of the parapharyngeal space can be used as references for the localization of nerves and blood vessels.3-D reconstruction of the image can clearly show the skull base,mandibular ramus,styloid process,carotid artery,internal jugular vein and other structures of the parapharyngeal space.There is a certain variation rate ininternal carotid artery and jugular vein,which provides important information for choosing a surgical approach and positioning the internal carotid artery during surgery.【期刊名称】《中国耳鼻咽喉颅底外科杂志》【年(卷),期】2018(024)002【总页数】5页(P109-113)【关键词】咽旁隙;经口入路;三维重建;容积再现【作者】石小玲;陶磊;唐作华;王申江;王文忠;叶昕裴【作者单位】复旦大学附属眼耳鼻喉科医院耳鼻咽喉头颈外科,上海200031;复旦大学附属眼耳鼻喉科医院耳鼻咽喉头颈外科,上海200031;复旦大学附属眼耳鼻喉科医院放射科,上海200031;复旦大学附属眼耳鼻喉科医院放射科,上海200031;复旦大学附属眼耳鼻喉科医院放射科,上海200031;复旦大学附属眼耳鼻喉科医院放射科,上海200031【正文语种】中文【中图分类】R817.4咽旁隙肿瘤是位于解剖毗邻复杂，病理类型多样，手术操作困难的头颈部疾病。
