Objective: To investigate the distribution and primary drainage sites of the venous drainage system in the pedicled nasal septal mucosal flap, as well as to examine protective measures for the venous system of the nasal septal mucosal flap and its application in repairing the nasal skull base through the anatomical study of the nasal septum mucosal venous system in cadavers. Methods: Gross anatomy dissections were performed on 13 sides perfused fresh frozen cadaveric head specimens. The nasal septum mucosal flap was separated along the perichondrium and subperiosteum, then passed across the vomer, anterior wall of sphenoid sinus, clivus, and towards the anterior edge of vertical plate of palatine bone. Detailed documentation, including photographs, was made to record the morphology, distribution and drainage location of veins of the nasal septum mucosal flap and its pedicle, along with number of sphenopalatine veins. Furthermore, venous injuries resulting from obtaining a pedicled nasal septal mucosa flap were observed. From March 2023 to March 2024, a retrospective analysis was conducted on patients with nasopharyngeal lesions who underwent surgical repair using a modified pedicled nasal septum mucosal flap for venous system protection in the ENT institute and Department of Otorhinolaryngology at the Eye & ENT Hospital of Fudan University. The postoperative endoscopy was employed to assess the viability of the mucosal flap. Results: The veins of the nasal septum mucosa were primarily located in the posterior region, including the vomerine region, anterior wall of the sphenoid sinus, clivus region, and posterolateral wall of the nasal cavity, in a reticular pattern. Perforating veins draining into these bony structures could be observed, although their quantity and morphology varied. Notably, no prominent sphenopalatine veins were identified in 10 specimens examined, while 3 specimens exhibited sphenopalatine veins: one with a small single branch and two with venous bundles. Preservation of the nasal septal vein was possible when dissection was limited to the anterior edge of the wing of vomer. A wider range of dissection increased the risk of veinous injury. In cases where only vascular pedicles at the sphenopalatine foramen were preserved, three cadaveric head specimens retained intact sphenopalatine veins, while drainage veins were completely destroyed in ten other specimens. Fifteen patients with unilateral lesions (8 with recurrent nasopharyngeal carcinoma and 7 with nasopharyngeal radionecrosis) were included in this study. The postoperative reconstructions were carried out using contralateral pedicled nasal septal mucosal flaps. The average follow-up time was 7 months (ranging from 3 to 12 months), and all the nasal septal mucosal flaps survived. Conclusions: The primary location of the drainage vein within the nasal septum mucosa is situated in its posterior region, where it penetrates into adjacent bone structures. Very few sphenopalatine veins pass through the sphenopalatine foramen. Extensive dissection of the pedicled nasal septal mucosal flap may potentially impair the venous system and adversely affect flap survival rates, necessitating further clinical exploration.
目的： 通过对鼻中隔黏膜静脉系统的尸头解剖学研究，探索带蒂鼻中隔黏膜瓣的静脉引流系统分布和主要引流部位，研究鼻中隔黏膜瓣静脉系统的保护方法及其在鼻颅底修复中的应用。 方法： 对13侧新鲜冰冻灌注尸头标本进行大体解剖，将鼻中隔黏膜瓣及其蒂部从软骨及骨面进行分离。拍照记录鼻中隔黏膜瓣及其蒂部静脉的形态、分布、引流部位及蝶腭孔静脉数量。观察获取带蒂鼻中隔黏膜瓣及分离黏膜瓣蒂部不同范围时对其静脉损伤的影响。回顾性分析自2023年3月至2024年3月，于复旦大学附属眼耳鼻喉科医院耳鼻喉科用保护静脉系统的改良带蒂鼻中隔黏膜瓣进行术后修复的鼻咽病变患者，根据术后电子鼻咽镜检查结果判断黏膜瓣是否成活。 结果： 鼻中隔黏膜静脉主要位于其后部，呈丛状，以骨性结构为标志将其分为犁骨区、蝶窦前壁区、斜坡区及鼻腔外侧壁区，可见穿支静脉引流至上述骨性结构。10侧标本未观察到明显蝶腭静脉，3侧存在蝶腭静脉，其中1侧蝶腭静脉呈细小单支，2侧蝶腭静脉呈静脉丛状。在犁骨翼部前缘以前游离鼻中隔黏膜时，不会损伤鼻中隔黏膜瓣主要静脉，鼻中隔黏膜瓣蒂部游离范围越大则损伤的静脉越多。当仅保留蝶腭孔血管蒂时，3侧尸头标本可保留蝶腭静脉，其余10侧标本引流静脉均被离断。本研究连续收集到15例患者，其中复发性鼻咽癌8例，鼻咽部放射性坏死7例，病变切除后均使用病变对侧分离至犁骨的带蒂鼻中隔黏膜瓣修复，术后用电子鼻咽镜平均随访7个月（3~12个月），鼻中隔黏膜瓣均成活。 结论： 鼻中隔黏膜引流静脉主要位于鼻中隔和鼻腔后部，并穿经上述部位的骨质。蝶腭孔很少有静脉穿行。在制备带蒂鼻中隔黏膜瓣时，过度分离其蒂部会损伤黏膜瓣的静脉回流，可能影响黏膜瓣的成活率，值得进一步临床研究。.