除皱手术相关面神经解剖学研究

发布时间：2018-03-11 19:08

  本文选题：面神经　切入点：除皱术　出处：《遵义医学院》2012年硕士论文　论文类型：学位论文

【摘要】：目的：长期以来,临床中对面神经的走行层次很难达成共识。该文密切结合除皱术,从三维角度对面神经的行程及其在筋膜中的走行层次进行研究,为临床操作提供解剖学依据。 方法：选用新鲜头部标本10例,男性3例(6侧)、女性7例(14侧),大致年龄25-70岁。以耳屏与眶下缘最低点连线(法兰克福平面的水平线)为x轴,以垂直于该平面、经过骨性外耳门中点的直线为y轴,建立坐标系1。将面神经各支在腮腺外的浅出点用坐标点(x、y)表示。通过肉眼及手术显微镜下观察面神经的分布特点。再以颧弓上缘水平线为x'轴,眶外缘垂线为y'轴,建立坐标系2。在坐标系2中,标记颧弓上方面神经颞支从某一筋膜层,移行至另一筋膜层的位置。在颞区颧弓上下、腮腺咬肌区和下颌角点附近切取全厚组织块,观察组织层次。组织切片染色、固定后,在显微镜下观察、记录。 结果：各支面神经的分支数存在很大个体差异。面神经各分支特点：①颞支。颞支有2-4支,分别称之为颞支Ⅰ、Ⅱ、Ⅲ、Ⅳ。各颞支从腮腺上缘浅出后,在颧弓下方走行于腮腺咬肌深面,在颧弓表面走行于颞中筋膜内。之后颞支继续斜向内上方走行。随着颞中筋膜向前上方逐渐变薄,各颞支也逐渐走向更浅层的颞筋膜。②颧支。1-4支,分别称之为颧支Ⅰ、Ⅱ、Ⅲ、Ⅳ。各颧支在腮腺上缘和前缘穿出后,在颧弓下方前行,走行于咬肌筋膜内。上位颧支先跨过颧大肌表面,然后再入肌。下位颧支的走行位置较深。在面神经颧支的浅出处,腮腺向前突出较明显。③颊支。约2-5支,分别称之为颊支Ⅰ、Ⅱ、Ⅲ、Ⅳ和Ⅴ。颊支走行于咬肌筋膜内或其深面。走行于咬肌筋膜深面者,在咬肌前缘穿出并走行于颊脂体表面。走行于其间者,自咬肌前部和中部陆续浅出至SMAS筋膜深面。④下颌缘支数。约1-2支,出腮腺后绝大部分在下颌体下缘之上的咬肌筋膜,向前下走行。在下颌角点前方跨面血管的浅深面后,进入颈阔肌和下颌骨体间隙,并分支入肌。在面血管后方,下颌缘支位于下颌体下缘之下。在面血管前方,下颌缘支均位于下颌体缘的上方。在面血管后部,下颌缘支均被覆较厚的咬肌筋膜。⑤颈支恒为1支。出腮腺后先垂直下降,走行于颈阔肌深面。颈支浅面有疏松的结缔组织被覆。 结论：①皮下颞部软组织由浅至深为颞浅筋膜、颞中筋膜、颞深筋膜浅层、颞浅脂肪垫、颞深筋膜深层和颞深脂肪垫。②面神经颞支走行于颞中筋膜,颧支、颊支和下颌缘支,主要分布于咬肌筋膜深面或中间。③颞浅筋膜浅面和颞深筋膜浅面是比较安全的分离平面。④在颧弓上方剥离,注意浅深筋膜移行区。⑤上位颧支位置较浅,容易受损。腮腺前缘和咬肌之间的颧支最容易受损。⑥在腮腺前缘、咬肌上段和颊脂体表面剥离时,容易损伤面神经颊支。⑦下颌缘上下2cm和距离口角2cm的范围内剥离时,注意保护下颌缘支。⑧在下颌角前缘的SMAS筋膜和颈阔肌深面剥离时,容易损伤颈支。
[Abstract]:Objective: for a long time, it is difficult to reach a consensus on the walking level of facial nerve in clinic. To provide anatomic basis for clinical operation. Methods: a total of 10 fresh head specimens were collected from 10 cases of male (3 cases), male (6 sides) and female (7 cases) with 14 flanks, aged 25-70 years. The line between the ear tragus and the lowest point of the orbital margin (the horizontal line of Frankfurt plane) was taken as the x axis, which was perpendicular to the plane. The straight line passing through the middle point of the osseous outer door is the y axis, Coordinate system 1. The superficial point of the facial nerve outside the parotid gland was expressed by the coordinate point XY). The distribution of the facial nerve was observed under the naked eye and under the surgical microscope. The horizontal line of the superior edge of the zygomatic arch was taken as the x' axis, and the vertical line of the outer border of the orbit was the y'axis. Coordinate system 2. In coordinate system 2, the temporal branch of facial nerve above zygomatic arch is marked from one fascia layer to another fascia layer. The whole thick tissue mass is removed from the upper and lower zygomatic arch, parotid masseter muscle area and mandibular corner point. Observe the tissue level. The tissue section is stained, fixed, observed under microscope, recorded. Results: there were significant individual differences in the number of branches of the facial nerve. The characteristics of each branch of the facial nerve were 1: 1 temporal branch and 2-4 temporal branch, which were called temporal branch 鈪，

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