面中部纤维脂肪垫的解剖学研究

发布时间：2018-04-01 20:21

本文选题：面中部纤维脂肪垫　切入点：解剖学　出处：《大连医科大学》2007年硕士论文

【摘要】： 目的:面部除皱术随着人们要求的日益增多发展起来,其经历了单纯解决面部皮肤松弛的皮肤剥离上提除皱术,SMAS层提拉除皱术、骨膜下层复合上提除皱术的演变。虽然在一定程度上对面部皱纹有所改善,但仍不能理想地解决面中部的衰老现象。因而面中部成为面部除皱术改进的重点,如何改善特定部位如鼻唇沟、唇颊沟形态使面中部整体恢复青春轮廓,重建优美的青春曲线,将成为整形美容外科医生的巨大挑战。面部衰老首先是因为面部软组织下垂。面部软组织由浅及深主要分为:皮肤层、皮下脂肪层、SMAS层(表浅肌肉腱膜系统)、肌肉层、骨膜层。骨膜与骨紧密相连,重力影响小;SMAS层有多个骨性起源,外侧有多个韧带支持,因此随年龄增长SMAS层无明显变化;有学者对SMAS层进行了研究,并应用提升SMAS层和皮肤的方法进行面部除皱,这些方法虽然对颏部和颈部效果明显,但没有改善消瘦松懈的面中部和较深的鼻唇沟。面中部纤维脂肪垫疏松连接于SMAS层,而与皮肤连接紧密,所以重力对于面中部浅表组织作用明显,随年龄增长,越是浅表的组织下垂越明显。面中部的改变是老化过程中的一个早期征象。因此此次试验着重研究面中部纤维脂肪垫的位置、形态、固定结构及其层次毗邻关系,为寻找新的面中部年轻化手术方法提供解剖学依据。方法:经过福尔马林浸泡6个月至一年的成人尸体头部标本10个,对其20侧面部进行解剖学研究,包括大体解剖和显微解剖。解剖时逐层锐性钝性结合剥离,注意寻找固定面中部纤维脂肪垫的纤维结构。必要时在3.5倍的手术显微镜下使用显微器械对尸体标本进行解剖。之后采用游标卡尺测量,精度为0.02 mm。并作文字和图象记录。结果:面中部皮肤深面除下眼轮匝肌睑部表面外广泛存在一皮下脂肪层。这一皮下脂肪层的厚度不均匀,上颌骨浅面的皮下脂肪较厚,颧骨外侧到耳屏前区域的皮下脂肪较薄。皮下脂肪有一个近似三角形增厚的区域,三角形的尖位于口角外下方,约平下颌角平面,在部分老年人可达下颌缘;底部沿眶下缘呈一弧线;内侧界为鼻唇沟;外侧界从颧骨和颧弓交界到达口角外下方或下颌缘。面中部纤维脂肪垫为由细小纤维隔组成的网状结构,其间有较大的脂肪颗粒。面中部纤维脂肪垫通过三个由致密的细小纤维隔形成的区域与其浅面的皮肤层及其深面的SMAS层连接。同时研究还发现面中部纤维脂肪垫与颊脂体通过薄层的表情肌即SMAS层可以清楚地分开。结论:面中部纤维脂肪垫是面中部皮下层的重要结构,浅面及深面均有韧带和纤维组织对其起到固定的作用。随着时间的流逝,这些结构松弛,面中部纤维脂肪垫发生下移从而导致了衰老面容的特征性改变。提拉面中部纤维脂肪垫可以恢复其原有的解剖位置及面部青春曲线。而且面中部纤维脂肪垫位于SMAS层浅面,而面神经位于SMAS层深面,剥离脂肪垫不会损伤面神经。因此悬吊面中部纤维脂肪垫是一种安全有效的面中部年轻化手术方法。另外面中部纤维脂肪垫和颊脂体是不同的,面中部纤维脂肪垫位于皮肤和SMAS层之间,而颊脂体位于表情肌即SMAS层深面,澄清了以往混淆的概念
[Abstract]:Objective: Rhytidoplasty with increasing demands of the development, it experienced a simple solution to facial skin sagging skin peeling on rhytidectomy, SMAS layer lifting operation, lifting the lower evolution of periosteum composite rhytidectomy. Although to some extent facial wrinkles were improved, but still not ideal to solve aging the phenomenon of midface. Thus the midface rhytidectomy has become the focus of improvement, how to improve specific areas such as nasolabial sulcus, buccolabial sulcus form so that the overall recovery of youth midface contour, reconstruction of beautiful young curve, will become a great challenge to plastic surgeons.
Facial aging is because descensus of facial soft tissue. The facial soft tissue by the shallow and deep is divided into: skin, subcutaneous fat layer, the SMAS layer (SMAs), muscle layer, periosteum layer. Closely connected with periosteum and bone, the influence of gravity; the SMAS layer has a plurality of bony origin, lateral there are multiple ligament support with age, so the SMAS layer has no obvious change; some scholars have conducted the research on the SMAS layer, and enhance the application method of SMAS layer and the skin of facial wrinkles, although these methods are obviously on the chin and neck, but no improvement was slack midface and deep nasolabial ditch. The midface fabric fat pad is connected to the SMAS layer of loose, and is tightly connected with the skin, so the gravity on the surface in the middle of superficial tissue obviously, with the increase of age, the more superficial tissue is more obvious. The change of midface is an early sign of aging process. Therefore, this experiment focuses on the location, morphology, fixed structure and adjacent relationship of the middle part of the fiber fat pad, so as to provide anatomical basis for finding new operative methods for the mid facial juvenilization.
Methods: after formalin soaked for 6 months to a year of adult cadaveric head specimens of 10, to study the anatomy of the 20 sides, including the gross anatomy and microanatomy. Anatomical layer with sharp blunt dissection, pay attention to find the fixed fiber midface fabric fat pad structure. When necessary use of instruments the anatomy of cadaver specimens in surgical microscope at 3.5 times. After using vernier caliper measurement, the precision is 0.02 mm. and text and image recording.
Results: the midface skin deep in the orbicularis oculi muscle eyelid surface exists widely. The subcutaneous fat layer is not uniform the subcutaneous fat thickness, maxillary superficial thick subcutaneous, zygomatic lateral to the subcutaneous fat pretragal area is thinner. The subcutaneous fat has a triangular thickening area the point of the triangle, located in the mouth below, joppien mandibular plane, in the part of the elderly to mandibular; along the bottom of the infraorbital rim is a curve; the medial boundary of nasolabial groove; the lateral boundary from the junction of malar and zygomatic to the angulus oris inferolateral or marginal mandibular reticular structure. The midface fabric fat pad fines on the grounds by composition, there is a big fat particles. The midface fabric fat pad through the three formed by fine fiber dense across the region and the shallow surface layer and deep layer of the skin SMAS connection. The study also found that in the face of fiber The fat pad and the buccal fat can be clearly separated by the thin layer of expression muscle, the SMAS layer.
Conclusion: the midface fabric fat pad is an important structure of midface subcutaneous layer, superficial and deep layer of ligament and fibrous tissue played a role of fixing it. With the passage of time, these structural relaxation, the midface fabric fat pad descending induce the characteristic change of aging face. Hand-Pulled Noodle middle fiber the fat pad can be restored to its original anatomic position and young face curve. And the midface fabric fat pad locate on the surface of SMAS layer, and the facial nerve in the SMAS layer, stripping the fat pad will not damage the facial nerve. Therefore lifting midface fabric fat pad is a safe and effective method for facial rejuvenation. The midface fabric fat pad and buccal fat body is different, the midface fabric fat pad located between the skin and the SMAS layer, and the buccal fat body in which SMAS expression of muscle layer, clarify the concept of the past confusion

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2007
【分类号】：R322;R622

【参考文献】