人皱眉肌肌内外神经解剖学研究

发布时间：2019-01-03 06:48

【摘要】： 目的通过对支配皱眉肌神经的解剖学研究，确认皱眉肌肌内外神经的来源、走行和分布。消除皱眉肌运动所导致的眉间皱纹是目前整形美容外科的一项难题，本研究旨在明确皱眉肌的神经解剖，从而为处理和治疗其产生的皱纹寻找适合的方法，并尽可能地减少皱眉肌功能丧失提供解剖学依据。(1)通过对尸头标本皱眉肌神经分布的解剖和肌内神经染色的研究，建立皱眉肌的神经支配模型。(2)为改善眉间纹的衰老形态的手术方式或其他治疗方法提供解剖学依据。实验方法对10％福尔马林溶液浸泡5个月至2年的成人尸头5具，10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，注意寻找面神经皱眉肌支配支走行及分布，必要时在3.5倍手术显微镜下使用显微器械对尸体标本进行显微解剖，利用改良的Sihler's肌内神经染色显示皱眉肌内神经，采取游标卡尺测量，精度为0.02m，并做文字和图象记录。实验结果面神经出茎乳孔后，各分支相互吻合，形成立体网状结构。皱眉肌受面神经多重分支支配。颞支分出外侧及内侧额支，外侧额支进入额肌，内侧额支进入眼轮匝肌，，两分支于皱眉肌中段进入皱眉肌。颧支上部分支进入眼轮匝肌，在内眦部与浅支汇合，一同进入降眉间肌后上行进入皱眉肌。浅颊支上行穿“三角窗”(眼轮匝肌、颧小肌、提上唇鼻翼肌)，与上颧支及浅颧支汇合成“角支”，跨越睑内侧韧带到达皱眉肌和降眉间肌。利用肌内神经染色可以清楚显示皱眉肌内神经，皱眉肌内神经呈水平节段性分布。结论面神经各分支间交错吻合成神经网，通过形成的神经网支配面部诸表情肌。皱眉肌受面神经颞支、颧支和颊支多重神经分支支配，同时亦与临近解剖区域表情肌相关联。皱眉肌肌内神经与皱眉肌走行大致垂直，呈水平节段性分布。因而面部年轻化手术中，去除眉间皱纹必须彻底切断皱眉肌所有支配神经。在最大限度的保留皱眉肌形态和功能的情况下，通过高选择性神经离断术可以安全有效的解决眉间皱纹。
[Abstract]:Objective to identify the origin, movement and distribution of the internal and external nerves of the frowning muscles by anatomic study of the innervation of the frowning muscles. It is a difficult problem for cosmetic surgery to eliminate the wrinkles caused by the frowning muscle movement. The purpose of this study is to clarify the neuroanatomy of the frowning muscles and to find suitable methods for the treatment and treatment of the wrinkles produced by them. As far as possible to reduce the loss of the function of frowning muscles to provide anatomical basis. (1) by studying the distribution of frowning nerve and the staining of intramuscular nerve in cadaveric head specimens, The innervation model of the frowning muscles was established. (2) the anatomical basis was provided for the operation or other treatment methods to improve the aging morphology of the intereyebrow striae. Methods Anatomy of 10 sides of adult cadaveric heads soaked in 10% formalin solution for 5 months to 2 years was studied, including gross anatomy and microanatomy. In dissection, the facial nerve frowning muscle was dissected layer by layer, and the innervation branches of the facial nerve frowning muscle were searched for walking and distribution. When necessary, the cadaver specimens were dissected with microinstruments under 3.5 times operation microscope. The improved Sihler's intramuscular nerve staining was used to display the intramuscular nerve of frown. The Vernier caliper was used to measure the intramuscular nerve. The accuracy was 0.02m.The written and image records were also made. The results showed that the branches of the facial nerve anastomosed with each other and formed a three-dimensional reticular structure after the caulomastoid foramen. The frowning muscle is innervated by multiple branches of the facial nerve. The temporal branch was divided into lateral and medial frontalis, lateral frontal branch into frontal muscle, medial frontal branch into orbicularis oculi muscle, and two branches into frowning muscle. The upper branch of zygomatic branch enters the orbicularis oculi muscle, and the medial canthus converges with the superficial branch. The superficial buccal branch goes up through the "triangle window" (orbicularis oculi muscle, zygomaticus minor muscle, upper lip and nasal alar muscle), converges with the superior zygomatic branch and the superficial zygomatic branch to form the "angle branch", and crosses the medial ligaments of the eyelid to the frowning muscle and the lower interfacial muscle. The intramuscular nerve of frown can be clearly displayed by intramuscular nerve staining, and the intramuscular nerve of frown is distributed horizontally. Conclusion the nerve network is formed by interlaced anastomosis between the branches of the facial nerve, and the facial expression muscles are innervated by the neural network formed. The frowning muscle is innervated by the temporal branch, zygomatic branch and buccal branch of facial nerve. The intramuscular nerve was approximately vertical to the frowning muscle and distributed horizontally. Therefore, facial rejuvenation surgery, the removal of wrinkles must be completely cut off all the innervation of the frown muscle. Under the condition of preserving the shape and function of the frowning muscle to the maximum extent, it is safe and effective to solve the intereyebrow wrinkles by high selective neurotomy.
【学位授予单位】：中国医科大学
【学位级别】：硕士
【学位授予年份】：2007
【分类号】：R322

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