颞区、乳突区的解剖研究及其在耳廓再造手术中的应用

发布时间：2018-06-22 04:08

本文选题：耳再造 + 解剖学　；参考：《北京协和医学院》2013年博士论文

【摘要】：目的：耳再造手术是整形外科中最具挑战性的手术之一,术中所涉及的解剖区域包括颞区和乳突区。本研究通过解剖尸头标本,明确颞区、乳突区层次及神经、血管分布和走行特点,并讨论其在手术中的应用。方法：采用一般解剖学方法,对4例(8侧)尸头标本的颞区和乳突区进行逐层解剖：1、由浅向深解剖颞区和乳突区的层次；2、解剖颞区和乳突区神经,观察其走行和分布；3、解剖耳周肌肉分布情况及耳后肌供血血管；4、解剖颞浅动脉、耳后动脉及其分支,观察耳后筋膜瓣中横行血管的走行、数量及其于耳后筋膜瓣上的分布特点；5、测量耳后筋膜瓣的厚度及范围。结果： 1、颞区层次由浅至深为：皮肤、皮下浅筋膜脂肪层、颞浅筋膜层、筋膜下疏松结缔组织层、颞深筋膜、颞肌、骨膜层；乳突区层次为：皮肤、皮下浅筋膜脂肪层、乳突浅筋膜层、筋膜下疏松结缔组织层、深筋膜层、骨膜层。2、颞区神经包括耳颞神经、面神经颞支,乳突区神经包括耳大神经和枕小神经。3、颞浅筋膜和耳后筋膜存在丰富的血运,分别由颞浅动脉和耳后动脉供血。耳后动脉于耳后区域向后方发出1-2条较粗的横行分支,走行于耳后筋膜表面,其分布范围约为8.8cm×5.95cm。4、耳后肌由耳后动脉向后方发出的单支细小分支供血。5、耳后筋膜瓣上、中、下部的厚度分别为1.24±0.11mm、2.86±0.25mm和3.80±0.23mm。结论：耳廓再造手术中应严格按解剖层次进行操作,在形成筋膜瓣时,应保持解剖层次的连续性。术中使用耳后筋膜瓣包裹耳支架,具有形成方便、切口隐蔽、颅耳沟清晰等优势,同时保留了颞浅筋膜的完整。在形成耳后筋膜瓣的过程中,可适当保留一层较薄的皮下浅筋膜脂肪层,以保证筋膜瓣的血供,筋膜瓣下部可自其背侧的胸锁乳突肌表面进行分离,并且可以将表面耳后肌去除,以减小筋膜瓣厚度。
[Abstract]:Objective:
Ear reconstruction is one of the most challenging operations in plastic surgery. The anatomical areas involved in the operation include the temporal region and the mastoid region. This study is a study of the temporal region, the level of the mastoid region and the nerve, the distribution of the vessels and the characteristics of the operation, and its application in the operation.
Method:
The temporal and mastoid regions of 4 cadaver head specimens of 4 cases (8 sides) were anatomically dissected by general anatomical methods: 1, the superficial and deep anatomy of the temporal and mastoid regions; 2, the anatomy of the temporal and mastoid nerve, and the observation of its walking and distribution; 3, the distribution of the auricular muscles and the blood supply of the posterior auricular muscle; 4, the anatomy of the superficial temporal artery and the posterior auricular artery. And the branches of the posterior fascia flap in the posterior auricular fascial flap, the number and the distribution of the posterior fascial flap; 5, the thickness and range of the posterior fascia flap were measured.
Result:
1, the temporal level is from shallow to deep: skin, subcutaneous fascia fatty layer, superficial temporal fascia layer, loose connective tissue layer under fascia, deep temporal fascia, temporal muscle, periosteum layer, skin, subcutaneous superficial fascia fatty layer, superficial fascia of mastoid fascia, loose connective tissue layer under fascia, deep fascia,.2 of periosteum layer, temporal nerve including auricular temporal deity. The temporal branches of the facial nerve and the mastoid nerve include the.3 of the auricular and occipital nerve, the superficial temporal fascia and the posterior fascia of the ear are rich in blood transportation, which are supplied by the superficial temporal artery and the posterior auricular artery, respectively. The posterior auricular artery emits 1-2 rough transverse branches in the posterior ear area, and travels on the surface of the posterior ear fascia, and its distribution range is about 8.8cm x 5.95cm.4. The posterior auricular muscle was supplied by the single branch of the posterior auricular artery to the posterior branch of the auricular artery for.5. The thickness of the posterior fascial flap of the ear was 1.24 + 0.11mm, 2.86 + 0.25mm and 3.80 + 0.23mm., respectively.
Conclusion:
During the reconstruction of the auricle, the operation should be carried out strictly according to the anatomical level, and the continuity of the anatomical level should be maintained when the fascial flap is formed. In the operation, the posterior ear fascia flap is used to wrap the ear stent. It has the advantages of convenient formation, concealed incision and clear cranial trench, while preserving the integrity of the superficial temporal fascia. It is appropriate to form the posterior fascia flap in the formation of the posterior ear. A thinner subcutaneous fascia fat layer is retained to ensure the blood supply of the fascia flap. The lower part of the fascia flap can be separated from the surface of the sternocleidomastoid muscle on the back side, and the posterior muscle of the ear can be removed to reduce the thickness of the fascia flap.
【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R602;R764.9

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