面神经下颌缘支的应用解剖

面神经下颌缘支的应用解剖 面神经下颌缘支的应用解剖 【摘要】 目的 了解面神经下颌缘支的正常层次解剖位置，为涉及面侧区和颌下区的美容外科手术提供临床应用解剖学资料。方法 解剖33具(共66例)成人尸体标本 的头颈部标本，观察了面神经下颌缘支的分支类型、走行、与面动脉的位置关系以及穿出腮腺处和与面动脉的交叉处的体位置。结果 面神经下颌缘支为1,2支， 以单干型居多，约占58%，大多行于下颌骨下缘上方约占44%，行于骨下缘下方 者占5%。未发现面神经下颌缘支不与面动脉交叉，位置在均下颌角下缘上、下方约0.5,1 cm范围内。面神经下颌缘支经过面动脉的浅面和深面者分别占89%和 6%;面神经下颌缘支穿出腮腺处的体表位置分别在下颌角上方和下颌支后缘前方1 cm交点附近，面神经下颌缘支与面动脉交处距下颌支后缘约4 cm，距下颌骨下缘约1 cm。结论 面神经下颌缘支的毗邻和行程关系较为复杂，了解其与周围结构的 重要位置关系，可以减少美容外科手术因神经损伤造成下唇及口角功能障碍的发 生。 【关键词】 面神经下颌缘支;应用解剖学;美容外科 ,Applied anatomy of the marginal mandibular branch of the facial nerve Abstract: Objective To address the anatomical position of anatomic location of the marginal mandibular branch of the facial nerve，providing clinical anatomical data for cosmetic surgery on the side and submaxillary region. Methods Totally 33 cases (66 sides) autopsies were observed, including the types and courses of the marginal mandibular branch of the facial nerves and their surface locations and relations with the facial artery in the area of heads and necks. Results A single trunk marginal mandibular branches accounts for 58%, the branches witch run along the upper and lower inferior border of border of mandible account for 44% and 5%.The surface location of the branches running out of the parotid gland is near the intersection between 0.5 to 1.0 cm above mandibular angle and the anterior of the posterior border of the mandible.The marginal mandibular branches which pass superficially and deep to the facial artery account for 89% and 6%, respectively. The surface location of the branches running out of the parotid gland is near the intersection between 1.0 cm above mandibular angle and the anterior of the posterior border of the mandible. The distances from the intersection between the nerve and the facial artery to the posterior border of the marginal mandibular branch and to lower border of the mandible were 4.0 cm and 1.0 cm, respectively. Conclusion Marginal mandibular branch of the facial nerve has a plicated adjacent and course, so understanding the adjacent relationships can reduce the nerve injury during cosmetic surgery. Keywords: marginal mandibular branch of the facial nerve; applied anatomy; aesthetic surgery 面神经下颌缘支的走行有许多变异，在颌下部施行某些美容外科手术时，往往易受损伤而导致口角及下唇运动障碍。目前有关面神经下颌缘支的应用解剖学资料不多,1,，尤其是体表定位资料尚少， 面神经下颌缘支的应用解剖对颌下部美容外科手术有实际指导意义。为此作者对面神经下颌缘支的分支类型、走行、面神经下颌缘支与面动脉的位置关系以及面神经下颌缘支穿出腮腺处与面动脉交叉处进行了体表定位测量，以期为美容外科手术提供临床应用解剖学资料。 1 材料与方法 1.1 材料 选取经福尔马林浸泡的头颈部保存完好的成人尸体标本33具(男19具，女14具)共66例。 1.2 解剖方法 采取逐层剖析，翻开皮瓣后，修净皮下组织，游离颈阔肌至口角高度以上，剖开腮腺鞘，在腮腺组织中仔细分离辨认面神经腮腺丛，在腮腺前下端寻找面神经下颌缘支的起点，仔细追踪直至末稍部。重点观察下颌缘支的行程、分型、与面动脉的位置关系,2,。用精确度为0.01 mm的游标卡尺测量面神经下颌缘支穿出腮腺处和与面动脉交叉处至下颌支后缘的水平距离和至下颌骨下缘的垂直距离。 1.3 统计学处理 用t检验进行统计学处理，所有数据用(?s)表示。 2 结果 2.1 面神经下颌缘支的走行 面神经下颌缘支为1,2支，多数为1支，均发自下颌角与耳垂的连线中点处，多数在腮腺下缘浅出(约67%)，少数在前缘和前下缘的转折处出腮腺(约29%)，发出后稍呈孤形，自咀嚼肌附着点处后缘至颏肌深面，沿下颌体下缘之上、下前行。在下颌角前方约3.5 cm处越过面动脉的浅、深面，然后进入颈阔肌和下颌体之间前行并分支入肌,3,。 2.2 出腮腺处及与面动脉交叉处距下颌支后缘和下颌骨下缘的距离 面神经下颌缘支穿出腮腺的体表位置大多在下颌角上方1 cm与下颌支后缘前方1 cm的交点附近;面神经下颌缘支与面动脉交叉的位置距下颌支后缘约4 cm，距下颌骨下缘约1 cm。