本文選題：面神經(jīng)　切入點：除皺術(shù)　出處：《遵義醫(yī)學(xué)院》2012年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：長期以來,臨床中對面神經(jīng)的走行層次很難達(dá)成共識。該文密切結(jié)合除皺術(shù),從三維角度對面神經(jīng)的行程及其在筋膜中的走行層次進(jìn)行研究,為臨床操作提供解剖學(xué)依據(jù)。 方法：選用新鮮頭部標(biāo)本10例,男性3例(6側(cè))、女性7例(14側(cè)),大致年齡25-70歲。以耳屏與眶下緣最低點連線(法蘭克福平面的水平線)為x軸,以垂直于該平面、經(jīng)過骨性外耳門中點的直線為y軸,建立坐標(biāo)系1。將面神經(jīng)各支在腮腺外的淺出點用坐標(biāo)點(x、y)表示。通過肉眼及手術(shù)顯微鏡下觀察面神經(jīng)的分布特點。再以顴弓上緣水平線為x'軸,眶外緣垂線為y'軸,建立坐標(biāo)系2。在坐標(biāo)系2中,標(biāo)記顴弓上方面神經(jīng)顳支從某一筋膜層,移行至另一筋膜層的位置。在顳區(qū)顴弓上下、腮腺咬肌區(qū)和下頜角點附近切取全厚組織塊,觀察組織層次。組織切片染色、固定后,在顯微鏡下觀察、記錄。 結(jié)果：各支面神經(jīng)的分支數(shù)存在很大個體差異。面神經(jīng)各分支特點：①顳支。顳支有2-4支,分別稱之為顳支Ⅰ、Ⅱ、Ⅲ、Ⅳ。各顳支從腮腺上緣淺出后,在顴弓下方走行于腮腺咬肌深面,在顴弓表面走行于顳中筋膜內(nèi)。之后顳支繼續(xù)斜向內(nèi)上方走行。隨著顳中筋膜向前上方逐漸變薄,各顳支也逐漸走向更淺層的顳筋膜。②顴支。1-4支,分別稱之為顴支Ⅰ、Ⅱ、Ⅲ、Ⅳ。各顴支在腮腺上緣和前緣穿出后,在顴弓下方前行,走行于咬肌筋膜內(nèi)。上位顴支先跨過顴大肌表面,然后再入肌。下位顴支的走行位置較深。在面神經(jīng)顴支的淺出處,腮腺向前突出較明顯。③頰支。約2-5支,分別稱之為頰支Ⅰ、Ⅱ、Ⅲ、Ⅳ和Ⅴ。頰支走行于咬肌筋膜內(nèi)或其深面。走行于咬肌筋膜深面者,在咬肌前緣穿出并走行于頰脂體表面。走行于其間者,自咬肌前部和中部陸續(xù)淺出至SMAS筋膜深面。④下頜緣支數(shù)。約1-2支,出腮腺后絕大部分在下頜體下緣之上的咬肌筋膜,向前下走行。在下頜角點前方跨面血管的淺深面后,進(jìn)入頸闊肌和下頜骨體間隙,并分支入肌。在面血管后方,下頜緣支位于下頜體下緣之下。在面血管前方,下頜緣支均位于下頜體緣的上方。在面血管后部,下頜緣支均被覆較厚的咬肌筋膜。⑤頸支恒為1支。出腮腺后先垂直下降,走行于頸闊肌深面。頸支淺面有疏松的結(jié)締組織被覆。 結(jié)論：①皮下顳部軟組織由淺至深為顳淺筋膜、顳中筋膜、顳深筋膜淺層、顳淺脂肪墊、顳深筋膜深層和顳深脂肪墊。②面神經(jīng)顳支走行于顳中筋膜,顴支、頰支和下頜緣支,主要分布于咬肌筋膜深面或中間。③顳淺筋膜淺面和顳深筋膜淺面是比較安全的分離平面。④在顴弓上方剝離,注意淺深筋膜移行區(qū)。⑤上位顴支位置較淺,容易受損。腮腺前緣和咬肌之間的顴支最容易受損。⑥在腮腺前緣、咬肌上段和頰脂體表面剝離時,容易損傷面神經(jīng)頰支。⑦下頜緣上下2cm和距離口角2cm的范圍內(nèi)剝離時,注意保護(hù)下頜緣支。⑧在下頜角前緣的SMAS筋膜和頸闊肌深面剝離時,容易損傷頸支。
[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，

本文編號：1599501