本文選題：面中部纖維脂肪墊　切入點(diǎn)：解剖學(xué)　出處：《大連醫(yī)科大學(xué)》2007年碩士論文

【摘要】： 目的:面部除皺術(shù)隨著人們要求的日益增多發(fā)展起來,其經(jīng)歷了單純解決面部皮膚松弛的皮膚剝離上提除皺術(shù),SMAS層提拉除皺術(shù)、骨膜下層復(fù)合上提除皺術(shù)的演變。雖然在一定程度上對面部皺紋有所改善,但仍不能理想地解決面中部的衰老現(xiàn)象。因而面中部成為面部除皺術(shù)改進(jìn)的重點(diǎn),如何改善特定部位如鼻唇溝、唇頰溝形態(tài)使面中部整體恢復(fù)青春輪廓,重建優(yōu)美的青春曲線,將成為整形美容外科醫(yī)生的巨大挑戰(zhàn)。 面部衰老首先是因?yàn)槊娌寇浗M織下垂。面部軟組織由淺及深主要分為:皮膚層、皮下脂肪層、SMAS層(表淺肌肉腱膜系統(tǒng))、肌肉層、骨膜層。骨膜與骨緊密相連,重力影響小;SMAS層有多個(gè)骨性起源,外側(cè)有多個(gè)韌帶支持,因此隨年齡增長SMAS層無明顯變化;有學(xué)者對SMAS層進(jìn)行了研究,并應(yīng)用提升SMAS層和皮膚的方法進(jìn)行面部除皺,這些方法雖然對頦部和頸部效果明顯,但沒有改善消瘦松懈的面中部和較深的鼻唇溝。面中部纖維脂肪墊疏松連接于SMAS層,而與皮膚連接緊密,所以重力對于面中部淺表組織作用明顯,隨年齡增長,越是淺表的組織下垂越明顯。面中部的改變是老化過程中的一個(gè)早期征象。因此此次試驗(yàn)著重研究面中部纖維脂肪墊的位置、形態(tài)、固定結(jié)構(gòu)及其層次毗鄰關(guān)系,為尋找新的面中部年輕化手術(shù)方法提供解剖學(xué)依據(jù)。 方法:經(jīng)過福爾馬林浸泡6個(gè)月至一年的成人尸體頭部標(biāo)本10個(gè),對其20側(cè)面部進(jìn)行解剖學(xué)研究,包括大體解剖和顯微解剖。解剖時(shí)逐層銳性鈍性結(jié)合剝離,注意尋找固定面中部纖維脂肪墊的纖維結(jié)構(gòu)。必要時(shí)在3.5倍的手術(shù)顯微鏡下使用顯微器械對尸體標(biāo)本進(jìn)行解剖。之后采用游標(biāo)卡尺測量,精度為0.02 mm。并作文字和圖象記錄。 結(jié)果:面中部皮膚深面除下眼輪匝肌瞼部表面外廣泛存在一皮下脂肪層。這一皮下脂肪層的厚度不均勻,上頜骨淺面的皮下脂肪較厚,顴骨外側(cè)到耳屏前區(qū)域的皮下脂肪較薄。皮下脂肪有一個(gè)近似三角形增厚的區(qū)域,三角形的尖位于口角外下方,約平下頜角平面,在部分老年人可達(dá)下頜緣;底部沿眶下緣呈一弧線;內(nèi)側(cè)界為鼻唇溝;外側(cè)界從顴骨和顴弓交界到達(dá)口角外下方或下頜緣。面中部纖維脂肪墊為由細(xì)小纖維隔組成的網(wǎng)狀結(jié)構(gòu),其間有較大的脂肪顆粒。面中部纖維脂肪墊通過三個(gè)由致密的細(xì)小纖維隔形成的區(qū)域與其淺面的皮膚層及其深面的SMAS層連接。同時(shí)研究還發(fā)現(xiàn)面中部纖維脂肪墊與頰脂體通過薄層的表情肌即SMAS層可以清楚地分開。 結(jié)論:面中部纖維脂肪墊是面中部皮下層的重要結(jié)構(gòu),淺面及深面均有韌帶和纖維組織對其起到固定的作用。隨著時(shí)間的流逝,這些結(jié)構(gòu)松弛,面中部纖維脂肪墊發(fā)生下移從而導(dǎo)致了衰老面容的特征性改變。提拉面中部纖維脂肪墊可以恢復(fù)其原有的解剖位置及面部青春曲線。而且面中部纖維脂肪墊位于SMAS層淺面,而面神經(jīng)位于SMAS層深面,剝離脂肪墊不會(huì)損傷面神經(jīng)。因此懸吊面中部纖維脂肪墊是一種安全有效的面中部年輕化手術(shù)方法。另外面中部纖維脂肪墊和頰脂體是不同的,面中部纖維脂肪墊位于皮膚和SMAS層之間,而頰脂體位于表情肌即SMAS層深面,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

【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2007
【分類號】：R322;R622

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 王志軍;高景恒;李吉;;面部韌帶的解剖學(xué)研究[J];實(shí)用美容整形外科;1992年03期

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本文編號：1697154