面神经腮腺外分支的解剖学研究及其临床意义

The Anatomy Study And Clinical Signification Of The Branches Of The Facial Nerve Out Of The Parotid Gland

目的准确地描述面神经腮腺外段的分支,走行等情况,为颌面外科、头颈部整形与美容外科提供重要的形态学资料。方法20具(40侧)新鲜成人头颈部标本,在手术显微镜下解剖观察并记录照相;利用上述形态学资料作为各种面神经损伤的诊断依据,指导相关手术的设计、分离和寻找面神经分支。结果①五组神经的分支数个体差异很大,平均颞支3.2支,颧支2.2支,颊支3.6支,下颌缘支1.3支,颈支恒为1支。②面神经急诊损伤探查缝合术12例,均成功。二级吻合前的损伤才具有神经缝合的条件,而二级(集中)吻合后的分支极其细小,探查、缝合基本不可能。③做面神经解剖术或者其他手术需辨清面神经各支时,颞中筋膜和咬肌筋膜是重要的标志。腮腺混合瘤切除面神经解剖术4例,跨面神经移植术2例,SMAS-颈阔肌除皱术千余例。这些手术中,发生明确的医源性面神经颧支损伤2例。结论①除颈支或单支的下颌缘支外,各组神经支可以被损伤或切断1～2支而不至于造成严重、永久的瘫痪;②在手术中,颞中筋膜与咬肌筋膜既是重要的保护结构,又是明确的辨别寻找标志。

Objective Precisely describe the branches, the run and so on of the facial nerve out of the parotid gland. Provide the important morphological data for the jaw surgery, the head and neck plastic and the esthetic surgery. Methods Dissect and observe 20 (40 sides) fresh corpse's heads with a operation microscope, then record and take pictures. Utilize the morphological data mentioned above as the diagnosis basis of the injury of the facial nerve, to guide the design of the relative operation and to separate and seek the branches of the facial nerve. Results 1.The average number of the five branches of the facial nerves has much difference: temporal branch:3.2, zygomatic branch:2.2, buccal branch:3.6, mandibular branch:1.3, cervical branch:1. 2.The twelve emergency operation in exploring and stitching some trauma of facial nerve have succeed. The injury before the secondary(concentrate) anastomasis could be sutured, but the injury after the secondary anastomasis could hardly be explored and stitched because these branches are too fine. 3.When we need to discern the branches in the dissection of the facial nerve or other operations, the miditemporal fascia and the masseter fascia are the two very important marks. Among the 4 resection of parotid gland mixed tumor, 2 cross facial nerve transplantation, thousand SMAS-platysma rhytidectomy, there are 2 definitely medical injury of zygomatic branch of the facial nerve. Conclusion 1. Besides the cervical branch or the single mandibular branch, every group of the facial nerve branch would not be injured badly or paralysis eternally with only 1～2 branches injured or cut. 2. In some operations, the miditemporal fascia and the masseter fascia are not only the important structure which should be protected, but also the two clear mark in seeking and discriminating the facial nerve.