下颌骨截骨美容术耳后入路的定位解剖研究

Anatomical investigation and localization of the approach from post aurem about mandible osteotomy cosmesis

目的:为下颌骨截骨术提供解剖学基础,建立简单可行的二维坐标系,使得行下颌骨截骨美容术耳后入路时能够有效地保护周围毗邻结构,提高手术准确度。方法:取新鲜成人女尸方形脸头部标本5个以及新鲜成人方形脸整尸标本1具,在两侧的颈外静脉插管加压灌注蓝色乳胶;另外取常规固定头部标本28侧,将两侧有关血管用丝线结扎,灌注蓝色广告画颜料,保证血管壁呈蓝色且清晰。取一张厚度为0.5mm的透明塑料膜,用圆规在塑料薄膜上建立直角坐标系,其最小刻度为0.2cm,将带有刻度的软塑料薄膜铺于标本的面侧区,坐标原点正对下颌角后下方的最凸点,y轴垂直于该连线(颧弓向外的最凸点与眼裂外侧点之间线段的延长线)。用油画笔将面神经的下颌缘支、颈支、下颌后静脉(取前缘)比较完整的描点到薄膜上。最后将薄膜平铺于玻璃上,测量得出坐标参数指标。结果:1.在面的左侧:①面神经下颌缘支、颈支、下颌后静脉三者上方的根部靠近并集中于该处,该点坐标(x,y)的坐标值为(11.4±4.2mm,24.6±5.2mm);②定义面神经下颌缘支与下颌支后缘交界处为A点,该点的坐标值为:(6.0±3.1mm,20.4±4.3);定义下颌缘支在下颌角前方与下颌骨下缘最靠近处为B点,则其坐标值为(38.2±5.3mm,-2.8±4.6mm);经下颌角最后下方最凸点(定义为O点),做垂直于AB的直线,该直线与面神经颈支的交点为C点,该点的坐标值为:(6.8±4.1mm,-8.5±5.3mm)。2.在面的右侧:①面神经下颌缘支、颈支、下颌后静脉三者的根部靠近并集中于该处,该点坐标(x,y)的坐标值为(-14.8±5.4mm,22.4±6.2mm);②定义面神经下颌缘支与下颌支后缘交界处为A'点,该点的坐标值为:(-6.0±4.5mm,18.8±5.7mm);定义下颌缘支在下颌角前方与下颌骨下缘最靠近处为B'点,则其坐标值为(38.4±4.2mm,-3.0±5.2mm);经下颌角最后下方最凸点(定义为O'点),做垂直于AB'的直线,该直线与面神经颈支的交点为C点,该点的坐标值为:(-6.4±4.6mm,-12.4±4.1mm)。结论:临床医生行下颌骨截骨美容术耳后入路时,可以考虑尽量在ABC和ABC'相对安全的三角形区域内进行操作。

Objective To provide the anatomical basis for the mandible osteotomy, establish a simple and feasible 2D coordinate system.It can contribute to the furtherance of protecting effectually the adjoin constitution, and raise the accuracy rating of the operation, when the clinician make the mandible osteotomy cosmesis. Methods In 10 side fresh adult Female head specimen and 1 fresh whole body,we perfuse the ambilateral external jugular vein; In 28 side routine retained head specimen, we deligation the ambilateral relevant blood vessel, and perfuse external jugular vein with the blue advertisement advertisement and made the vessel wall drum dyeing, and the vessel wall look ampros.On a page of ransparent plastic film whose thickness is 0.5mm, we construct a rectangular coordinate system with compasses needle .The scale division value of the rectangular coordinate system is 0.2cm.Then,we spread the soft graduated plastic film on the face lateral area,determin the zero of the rectangular coordinate system on the plastic film exactly lie on the most prominent dot of angle of mandible and Y axle is perpendicular to the line that is between the most prominent dot on outside-posterior direction on zygomatic arch and the lateral dot of rima oculi.We trace these dot of the marginal mandibular branch of facial nerve,the cervical branch of facial nerve, retromandibular vein, to the plastic film with oil paintbrush.In fine, we spread the plastic film on glass, measure these plot and get the indicatrix value. Results On left hand side, ① the root of the ramus marginalis mandibulae nervi facialis, cervical branch of facial nerve and retromandibular vein, is near to one another and to centralize at the position, whose coordinate value is （11.4±4.2mm,24.6±5.2mm）. ②We definie that the juncture of the ramus marginalis mandibulae nervi facialis and the ramus of mandible is A, the coordinate value of A dot is （6.0±3. 1mm, 20.4±4.3mm） ; We definie that the nearest position the ramus marginalis mandibulae nervi facialis near to the inferior border of mandible is B, the coordinate value of B dot is （38.2± 5.3mm,-2.8±4.6mm）.Then, we through the most prominent dot of angle of mandible （O dot） draw a line that the line is perpendicular to AB line segment.we find the point of intersection of the line and AB line segment, definie the point of intersection is C, the coordinate value of C dot is （6.8±4.1mm , -8.5±5.3mm）.On right hand side, ①the root of the ramus marginalis mandibulae nervi facialis, cervical branch of facial nerve and retromandibular vein , is near to one another and to centralize at the position, whose coordinate value is （-14.8±5.4mm , 22.4±6.2mm）.②We definie that the juncture of the ramus marginalis mandibulae nervi facialis and the ramus of mandible is A′, the coordinate value of A′ dot is （-6.0±4.5 mm ,18.8±5.7 mm）. We definie that the nearest position the ramus marginalis mandibulae nervi facialis near to the inferior border of mandible is B′, the coordinate value of B dot is （38.4±4.2 mm , -3.0±5.2mm）.Then, we through the most prominent dot of angle of mandible （O′dot） draw a line that the line is perpendicular to A′B′ line segment.we find the point of intersection of the line and AB line segment, definie the point of intersection is C′, the coordinate value of C′dot is （-6.4±4.6mm ,-12.4±4.1mm）. Conclusion When the clinician make the mandible osteotomy cosmesis through the approach from post aurem,may consider the relative safe △ABC and △A′B′C′ district.