下颌角区域解剖结构特征与颅耳沟微创切口

Anatomy structure characteristics of mandibular angle region and minimally invasive incision at the auriculocephalic sulcus

背景:下颌角整形常采用口外切口、口内切口、口内外联合切口等3种入路,颅耳沟微创切口下颌角截骨作为一种较新的入路方式,其报道尚不多见。目的:明确下颌角及其相关血管神经的解剖,为颅耳沟微创切口下颌角截骨手术提供解剖依据。设计、时间及地点:单一样本观察,于2008-02/05在解放军第二军医大学解剖教研室完成。材料:成人头颅标本15个,男4例,女11例,共30侧;成人下颌骨15个30侧。方法:将成人头颅标本15个30侧逐层解剖,观察下颌角的解剖层次,行经下颌角区域的血管神经的分布、走行及与下颌角的位置关系;选用15个成人下颌骨并做标记线,依次沿标记线锯开下颌骨,用游标卡尺分别测量颏孔、下颌孔及各横断面的下颌管截面至下颌骨边缘、内壁、外壁的距离并计算各项指标的x_±s。主要观察指标:①下颌角区域的解剖层次。②下颌角区域的血管。③下颌角区域的神经。④下颌管。结果:耳大神经、颈外静脉、面神经颈支、面动脉、面静脉在下颌骨下缘水平距离下颌角的距离分别是(19.48±6.45),(13.84±3.78),(9.58±3.05),(22.62±7.16),(20.08±6.45)mm;面神经下颌缘支出腮腺的位置距离下颌角(7.79±2.57)mm;下颌管在第3磨牙外缘至下颌角最凸点连线距离是(16.97±2.24)mm。结论:下颌角区域解剖结构复杂,有许多重要的血管神经,但尚有一定规律可循,颅耳沟微创切口从解剖学角度相对安全。

BACKGROUND： Intra-oral, extra-oral, and combination of intraoral and extra-oral incisions often use in mandibular angle contouring surgery. Minimally invasive incision at auriculocephalic sulcus in mandibular angle osteotomy is a new approach, but its report is rare. OBJECTIVE： To observe the anatomical structure of the mandibular angle and its related blood vessels and nerves, and to provide the anatomical basis for the minimally invasive incision at auriculocephalic sulcus in mandibular angle osteotomy. DESIGN, TIME AND SETTING： A single sample observational experiment was performed at Department of Anatomy in the Second Military Medical University from February to May in 2008. MATERIALS： A total of 15 adult skull specimens （30 laterals）, including 11 female and 4 male, and 15 adult mandible （30 laterals） were used in the experiment. METHODS： Anatomical study was performed on 30 laterals of 15 skull specimens, observing distributions and arrangement of blood vessels and nerves as well as their position relation with mandibular angle. After sawing the mandible bones along mark lines, the distances from the mental foramen, mandibular foramen, and each section of mandibular canal to the edge, internal wall and external wall of the mandible bone were measured. The results were expressed as Mean±SD. MAIN OUTCOME MEASURES： The anatomical level, blood vessels, nerves and mandibular canals of mandibular angle region were observed. RESULTS： The distances from great auricular nerve, external jugular vein, cervical branch of facial nerve, facial artery and facial vein to the mandibular angle were （19.48±6.45）, （13.84±3.78）, （9.58±3.05）, （22.62±7.16） and （20.08±6.45） mm, respectively. The distance from the location of marginal mandibular branch of facial nerve running out of the parotid gland to the mandibular angle was （7.79±2.57） mm. The distance from the location of mandibular canal at outer margin of third molar to the mandibular angle was （16.97±2.24） mm. CONCLUSION： The anatomical structure of the mandibular angle region is complex, and there are many important blood vessels and nerves. Minimally invasive incision at auriculocephalic sulcus is relatively safe in anatomy.