耳后入路下颌角截骨术的应用解剖研究

Applied anatomical research on mandibular angle osteotomy from post aurem approach

目的:通过对下颌角区域解剖结构的逐层研究,确定出耳后入路下颌角截骨术操作的安全层次和范围,为该术式的顺利实施提供可靠的参考。方法:选用成人头颅标本11具(男8,女3)22侧。大体进行肉眼解剖,微细结构在10倍手术放大镜下解剖,使用游标卡尺(精确到0.02mm)测量相关数据。结果:耳后入路历经的层次由浅入深依次是皮肤、皮下脂肪、颈阔肌及耳后筋膜浅层、腮腺咬肌筋膜、腮腺和咬肌及胸锁乳突肌、下颌骨骨膜、下颌骨。绝大多数标本在皮肤、皮下脂肪、颈阔肌及耳后筋膜浅层未见重要血管神经走行。在颈阔肌深层,面神经颈支平下颌角处与下颌角顶点距离最短,为(0.993±0.179)cm;颈外静脉平下颌角处、腮腺下缘、面神经下颌缘支与下颌角顶点距离较近,分别为(1.223±0.298)cm、(1.211±0.735)cm、(1.354±0.338)cm;耳大神经平下颌角处、面动/静脉跨下颌骨下缘处至下颌角顶点的距离较远,分别为(2.047±0.339)cm、(2.612±0.511)cm。结论:耳后入路下颌角截骨术有其安全操作层次和范围可循,下颌角区域的逐层应用解剖及数据测量对该手术入路有指导意义。

Objective The purpose of this research was to determine the anatomic layers and distances of the mandibular angle region, and to assess mandibular angle osteotomy from post aurem approach in prominent mandibular angle. Methods Dissections of the mandibular angle region were performed in 11 adult cadaveric heads （22 laterals）. Distances ranged between mandibular angle vertex and important anatomic structures nearby were measured in each lateral with 10 times operating loupe and vernier caliper. Results The way from post aurem has been through a progressive approach followed by skin, subcutaneous fat, platysma and superficial fascia of post aurem, fascia parotidea masseterica, parotid gland, masseter muscle and sternocleidomastoid muscle, mandibular periosteum and the mandible. Mostly there were no important vessels and nerves in the skin, subcutaneous fat, platysma and superficial fascia layers. Deep in the platysma, the distance between cervical branch of the facial nerve even with the mandibular angle and the mandibular angle vertex was short, mainly （0.993 ± 0.179）cm. The distances from jugular vein even with the mandibular angle, the lower edge of the parotid gland and marginal mandibular branch of the facial nerve to the mandibular angle vertex were longer, which were （1.223 ± 0.298）cm,（1.211 ± 0.735）cm,（1.354 ± 0.338）cm, respectively. The even longest distances were from great auricular nerve even with the mandibular angle, the point that facial artery and facial vein cross the margin of mandible to the mandibular angle vertex, which were （2.047 ± 0.339）cm,（2.612 ± 0.511）cm, respectively. Conclusion Our findings suggest that the post aurem approach is feasible for mandibular angle osteotomy. Besides, the preopration anatomy guidance is helpful.