颞肌蒂下颌骨瓣修复面中份骨缺损的应用解剖

Anatomic study of mandibular bone flap pedicled with temporal muscle for midface bone defect

目的 为颞肌蒂下颌骨瓣修复面中份骨缺损提供解剖学基础. 方法 在30侧发育正常的成人尸体标本上解剖观测颞肌和下颌支的形态、血供及其两者的关系,并测量有关数据. 结果 颞肌主体呈扇形,向下分为3个肌束：前外侧肌束、前内侧肌束、后侧肌束,分别止于下颌支前缘、颞嵴和冠突内侧面后份,向下直至第3磨牙远中,附着于下颌支前份内侧面约3/4的区域;供应颞肌的动脉主要有：颞中动脉,外径（0.76±0.20）mm;颞深前动脉,外径（0.79±0.21）mm;颞深后动脉,外径（0.98±0.64）mm;多支细小的颞深副动脉.颞深动脉发出分支,形成肌动脉骨穿支和骨膜动脉网,为下颌支前份供血.下颌支呈矩形,以下颌切迹最低点、下颌孔和下颌管的连线为分界线,将下颌支分为前份和后份,前份可供骨量大小为（46.67±6.85）mm×（17.98±2.64）mm ×（11.49±0.99）mm. 结论 以颞肌为蒂下颌骨瓣具有血供可靠,骨量充足,应用该骨瓣修复面中份骨缺损,具有良好的解剖学基础.

Objective To study the anatomy of mandibular bone flap pedicled with temporal muscle for midfacial bone defects. Methods The shape and blood supply of the temporal muscle and mandibular ramus,as well as their relationship,were observed and measured in 30 sides of adult head specimens. Results The temporal muscle has a fan-shaped main portion,then is scattered into three bundles as anterolateral,anteromedial,posterior bundles,which end respectively at anterior border of ramus,the temporal ridge and posterior portion of coronoid process.Then the muscle goes downward until it reaches the distal side of the third medial surface molar and attaches the 3/4 of medial surface of anterior portion of ramus.The blood supply of temporal muscle includes the medial temporal artery with external diameter of（0.76 ± 0.20）mm,the anterior deep temporal arteries with external diameter of（0.79 ±0.21）mm,posterior deep temporal arteries with external diameter of（0.98 ± 0.64）mm,the accessory deep temporal artery formed by many little branches.The anterior part of ramus is supplied by the periosteal arteries and the bony perforator of the deep temporal arteries.Rectangular ramus of mandible was divided into anterior portion and posterior portion by the line linking the lowest point of mandibular notch,mandibular foramen and mandibular canal.Anterior portion can supply a bone flap with a size of（46.67 ±6.85）mm×（17.98 ±2.64）mm ×（11.49 ±0.99）mm. Conclusions The mandibular bone flap pedicled with temporal muscle has a reliable blood supply and abundant bone volume.It is feasible to design a mandibular bone flap pedicled with temporal muscle for midfacial bone defect.