下颌角截骨修复与下颌后静脉的解剖学观测(英文)

Anatomical observation of the retromandibular vein by mandibular angle ostectomy

背景:颌角截骨术中下颌角周围的动脉损伤较常见,但下颌后静脉壁薄,位置较深,也容易受到损伤导致出血,有关下颌后静脉的解剖学研究国内外文献报道甚少。目的:观测下颌后静脉的组成、属支、回流及其与面神经、下颌角等结构的关系。方法:随机选取经甲醛固定的成人尸体20例(40侧),找到并修洁下颌后静脉及其属支,观察测量下颌后静脉的组成、属支、回流及其与面神经、下颌骨等结构的关系。结果与结论:①下颌后静脉起点恒定,其长度平均值为(4.51±2.01)cm,起始部外径平均值为(0.52±0.28)cm,34侧由颞浅静脉和上颌静脉合成,6侧直接起于颞浅静脉。依其回流及走行分为两种类型:一种分为前后支,前支大部分汇入颈内静脉,小部分汇入颈外静脉;后支则与耳后静脉结合汇入颈外静脉;另一种不分前后支,直接与耳后静脉结合汇入颈外静脉。②下颌后静脉的属支及其出现率为面横静脉88%,下颌关节静脉98%,腮腺后静脉95%,耳前静脉58%,茎突静脉43%等。③88%下颌后静脉位于面神经上、下干及其分支的内侧。下颌后静脉与面神经干或其主要分支近于十字形交叉,它们之间多直接相贴。④下颌后静脉及其属支形成的弧形结构紧贴下颌角下缘及后缘行走的占75%,与下颌角最低点有一定距离(平均值为0.58cm)的占25%;在下颌支后缘中下段,100%的下颌后静脉及其属支与下颌支后缘紧密相邻,静脉壁与骨皮质仅隔以菲薄的骨膜。而此处正是下颌角截骨线的位置,无论是剥离还是截骨时都容易损伤该静脉。

BACKGROUND：Arterial injury surrounding the mandibular angle is very common during mandibular angle ostectomy.The retromandibular vein is susceptible to injury owing to thin vascular wall and deep location.Anatomical studies regarding the retromandibular vein are rarely reported.OBJECTIVE：To observe the construction,branches,backstreaming of the retromandibular vein and its relation to the facial nerve and mandibular angle.METHODS：Twenty formalin-fixed adult cadavers（40 samples）were randomly selected.Bilateral retromandibular veins and their branches were cleaned.The construction,branches,backstreaming of the retromandibular vein and its relation to the facial nerve and mandibular angle were anatomically observed.RESULTS AND CONCLUSION：The retromandibular vein originated constantly and provided an average length of（4.51±2.01）cm,with an average outer diameter of（0.52±0.28）cm at the origination part.A total of 34 samples showed that the retromandibular vein was formed by the union of the superficial temporal and maxillary veins,and six samples showed that the retromandibular vein originated from the superficial temporal vein.The retromandibular vein divided into two types according to the backstreaming and course：one type consisted of the anterior and posterior branches：the anterior branch mostly drained into the internal jugular vein and minorly drained into the external jugular vein;the posterior branch was joined by the posterior auricular vein and became the external jugular vein.Another type of retromandibular vein without the anterior and posterior branches directly connected with the posterior auricular vein and entered the external jugular vein.The retromandibular vein had the following branches（appearance frequency）：facial transverse vein（88%）,mandibular articular vein（98%）,parotid veins（95%）,anterior auricular veins（58%）,styloid process vein（43%）.88% of the retromandibular vein was located in the superior and inferior trunks of the facial nerve and in the medial branches.The retromandibular vein connected with facial nerve trunk or major branches in a decussated fashion.75% of the arc-shaped structures formed by the retromandibular vein and its branches coursed close to the inferior and posterior border of the mandibular angle,and 25% of the arc-shaped structures were not close to the lowest point of the mandibular angle.The thin periosteum between the venous wall and cortical bone was just the position of ostectomy line of mandibular angle.The retromandibular vein was easily injured no matter in vein dissection or ostectomy.