面神经垂直段及其周围结构的临床应用解剖

Surgical Anatomy of Vertical Section of Facial nerve and Its Surrounding Structures

目的：探讨颞骨手术中面神经垂直段的走行特点及其定位方法。方法应用30例（60侧）成人尸头标本,（其中3例新鲜标本,27例10%福尔马林固定标本）。在手术显微镜下模拟乳突部位手术,暴露面神经垂直段及其周围结构,观察面神经垂直段的走行特点,与周围结构的关系以及面神经管周围的骨质变化特点。结果面神经垂直段长度（16.31±1.29）mm,面神经垂直段至后半规管距离（2.65±0.85）mm,面神经垂直段至骨性外耳道口距离（17.28±1.09）mm,面神经垂直段至颈静脉球距离（3.58±1.32）mm,面神经垂直段至外耳道后壁距离（4.67±0.39）mm,面神经垂直段至乙状窦距离（6.42±2.65）mm.面神经隐窝外侧气房存在者88.33%,面神经隐窝外侧气房位于面神经管外0～2mm.接近面神经管部位血运丰富,为营养面神经的微血管所在.锥隆起在面神经管稍靠内侧,附着在面神经管内1/3以内位置,面神经垂直段位于二腹肌嵴的前端并稍靠内。鼓乳裂消失就接近面神经垂直段。结论面神经隐窝外侧气房、锥隆起、二腹肌嵴、鼓乳裂等,能够帮助我们定位面神经垂直段。解剖学实践、体会面神经垂直段与接近面神经过程中骨质的改变、颜色改变,才能更准确地定位面神经。

Objective To study the anatomy of the vertical section of the facial nerve. Methods This study was con-ducted using 30 cadavers （27 formalin-fixed cadavers and 3 fresh cadavers） whose facial nerves were dissected bilaterally un-der an operative microscope via a translabyrinthine or facial recess approach. The topographical features of the facial nerve and its relationship with surrounding structures were studied. Results The length of the vertical section of the facial nerve was 16.31＋1.29 mm. The distance from the vertical section of the facial nerve to the posterior semicircular canal, osseous ex-ternal auditory canal opening, the jugular bulb, the posterior wall of the external, and the sigmoid sinus were 2.65±0.85 mm, 17.28 ± 1.09 mm, 4.67 ± 0.39 mm and 6.42 ± 2.65 mm, respectively. The frequency of air cells lateral to the facial recess was 88.33%, with a separation of 0-2mm. Abundant blood vessels were seen near the facial nerve canal, likely providing rich blood supply to the nerve, The pyramidal eminence was slightly medial to the facial nerve canal. The facial nerve vertical sec-tion lied anterior and slightly medial to the front end of the digastric crest. The tail of the tympanomastoid fissure was near the facial nerve vertical section. Conclusions Structure s like the air cells lateral to the facial recess, pyramidal eminence, crest of the digastric and tympanomastoid fissure can be helpful in locating the vertical section of the facial nerve. Repeated train-ing and practice and careful observation of the change in bone texture and color while approaching the vertical section are all important in correctly locating the facial nerve.