鼻外侧神经的临床解剖学研究

Clinically anatomic study of lateral nasal nerve

目的 观察鼻外侧神经的解剖结构,为鼻整形术时减少鼻外侧神经的损伤提供解剖学依据.方法 选用10％甲醛固定的头部标本20具,对其进行大体解剖,依次切开皮肤、皮下组织,显露鼻背筋膜,沿中线分离鼻背筋膜后,于鼻背筋膜深层显露鼻外侧神经起点,沿起点向鼻尖方向解剖,观察神经位置及分支情况,并用相机拍照.结果 鼻外侧神经从鼻骨和鼻外侧软骨结合处发出,紧贴鼻背筋膜层,走行于鼻背筋膜下疏松结缔组织层内,鼻部发出点距鼻背正中线距离为5.40～6.80 mm,平均为（5.90±0.47）mm,向下逐渐浅出,分布于鼻背下部、鼻翼、鼻尖等处的皮肤.结论 为避免损伤鼻外侧神经,应尽量在直视下手术;若盲视下手术,在鼻骨和鼻外侧软骨结合处分离时应尽量控制在距鼻背正中线5.4 mm以内,在鼻背筋膜下分离时应紧贴骨膜、软骨膜操作.

Objective To observe the anatomy and variations of lateral nasal nerve,in order to provide anatomical basis of avoiding the injury of lateral nasal nerve.Methods Twenty cadaveric heads were fixed in 10％ fornalin,the gross anatomy was performed on them by dissecting skin,subcutaneous tissue to expose the fascia of nasal dorsum,and then it was separated along the midline line to demonstrate the starting point of lateral nasal nerve in the deep layer of the fascia of nasal dorsum.Dissection was carried on form the starting point to the nasal tip to observe the position and branches of lateral nasal nerve and the results were recorded by photograph.Results Lateral nasal nerve started at the junction between the nasal bone and upper lateral cartilage,running along the fascia of nasal dorsum to the loose tissue layer under the fascia of nasal dorsum.The distance from the nasal point to the midline of the nasal dorsum was 5.40 to 6.80 mm,the mean was （5.90 ± 0.47） mm.It run downwards gradually to the shallow surface and distribute in the skin of the lower part of the nasal dorsum,nasal alar and nasal tip.Conclusion In order to avoid the injury of lateral nasal nerve,as far as possible do operation under direct vision; If the operation under blind sight,dissection at the junction of the nasal bone and upper lateral cartilage area should be limited within 5.40 mm from the midline; Dissection of cavity deep the fascia of nasal dorsum should close to the bone membrane and cartilage membrane.