颈腮区手术中耳大神经的临床解剖学观察

The observation of clinical anatomy of great auricular nerve in neck and parotid region surgery

目的 研究耳大神经的应用解剖学，为颈腮区相关手术提供临床解剖资料。方法 选取安徽医科大学第一附属医院耳鼻咽喉头颈外科2010年11月—2013年10月45例（52侧）头颈腮腺区手术病例进行前瞻性研究，在手术中观察耳大神经出肌点的位置、行程、分支点、分支及其与颈外静脉之间的关系。其中全颈淋巴结清扫术25例（32侧）、腮腺恶性肿瘤手术4例、咽旁间隙肿瘤16例。结果 耳大神经多于胸锁乳突肌后缘中点上下10mm范围内穿出占94．2％（49／52），并多以单干形式上行，在胸锁乳突肌前缘、腮腺尾部以及下颌角下方10mm左右分成前、中、后3个终支。耳大神经伴行于颈外静脉的后方上行（间距不超过20mm）。结论 耳大神经解剖变异较大，其主干与颈外静脉关系密切，手术时尽可能避免耳大神经损伤。

Objective To study the anatomy landmark of great auricular nerve, and to provide anatomical documentation to surgeries of parotid region. Methods Fifty-two cases of great auricular nerve with parotid region surgery were chosen from November 2010 to October 2013 in the First Affiliated Hospital of Anhui Medical University. The location of muscle exit point, path, bifurcation, branches and the relation with external jugular vein of the great auricular nerve were observed. In 52 cases, there were 25 cases of radical neck dissection （32 sides ）, 4 cases of malignant tumor of parotid gland, and 16 cases of parapharyngeal space tumor. Results The exit point of great auricular nerve through cleidomastoidal was mostly located within 10 mm of the middle of the posterior border of cleidomastoidal （49/52, 94.2% ） , most of them with one stem and separated into three branches at the anterior border of cleidomastoidal, the tail of parotid gland and 10 mm inferior of mandibular angle. The great auricular nerve was located behind external jugular vein and they are parallel. The space between them was less than 20 mm. Conclusions The variations of the great auricular nerve are very common, but the relationship with the external jugular vein is close, we can locate the great auricular nerve by the anatomic landmarks; and avoid the injury of the great auricular nerve.