咬肌前间隙的解剖学研究与临床应用

The anatomic study and clinical application of the premasseter space

目的 通过咬肌前间隙的解剖学研究,进一步完善解剖学知识,并探讨咬肌前间隙在除皱术中的应用,以避免术中损伤面神经.方法 选取12具24侧新鲜成人尸头标本,在手术显微镜下进行解剖并于光学显微镜下组织切片观察,同时对810例患者的SMAS下除皱手术进行术中观察.结果 ①咬肌浅面存在多个软组织间隙,其周边有支持韧带形成并加强,SMAS和咬肌筋膜之间有多个薄弱的纤维隔分隔间隙.②咬肌前间隙进一步可分成SMAS颈阔肌下间隙和SMAS腱膜下间隙,颈阔肌下间隙较SMAS腱膜下间隙容易辨别和分离.③间隙的松弛、扩张、滑动是下面部老化的重要原因,将之命名为层状松弛理论.结论 咬肌浅面存在2种性质的软组织间隙,间隙性质的不同易使分离平面发生错误,是增加除皱术中面神经损伤风险的重要解剖学因素.层状松弛理论可以更好地解释老化过程.面部间隙内分离提紧是治疗老化的首选方法.

Objective Through the anatomy study of the premasseter space,further improved the anatomic knowledge of the premasseter space and explored its application in rhytidectomy,in order to reduce the risk of facial nerve injury.To further improve the anatomic knowledge of the premasseter space and to determine its application in rhytidectomy.Methods The anatomy of the premasseter region was investigated in 12 fresh cadaver （24 hemi-faces） dissections;810 patients of SMAS rhytidectomy procedures were observed.Results ①There were several soft tissue spaces superficial to the masseter muscle,and the boundaries were strengthened by retaining ligaments.Adjacent spaces were separated by numerous weak fiber membranes connecting the SMAS and masseter fascia.② The space was further divided into two parts;one part was located under the platysma and another part was under the aponeurosis of SMAS.The former part was easier to identify and dissect.③The relaxation,expansion,and sliding of the space is an important reason in the face sags with aging,which is referred to as the layered ptosis theory.Conclusions The soft tissue space superficial to the masseter muscle have two different characteristics.The different nature of the two parts of the space can easily mislead dissection to the wrong layer,which is the important anatomical factors for the risk of facial nerve damage in rhytidectomy.The layered ptosis theory seem to better explain the process of aging.The primary treatment of aged face was facial space dissection and tighten.