经口内定位面神经颊支与咬肌神经的相关解剖研究

An Anatomical Study Related to Locating the Facial Nerve Buccal Branch and Masseter Nerve Intraorally

目的针对内镜手术特点,研究经口内镜下面神经颊支咬肌神经吻合术可行性和安全性,定位面神经颊支、咬肌神经的解剖特征,为经口内镜下面神经颊支咬肌神经吻合提供解剖基础。方法对国人10具固定成人尸头(20侧)及3具新鲜成人尸头(6侧)进行解剖,在尸头上观察颞骨外面神经、咬肌神经与周围解剖的毗邻关系,测量面神经颊支咬肌神经吻合术相关的解剖数据。结果在固定标本、新鲜标本中,腮腺导管口至上颊支发出点的距离分别为58.19±4.37 mm,55.54±4.66mm;腮腺导管口至咬肌神经第一段之间的距离分别为43.94±2.20mm,41.76±2.75mm;腮腺导管口至咬肌神经第二段之间的距离分别为35.69±4.39 mm,33.54±2.63mm;上颊支发出点至咬肌神经第一段之间距离分别为21.60±2.57 mm,19.90±2.32mm;上颊支发出点至咬肌神经第二段之间距离分别为22.45±1.78 mm,21.61±2.90mm;下颌骨升支前缘至上颊支发出点距离分别为37.59±4.16 mm,40.53±2.13mm;下颌骨升支前缘至咬肌神经第一段距离分别为27.78±5.92 mm,26.95±2.02mm;下颌骨升支前缘至咬肌神经第二段距离分别为20.57±6.90 mm,22.48±3.63mm;腮腺导管口至上颊支发出点连线与水平线的夹角分别为23.75±1.71°,25.29±2.95°;腮腺导管口至咬肌神经第一段连线与水平线的夹角分别为37.75±3.86°,39.00±2.76°;腮腺导管口至咬肌神经第二段连线与水平线的夹角分别为30.25±9.42°,36.33±3.72°;下颌骨升支前缘至上颊支发出点连线与水平线的夹角分别为23.15±2.58°,24.17±2.71°;下颌骨升支前缘与咬肌神经第一段连线与水平线的夹角分别为49.30±4.69°,52.83±4.62°;下颌骨升支前缘与咬肌神经第二段连线与水平线的夹角分别为50.25±5.12°,50.33±3.62°。结论利用口内腮腺导管口、上颌骨升支前缘可定位面神经的上颊支、咬肌神经的第一段第二段;在内镜及相关特殊器械辅助下行面神经颊支咬肌神经吻合在理论上是安全可行的。

Objective To investigate anatomical features of the buccal branch of facial nerve and masseter nerverelevant to locating the nerves during transoral endoscopic facial nerve buccal branch-masseter nerve anastomosis.Methods The anatomical parameters of the facial nerve buccal branch and masseter nerve were measured in 10 fixed adult cadaver heads(20 sides)and 3 fresh adult cadaver heads(6 sides).Results and,The distance from the parotid duct opening to the buccal branch was 58.19±4.37 mm in fixed specimens and 55.54±4.66 mm in fresh specimens,re-spectively.The distance between the parotid duct and the first and second segments of the masseter nerve was 43.94±2.20 mm and 35.69±4.39 mm in fixed specimens,and 41.76±2.75 mm,33.54±2.63 mm in fresh specimens,respective-ly.,The distance from the point of origin of the upper buccal branch to the first and second segments of the masseter nerve was 21.60±2.57 mm and 22.45±1.78 mm in fixed specimens,and were 19.90±2.32 mm,21.61±2.90 mm in fresh specimens,respectively.The distance from the leading edge of the ascending ramus of the mandible to the upper buccal ramus was 37.59±4.16 mm in fixed specimens and 40.53±2.13 mm in fresh specimens,respectively.The distance from the anterior margin of the ascending ramus of the mandible to the first and second segments of the masseter nerve was 27.78±5.92 mm and 20.57±6.90 mm in fixed specimens,and were 26.95±2.02 mm and 22.48±3.63 mm in fresh speci-mens,respectively.The angle between the upper buccal branch of parotid duct opening and the horizontal plane was 23.75±1.71°in fixed specimens and 25.29±2.95°in fresh specimens,respectively.The angle between the first and sec-ond segments of parotid duct opening and the horizontal plane and between the masseter nerve and the horizontal plane were 37.75±3.86°and 30.25±9.42°in fixed specimens and 39.00±2.76°and 36.33±3.72°in fresh specimens,respective-ly.The angle at which the anterior margin of the mandibular ascending branch and the upper buccal branch meet the hor-izontal plane was 23.15±2.58°in fixed specimens and 24.17±2.71°in fresh specimens,respectively.The angle between the anterior margin of the ascending ramus of the mandible and the horizontal plane and between the first and second segments of the masseter nerve and the horizontal plane was 49.30±4.69°and 50.25±5.12°in fixed specimens,and 52.83±4.62°and 50.33±3.62°in fresh specimens,respectively.Conclusion The upper buccal branch of facial nerve and the first and second segments of the masseter nerve can be located by the parotid duct opening and the anterior margin of the ascending branch of the mandible.Our study suggests that endoscopy assisted anastomosis of the buccal branch of facial nerve and masseter nerve is feasible and safe in theory.