面颈部分区及其局部结构解剖学:表浅肌肉腱膜系统

Compartmentalization and local structural anatomy of the face and neck: superficial musculoaponeurotic system

面颈部SMAS解剖学的首次阐明距今已有44年。由于SMAS在美容手术中的重要性,学者们对其进行了持续深入的研究且从未停止。在笔者团队及所有国内外学者的以往研究中,多是侧重于对SMAS静态解剖学、结构特点、临床应用的观察和描述。近十年来,随着各种"微整形"方法的广泛应用后,出现了动态畸形和僵化脸等各种并发症,促使笔者将SMAS中的动态构成作为课题研究。研究对象包括:⑴尸头标本。⑵注射填充透明质酸或/和颗粒脂肪的病例。⑶线技术术后病例。⑷溶脂针(成分不详)注射后病例。在后3种病例的手术中,笔者应患者要求将注射材料和线材料及其瘢痕、炎症灶、肉芽肿做充分而必要的清理、松解。这实际上是一种"病理解剖"的过程,然后将此病理解剖结果和正常标本解剖观察结果作为对照,再将上述病例术前表情与正常人表情作为对照,最终推导出SMAS中的动态构成与静态构成的"结构功能"。

There have been 44 years from the first elucidation of facial and neck superficial musculoaponeurotic system(SMAS)anatomy to this day. Because of the importance of SMAS in the cosmetic surgery, the scholars have conducted continuous and deep research. In previous studies at home and abroad, most of them focus on the observation and description of SMAS static anatomy, structural characteristics and clinical application. After broad application of various "minimally invasive plastic surgery" methods in recent 10 years,complications such as dynamic malformation and stiffness face have occurred. Therefore, the dynamic composition in SMAS was selected as the research subject. The study including(1) cadaver head specimen,(2) patients underwent hyaluronic acid injection or/and fat granule,(3) patients after buried suture treatment and(4) patients after lipodissolve injection(unknown composition). In the patients underwent last three operations, the injection materials, sutures, inflammation and granuloma were adequately cleared and scars were released. Actually,this is a process of "pathological anatomy". The results of pathological anatomy and normal anatomy were as control, preoperative expression of the above patients and normal expression were as control, the "structural function" of dynamic composition and static composition in SMAS was finally derived.