面动脉及其分支的解剖测量

Anatomic study of facial artery

目的研究面动脉及其分支的解剖特征,为面部整形手术和注射操作提供指导。方法通过杭州师范大学医学院捐赠的19例(28侧)成人新鲜面部标本(男10例、女9例),对面动脉及其分支进行精细解剖,观察并使用电子游标卡尺测量面动脉的类型、层次、与鼻唇沟关系、长度、直径、与口角距离、分支及颏下动脉情况。结果28侧标本均存在面动脉,起自颈外动脉,在下颌缘下方发出颏下动脉,上行至咬肌前缘跨过下颌骨进入面部,进入面部后分支情况多变。在整个走行过程中,面动脉发出颏下动脉100%(28/28)、下唇动脉100%(28/28)、上唇动脉100%(28/28)、鼻外侧动脉92.9%(26/28)、内眦动脉57.1%(16/28)。按血管走行可分为4型,Ⅰ型(含所有分支且内眦动脉直接起自面动脉下段)8侧(28.6%),Ⅱ型(含所有分支且内眦动脉为终末支)8侧(28.6%),Ⅲ型(无内眦动脉)10侧(35.7%),Ⅳ型(无内眦动脉和鼻外侧动脉)2侧(7.1%)。面动脉下段均位于表情肌深面,在口角外侧(26.0±5.0)mm处延续为中段,该段行走层次多变,可在表情肌深浅层中穿行,经过鼻槛水平后延续为上段,均位于表情肌浅面。24侧(85.7%)面动脉位于鼻唇沟内侧,4侧(14.3%)骑跨于鼻唇沟。面动脉上、中、下3段长度分别为(26.4±10.9)mm、(29.7±8.4)mm、(33.5±6.9)mm,上、中、下3段起点直径分别为(1.09±0.21)mm、(1.85±0.12)mm、(2.45±0.48)mm。面动脉在口角外侧经过,其与口角水平线交点到口角点的距离为(26.0±5.0)mm。上唇动脉起点距口角水平线的距离为(8.0±1.4)mm,距下颌角的距离为(55.0±5.2)mm。下唇动脉起点距口角水平线的距离为(17.1±11.1)mm,距下颌角的距离为(44.2±5.2)mm。颏下动脉起点直径(1.4±0.1)mm,颏下动脉起点距口角水平线距离为(34.9±2.6)mm,距下颌角的距离为(29.4±5.8)mm,距离下颌骨下缘(6.4±0.8)mm;在下颌骨中线处,颏下动脉距离下颌骨下缘(9.0±1.0)mm;在正中矢状面处,颏下动脉距离下颌骨下缘(8.4±1.0)mm。结论面动脉的类型繁多,但其分支和走行层次有一定的规律,其通常从咬肌前缘进入面部,在口角外侧经过,从表情肌深面逐渐走行至浅面,沿着鼻唇沟向上走行,沿途发出分支。掌握面动脉的解剖有助于安全实施整形手术和治疗操作。

Objective Facial artery is the main blood supply source of facial soft tissue,which has an important influence on facial plastic surgery and injection procedures.There are many types of facial arteries.They have wide coverage,and travel several layers.In this study,the detailed characteristics of the facial arteries were revealed by cadaver dissection.Methods In 19 donated fresh cranial(28 sides)specimens,the facial arteries were dissected.And then the type,layer,relationship with nasolabial groove,length,diameter,distance from the oral commissure,branches and submental artery were observed and measured.Results Facial arteries were found in all cadavers,starting from the external carotid arteries,branching submental arteries below the mandibular margins,ascending to the anterior edge of the masseter muscles,crossing the mandibles and entering the faces.After entering into the faces,the facial arteries branched the submental arteries(100%,28/28),lower labial arteries(100%,28/28),upper labial arteries(100%,28/28),lateral nasal arteries(92.9%,26/28)and the angular arteries(57.2%,16/28)throughout the courses.According to the vascular route,the facial artery was classified into four types.In Types Ⅰ(8 sides),all branches were included and the angular arteries arose directly from the lower segment of the facial arteries(28.6%).In Types Ⅱ(8 sides),all branches were included and the angular arteries were the terminal branches(28.6%).In Types Ⅲ(10 sides),angular arteries were absent(35.7%).In Type Ⅳ(2 sides),angular arteries and lateral nasal arteries were absent(7.1%).The lower segment of facial artery coursed under the facial expression muscles,and continued to the middle segment at the point which was(26.0±5.0)mm away from the oral commissure on the lateral side.The layer that the facial artery coursed was varied.It passed through the superficial layer of the facial expression muscles.After passing the horizontal line parallel to the lower margin of nasal sill,the upper segment continued to on the superficial layer of the facial expression muscles.The facial arteries were mostly located medial to the nasolabial fold(24 sides,85.7%)and occasionally across the nasolabial fold(4 sides,14.3%).The lengths of the upper,middle and lower segments of facial artery were(26.4±10.9)mm,(29.7±8.4)mm,and(33.5±6.9)mm,respectively.The diameters in starting point of upper,middle and lower sections were(2.45±0.48)mm,(1.85±0.12)mm,and(1.09±0.21)mm,respectively.The facial artery passed lateral to the oral commissure and the distance from the intersection of the horizontal line to the oral commissure was(26.0±5.0)mm.The starting point of the superior labial artery locacted below the horizontal line was(8.0±1.4)mm away from the horizontal line of the oral commissure and(55.0±5.2)mm from the mandibular angle.The starting point of the inferior labial artery located below the horizontal line was(17.1±11.1)mm from the horizontal line of the oral commissure,and the distance from the mandibular angle was(44.2±5.2)mm.The diameter of the submental artery in its starting point was(1.4±0.1)mm.The distance from the starting point of the submental artery to the horizontal line of the oral commissure was(34.9±2.6)mm,and the distance from the mandibular angle was(29.4±5.8)mm.The starting point of the submental artery was(6.4±0.8)mm from the lower margin of the mandible.In the midline of the mandible,the distance between the submental artery and the lower margin of the mandible was(9.0±1.0)mm.In the midsagittal plane,the starting point of the submental artery was(8.4±1.0)mm from the lower margin of the mandible.Conclusions There were several types of facial arteries and the courses were various,but the way they branched and the layers they coursed had certain rules.Understanding the anatomy of facial arteries is helpful to keep the treatment safe.