耳后入路下颌角截骨术的应用解剖研究

耳后入路下颌角截骨术的应用解剖研究

作者：程巍宋建星

来源：《中国美容医学》2010年第02期

[摘要]目的:通过对下颌角区域解剖结构的逐层研究,确定出耳后入路下颌角截骨术操作的

安全层次和范围,为该术式的顺利实施提供可靠的参考。方法:选用成人头颅标本11具(男8,女3)22侧。大体进行肉眼解剖,微细结构在10倍手术放大镜下解剖,使用游标卡尺(精确到0.02mm)测量相关数据。结果:耳后入路历经的层次由浅入深依次是皮肤、皮下脂肪、颈阔肌及耳后筋

膜浅层、腮腺咬肌筋膜、腮腺和咬肌及胸锁乳突肌、下颌骨骨膜、下颌骨。绝大多数标本在皮肤、皮下脂肪、颈阔肌及耳后筋膜浅层未见重要血管神经走行。在颈阔肌深层,面神经颈支平

下颌角处与下颌角顶点距离最短,为(0.993±0.179)cm;颈外静脉平下颌角处、腮腺下缘、面神经下颌缘支与下颌角顶点距离较近,分别为(1.223±0.298)cm、(1.211±0.735)cm、(1.354±0.338)cm;耳大神经平下颌角处、面动/静脉跨下颌骨下缘处至下颌角顶点的距离较远,分别为

(2.047±0.339)cm、(2.612±0.511)cm。结论:耳后入路下颌角截骨术有其安全操作层次和范围可循,下颌角区域的逐层应用解剖及数据测量对该手术入路有指导意义。

[关键词]下颌角截骨术;耳后入路;应用解剖

[中图分类号]R322[文献标识码]A[文章编号]1008-6455(2010)02-0212-03

Applied anatomical research on mandibular angle osteotomy from post aurem approach

CHENG Wei,SONG Jian-xing

(Department of Plastic Surgery, Changhai Hospital,the Second Military Medical

University,Shanghai,200433,China)

Abstract:ObjectiveThe purpose of this research was to determine the anatomic layers and distances of the mandibular angle region, and to assess mandibular angle osteotomy from post aurem approach in prominent mandibular angle.MethodsDissections of the mandibular angle region were performed in 11 adult cadaveric heads (22 laterals). Distances ranged between mandibular angle vertex and important anatomic structures nearby were measured in each lateral with 10 times operating loupe and vernier caliper.ResultsThe way from post aurem has been through a progressive approach followed by skin, subcutaneous fat, platysma and superficial fascia of post aurem, fascia parotidea masseterica, parotid gland, masseter muscle and sternocleidomastoid muscle, mandibular periosteum and the mandible. Mostly there were no important vessels and nerves in the skin, subcutaneous fat, platysma and superficial fascia layers. Deep in the platysma, the distance between

cervical branch of the facial nerve even with the mandibular angle and the mandibular angle vertex was short, mainly(0.993 ± 0.179)cm. The distances from jugular vein even with the mandibular angle, the lower edge of the parotid gland andmarginal mandibular branch of the facial nerve to the mandibular angle vertex were longer, which were (1.223 ± 0.298)cm,(1.211 ± 0.735)cm,(1.354 ±

0.338)cm, respectively. The even longest distances were from great auricular nerve even with the mandibular angle, the point that facial artery and facial vein cross the margin of mandible to the mandibular angle vertex, which were (2.047 ± 0.339)cm,(2.612 ± 0.511)cm, respectively. Conclusion Our findings suggest that the post aurem approach is feasible for mandibular angle osteotomy. Besides, the preopration anatomy guidance is helpful.

Key words:the mandible osteotomy;the approach from post aurem; applied anatomy

在东方人的审美观念中,女性以卵圆形的面部轮廓为美。然而,下颌角肥大会导致面部轮廓呈现方形,往往使女性失去温柔、妩媚的特征。目前临床最常用的矫治方法为下颌角截骨术,其手术入路主要有口外、口内、口内与口外联合及耳后入路四种。其中耳后入路术式由于具有完全为无菌操作,切口隐蔽但暴露良好等优点[1],逐渐受到国内、外整形外科学者的关注。但是,该术式所涉及的重要结构多,且以往对这一入路的安全操作层次和范围的应用解剖研究相对较少,造成术者对该入路的应用解剖不熟悉,术中可能损伤重要解剖结构,导致严重的手术并发症[2]。针对这一问题,我们在2009年2月至6月期间对11具头颅标本进行解剖观察,总结出耳后入路

下颌角截骨术的手术安全操作层次和范围,提出可供参考的解剖学标志,为耳后入路下颌角截骨术的实施提供应用解剖学依据。

1标本和方法

1.1 标本:选用经10%甲醛溶液固定、改良氧化铅-明胶经颈总动脉灌注的成人头颅标本11

具(男7,女4)22侧。

1.2 设计切口及解剖:于常规耳后切口位置分别向上、下延长:自颅耳沟上缘起经颅耳沟向下,绕过耳垂后继续沿下颌支后缘及下颌骨下缘走行至颏部;为清楚暴露本区域解剖结构加做耳前

切口:自耳垂下方绕过耳垂沿耳前向上,与颅耳沟上缘切口会合后转向枕部发际边缘,并延伸至乳突附近。以实际手术入路为依据,由耳后皮肤至下颌角骨质逐层、以颅耳沟上缘为起点由近及

远地进行肉眼解剖,微细结构在10倍手术放大镜下解剖。