颏下逆行岛状皮瓣血管蒂与面神经分支的应用解剖  

Anatomical relationship between pedicle of reversed submental island flap and branches of facial nerve

作　　者：范艳[1] 刘子豪[2] 李国萍 黄杰[2] 张秀玲[2] 段爱红[2] 纪秉慧 陈绍春[1] 

机构地区：[1]昆明医科大学基础医学院解剖学与组织学胚胎学系 [2]昆明医科大学口腔学院 [3]第三附属医院头颈外科,昆明650500

出　　处：《解剖学杂志》2013年第2期220-223,共4页Chinese Journal of Anatomy

摘　　要：目的：研究颏下逆行岛状皮瓣血管蒂与面神经分支的解剖关系，为该皮瓣在临床的推广应用、提高手术成功率、减少面神经损伤提供解剖学依据。方法：利用福尔马林灌注固定的头颈部标本，解剖观测面动、静脉与面神经分支的交叉关系、交叉点至神经入肌点的距离、面神经各分支出腮腺处至入肌处的距离；模拟逆行蒂颏下瓣修复眼部缺损的手术过程。结果：面神经颈支从下颌角后方出腮腺向前下走行于颈阔肌深面而分布于该肌，该神经出腮腺处至面动、静脉与下颌缘交点处的距离为29．4mm±4．0mm；面神经下颌缘沿下颌骨下缘走行，与下颌骨之间常有淋巴结分隔，该神经均于面动、静脉浅面与其交叉，交叉点至下颌缘支入肌处的距离为16．9mm±3．7mm，下颌缘支出腮腺处至入肌处的距离为44．3mm±5．1mm；面神经颊支多以2干出腮腺，行程中各颊支之间及与下颌缘支、颧支之间互相吻合形成多个神经弓，在颊脂体表面常交织成丛，继而发出分支进入颧大肌、颊肌和笑肌，与面静脉形成2～4个交叉点，口角平面通常有一个交叉点，其余交叉点均在口角平面以上。结论：为了提高颏下逆行带蒂岛状皮瓣的转瓣点，须从面神经下颌缘支与下颌骨之间向上牵拉皮瓣，因此需充分分离神经与骨之间的间隙，以免牵拉皮瓣经过该间隙时损伤面神经下颌缘支；血管蒂旋转点不宜高于口角水平，以免损伤面神经颊支、口角诸肌和影响皮瓣的血供。Objective： To study the anatomic relationship between pedicle of reversed submental island flap and branches of fa- cial nerve and to provide anatomic basis for extending the utilization of this kind of flap, enhancing successful rate of operation and reducing lesion of the facial nerve. Methods： 20 human samples （40 sides） of the head and neck fixed with formalin were dissected to observe the anatomic relationships among the facial artery/vein and branches of the facial nerve, to measure the distances from crossing-points to muscle-penetrating points of the nerves, to measure the length of the nerves from the parotid gland to corresponding muscles, and to imitate the operation process of reconstructing eye region with reversed submental is land flap on cadaver. Results： （1） The cervical branch of the facial nerve left the parotid gland behind submandibular angle and then ran anteroinferiorly to innervate platysma. The distance from the point which the cervical branch left parotid gland to the point which the facial artery/vein crossed with submandibular margin was 29.4 mm_＋4.0 turn; （2） The submandibular marginal branch ran forward along submandibular margin and was usually separated from mandibular bone by lymph nodes. In all cases, this branch crossed over the facial artery/vein. The distance from the crossing-point to the muscle-penetrating-point was 16.9 mini3.7 ram, and the distance from the parotid gland to the muscle-penetrating-point was 44.3 mm±5. 1mm; （3） The buecal branches left parotid gland usually as two trunks. Commonly, they connected each other and connected with submandibular marginal branch and zygomatic branch to form several nerve arches, and usually form a nerve plexus on the surface of buccal fat pad, then gave off smaller ramus and innervate zygomaticus major, buccinator and risorius. These nerves formed 2 4 crossing points with the facial vein and only one crossing point was at eheilion level, and others were superior to cheilion. Conclusion： （1） In order t

关 键 词：颏下 逆行岛状皮瓣 血管蒂 面神经 

分 类 号：R658.2[医药卫生—外科学]