腮腺手术中以颞浅动脉定位颞支的面神经解剖方法  

Anatomy of facial nerve for locating temporal branch using superficial temporal artery as landmark during parotidectomy

作　　者：刘凯浪 冯鑫慧 阮彩莲[1] 

机构地区：[1]延安大学医学院,陕西延安716000

出　　处：《右江民族医学院学报》2017年第6期465-468,共4页Journal of Youjiang Medical University for Nationalities

摘　　要：目的对腮腺手术中以颞浅动脉定位颞支的面神经解剖依据、方法及手术时间进行探讨。方法选取我校第一附属医院2012年3月—2014年3月接收的行腮腺肿瘤手术的66例患者为研究对象。对所有患者复合麻醉成功后,先解剖颞支,在完成腮腺区肿瘤切除后术后,采用神经解剖术方法对面神经颞支的分布特点进行总结,同时对患者术后情况进行统计分析。结果面神经颞支位置在耳屏前缘,在走行过程中逐级发出分支,颞支主要分布在眼轮匝肌外侧,额结节下方的眼轮匝肌与额肌交汇处则构成了其分布的最后区域,不仅能支配眼轮匝肌,同时能支配额肌、皱眉肌。眶外上缘到颞支外上缘间的垂直距离为(1.2±0.3)cm。66例患者中仅1例患者神经受侵切断,但并未发生神经受损并发症,其他患者神经定位均显示准确;以颞浅动脉定位颞支的面神经解剖手术过程时间最长与最短分别为1h和40 min,人均手术时间在46min;无一例患者有涎瘘现象。结论在腮腺手术中,采用以颞浅动脉定位颞支的面神经解剖方法,不仅能够准确定位神经位置,而且术后并发症少,在腮腺手术中具有指导作用,值得临床推广应用。Objective To explore the anatomical evidences,method and duration of facial nerve anatomy for locating temporal branch using superficial temporal artery as landmark during parotidectomy. MethodsSixty-six patients undergone parotid tumor surgery at the First Affiliated Hospital of Yan＇an University from March 2012 to March 2014 were selected as research subjects.After the compound anesthesia succeeded for all patients,the temporal branch anatomy was firstly performed before parotid tumor was removed.Then the distribution characteristics of facial nerve temporal branch were summarized by using facial nerve dissection method and postoperative situation of patients were statistically analyzed. Results Facial nerve temporal branch was in front of tragus and the branches grew out step by step in the course of temporal branch.Temporal branch was mainly distributed in the lateral portion of the orbicularis oculi muscle,and the intersection of orbicularis muscle below the nodules and the frontal muscle was the last distribution region.The facial nerve temporal branch could not only dominant orbicularis muscle,but also dominant frontal muscle and corrugator.The vertical distance between the lateral frontal edge of orbit and the lateral frontal edge of temporal branch was（1.2±0.3）cm.Only one patient＇s nerves were cut off among 66 cases,but no neurological complications occurred.Other patients＇ neurological localization were presented accurately.About the cost time of anatomical procedures,the longest anatomical duration was 1 hour and the shortest was 40 minutes,the average anatomical duration was 46 minutes.No patient had salivary fistula. Conclusion Anatomy of facial nerve for locating temporal branch using superficial temporal artery as landmark in parotidectomy,can not only locate the nerves accurately,but also have less postoperative complications,which can guide parotid gland surgery and is worthy of clinical application.

关 键 词：腮腺手术 腮腺肿瘤 颞浅动脉 颞支 面神经 

分 类 号：R739.87[医药卫生—肿瘤]