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目的明确 SMAS 与面神经的关系。方法对12具(24侧)成人尸头行大体解剖观察。结果 SMAS 分布于面中部,向前逐渐变薄,于口角水平外侧有小范围的“洞区”。面神经出腮腺后,并非在 SMAS 深面,而是在咬肌筋膜深面走行。面神经额支在颧弓以下0.5cm 区域穿出深筋膜,跨过颧弓。在颊脂肪垫区,大部分面神经分支走行在垫内,小部分分支形成面神经丛,分布于其表面。在颧大肌表面上1/3恒定有一颧支跨过,支配眼轮匝肌下外侧9例(占37.5%);颧大、小肌及眼轮匝肌8例(占33.3%);颧大、小肌7例(占29.2%)。结论面部多层次剥离除皱术应在颧弓以下0.5cm 区域行 SMAS 下剥离,至面中部时,应注意保护颧大肌表面上1/3段的面神经颧支,只在颧大肌中下2/3段区域进行剥离,向内掀起颧脂肪垫;或通过下睑缘皮肤切口,向下掀起眼轮匝肌(注意保护位于颧大肌上1/3段的面神经颧支),与经耳前 SMAS 下剥离腔隙连通,如上操作可避免面神经损伤。
Objective To clarify the relationship between SMAS and facial nerve. Methods Twelve (24 sides) adult cadaver heads were dissected. Results SMAS distributed in the middle of the face, gradually thinning forward, outside the level of the mouth of a small area of “hole.” Facial paroxysm outside the parotid, not deep in the SMAS, but deep in the muscle fascia walking. Facial nerve branch in the area below the zygomatic arch 0.5cm deep fascia, across the zygomatic arch. In the buccal fat pad area, most of the facial nerve branches walk in the pad, a small part of the formation of facial nerve plexus, distributed in its surface. On the surface of the zygomaticus, one third of the zygomatic branches are constant, with 9 cases (37.5%) under the inferior orbicularis oculi. Eighty cases (33.3%) of zygomatic major and minor muscles and orbicularis oculi muscle Large and small muscles in 7 cases (29.2%). Conclusion Facial multilevel debridement should be stripped at 0.5cm below the zygomatic arch under SMAS. To the middle of the face, care should be taken to protect the facial nerve zygomaticus on the 1/3 of the surface of the zygomaticus, only in the middle and lower zygomaticus 2/3 of the area to peel off the zygomatic fat pad inward; or through the skin incision on the lower eyelid, orbital lift off orbicularis (attention to protect the zygomatic muscle in the upper third of the facial nerve zygomatic branch), and the Ear SMAS stripping under the lacunar connectivity, as above operation to avoid facial nerve injury.