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目的为面颞区SMAS分离除皱术防止面神经额支损伤提供解剖学依据。方法在4例新鲜标本和26例防腐固定标本上,解剖观测了面神经额支的走行、分布、毗邻,建立相关的坐标体系,并得出面神经额支的体表定位的坐标参数,分析额支的分布特点及预防其损伤的手术操作方法。结果额支由颞支发出后,在颞浅筋膜深面由后下方向前上方走行,一些进入额肌,一些进入眼轮匝肌。面神经额支在向前上方走行的过程中,不断分支、吻合,分布区域呈扇形展开。其右侧最前支的坐标值(mm)为:(0.0,-4.5±3.4)、(4.0,1.6±4.6)、(8.0,4.3±4.5)、(12.0,8.1±5.1)、(16.0,10.4±5.4)、(20.0,12.3±5.7)、(24.0,14.4±4.6)、(28.0,17.3±5.4);右侧最后支的坐标值为:(-20.0,1.1±5.4)、(-16.0,11.2±4.2)、(-12.0,17.3±5.5)、(-8.0,22.7±5.7)、(-4.0,26.4±5.5)、(0.0,28.1±5.1);其左侧最前支的坐标值为:(4.0,-3.1±3.4)、(0.0,-2.5±3.7)、(-4.0,1.9±3.4)、(-8.0,4.7±5.2)、(-12.0,7.9.1±4.6)、(-16.0,11.3±5.1)、(-20.0,13.3±4.8)、(-24.0,15.4±4.4)、(-28.0,17.8±5.4);左侧最后支的坐标值为:(24.0,-1.0±3.4)、(20.0,1.8±4.3)、(16.0,10.6±5.1)、(12.0,16.7±5.7)、(8.0,23.3±4.9)、(4.0,25.8±5.7)、(0.0,27.9±5.8)。结论临床医生熟悉面神经额支的位置、走行,有利于减少SMAS分离除皱术对其损伤。
Objective To provide anatomical basis for facial and temporal SMAS separation and debridement to prevent facial nerve branching injury. Methods In 4 fresh specimens and 26 preserved specimens, anatomical observation of the facial nerve branches was carried out. The coordinate system was established and the coordinate parameters of the facial nerve support were obtained. The distribution of traits and surgical methods to prevent their injury. Results of the amount of branch issued by the temporal branch, in the temporal superficial fascia deep surface from the bottom to the top before the walk, some into the frontal muscles, some into the orbicularis oris. Facial nerve branch in the process of moving forward and upward, continue to branch, anastomosis, the distribution area was fan-shaped. The coordinates of the forefront of the right side were (0.0, -4.5 ± 3.4), (4.0,1.6 ± 4.6), (8.0,4.3 ± 4.5), (12.0,8.1 ± 5.1), (16.0,10.4 ± 5.4, 20.0, 12.3 ± 5.7, 24.0, 14.4 ± 4.6, 28.0, 17.3 ± 5.4, respectively. The coordinates of the last branch on the right were: (-20.0,1.1 ± 5.4), (-16.0, 11.2 ± 4.2), (-12.0 ± 17.3 ± 5.5), (-8.0 ± 22.7 ± 5.7), (-4.0 ± 26.4 ± 5.5), (0.028 ± 5.1) (4.0, -3.1 ± 3.4), (0.0, -2.5 ± 3.7), (-4.0, 1.9 ± 3.4), (-8.0, 4.7 ± 5.2), (-12.0, , 11.3 ± 5.1), (-20.0,13.3 ± 4.8), (-24.0,15.4 ± 4.4), (-28.0,17.8 ± 5.4), respectively. The coordinates of the leftmost branch were (24.0 ± 1.0 ± 3.4) , (20.0,1.8 ± 4.3), (16.0,10.6 ± 5.1), (12.0,16.7 ± 5.7), (8.0,23.3 ± 4.9), (4.0,25.8 ± 5.7), (0.0,27.9 ± 5.8) respectively. Conclusion Clinicians familiar with the location of facial nerve branch, walking, help to reduce SMAS separation and debridement of their injury.