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目的为耳后发际入路内镜辅助下颌下腺切除术提供解剖学依据,并评价其可行性和安全性。方法新鲜尸体15具(30侧),观测耳后发际区和颌下区的解剖层次及重要结构。新鲜尸体5具(10侧),模拟内镜手术,术后解剖标本,观察有无神经、血管损伤。结果耳后发际区的分离层面在表浅肌肉腱膜系统与颈深筋膜浅层之间。胸锁乳突肌上部浅面,由后上至前下依次为枕小神经、耳大神经、颈外静脉。颌下区的分离层面在颈阔肌深面与下颌下腺鞘膜之间。下颌缘支出腮腺后:①66.7%行于下颌骨下缘之上(7.21±0.50)mm;②23.3%平行下颌骨下缘;③10%行于下颌骨下缘以下(9.43±0.32)mm。在咬肌前下角处,面神经下颌缘支均与面动脉和面静脉交叉,交叉点至下颌角距离分别为(29.86±2.77)mm和(25.71±3.32)mm。舌下神经经茎突舌骨肌和二腹肌后腹深面进入颌下区。舌骨舌肌浅面,自上而下分别是舌神经、下颌下腺导管、舌下神经。10侧模拟手术顺利完成,术中无重要结构损伤,无需中转切口。结论熟悉耳后发际区和颌下区的解剖层次、标志及参数,耳后发际入路内镜辅助下颌下腺切除术安全、可行。
Objective To provide an anatomical basis for endoscopic assisted submandibular gland dissection after posterior rhizotomy and to evaluate its feasibility and safety. Methods Fifteen fresh cadavers (30 sides) were used to observe the anatomical level and the important structures of the posterior posterior auricular and submandibular areas. Fresh body 5 (10 sides), simulated endoscopic surgery, postoperative anatomical specimens, to observe whether the nerve, vascular injury. Results The separation area of the posterior hairline between the superficial muscular aponeurosis system and the superficial cervical fascia. Sternocleidomastoid upper part of the superficial, followed by top to bottom followed by the occipital small nerve, large auricular nerve, external jugular vein. Separation of the submandibular area in the deep platysma and submandibular gland between the sheath. Mandibular margin of the parotid gland: ①66.7% of the line above the lower edge of mandibular (7.21 ± 0.50) mm; ②23.3% parallel to the lower edge of the mandible; ③10% line below the lower edge of the mandible (9.43 ± 0.32) mm . At the lower extremity of the masseter muscle, the marginal mandibular branch of the facial nerve was intersected with the facial artery and the facial veins. The distances from the intersection to the mandibular angle were (29.86 ± 2.77) mm and (25.71 ± 3.32) mm, respectively. The hypoglossal nerve enters the submandibular area through the stylohyoid muscles and the abdominal ventral deep ventral area. Hypoglossal surface of the tongue, from top to bottom, respectively, the lingual nerve, submandibular gland duct, hypoglossal nerve. 10 side simulation operation was successfully completed, no important structural damage during operation, no need for transit incision. Conclusions It is safe and feasible to be familiar with anatomical level, signs and parameters of the hairline and submandibular area in the ear, and endoscopic assisted submandibular gland resection with posterior rhizotomy.