面神经腮腺段的应用解剖_20215

面神经腮腺段的定位解剖

姜 吉 良， 吴 斌，刘 冬 强， 曹 妍 群

（邵阳医学高等专科学校解剖学教研室，湖南 邵阳 422000）

摘要：目的 为腮腺区外科手术提供面神经腮腺段的定位解剖学资料。方法 以颞骨的颧突根与下颌角后缘的连线为Y 轴，以过乳突尖并垂直于Y 轴的直线为X 轴设定坐标系，以该坐标系为参照观测32具(64侧) 成年尸体腮腺内面神经干的始、止点和面神经主要分支起点、出腮腺的位置和行走方向。结果 面神经上、下干的起点位置分别是：－17.32±1.22mm 和－7.24±0.86mm 、－17.32±1.22mm 和－7.24±0.86mm ，止点位置分别是：－10.26±1.02mm 和17.24±1.22mm 、－12.82±1.12mm 和－12.22±0.88mm ，行走方向与X 轴成角分别是：36.2±5.2、－38.3±4.6；颞支、颧支、上颊支、下颊支、下颌缘支、颈支的起点位置分别是：－10.26±1.02mm 和27.24±1.22 mm 、－3.27±0.24mm 和24.36±4.27mm 、－3.85±0.86mm 和18.42±2.06mm 、－3.26±1.04mm 和14.24±3.26mm 、－11.72±2.35mm 和－6.43±2.06mm 、－12.82±1.12mm 和－12.22±0.88mm ，出腮腺点位置分别是：0.42±0.08mm 和38.56±6.68mm 、8.2±2.44mm 和36.04±4.28mm 、18.26±3.64mm 和26.82±3.86mm 、25.48±4.76mm 和9.66±1.58mm 、4.25±0.54mm 和－13.63±5.23 mm 、－1.08±0.22mm 和－16.26±3.64mm ，行走方向与X 轴成角分别是：68.1±2.04、34.8±4.7、9.4±1.56、－3.7±1.35、－55.6±2.85、－68.3±2.63。结论 根据颌面部外科手术需要，可通过体表标志线精确确定面神经干及其主要分支在腮腺内的位置和行走方向。

关键词：面神经干；面神经主要分支；定位解剖；X 轴；Y 轴 [**************]0

Addressable anatomy of the parotid segment of facial nerve

JIANG Ji-liang,WU Bin, LIU Dong-qiang, CAO Yan-qun

(Department of Human Anatomy,Shaoyang Medical College, Shaoyang Hunan 422000)

Abstract:【Objective 】To observe and measure the parotid segment of facial 【作者简介】：姜吉良（1962-），男，副教授，研究方向：人体解剖学教学及临床应用。

nerve in order to prove addressable anatomic data for operatio ns in parotid region. 【Methods 】A frame of axes was established by means of setting the line linking root of zygoma on temporal bone to the trailing edge of angulus mandibulae as Y-axis, and setting the straight line passing across mastoidale and perpendicular to the Y-axis as X-axis. The position and travelling direction of the facial nerve trunks and their main branches in the parotid were observed and measured on 32 adults(64 sides) cadavervic heads refer to the frame of axes.

【Results 】The starting point of the upper, lower trunks of facial nerve were －17.32±1.22mm and －7.24±0.86mm 、－17.32±1.22mm and －7.24±0.86mm respectively.Their terminal point were －10.26±1.02mm and 17.24±1.22mm 、－12.82±1.12mm and －12.22±0.88mm respectively. The included angle between the trunks and the X –axis were 36.20±5.20、－38.30±4.60 respectively；The starting point of the temporl,zygomatc, upper buccal, lower buccal, marginal mandbular and cervical branch of facial nerve were －10.26±1.02mm and 27.24±1.22mm 、－3.27±0.24mm and 24.36±4.27mm 、－3.85±0.86mm and 18.42±2.06mm 、－3.26±1.04mm and 14.24±3.26 mm 、－11.72±2.35mm and－6.43±2.06mm 、－12.82±1.12mm and －12.22±0.88mm respectively.the point moving away from the parotid of these branches were 0.42±0.08mm and 38.56±6.68mm 、8.2±2.44mm and 36.04±4.28mm 、18.26±3.64mm and 26.82±3.86mm 、25.48±4.76mm and 9.66±1.58mm 、4.25±0.54mm and －13.63±5.23mm 、－1.08±0.22mm and －16.26±3.64mm respectively. The included angle between the branches and the X –axis were 68.10±2.040、34.80±4.70、9.40±1.560、－3.70±1.350、－55.60±2.850、－68.30±2.630 respectively. 【Conclusion 】The position and travelling direction of the facial nerve trunks and their main branches in the parotid might be made certain acculately through the marker line on the body surface according to the requirement of manollifacial surgery.

Key words: trunk of facial nerve；main branch of facial nerve；addressable anatomy；X –axis ；Y –axis

鉴于面神经与腮腺的特殊解剖关系，手术治疗腮腺肿瘤时误伤面神经及其分支是发生医源性面神经损伤的主要原因[1]。近年来，随着腮腺外科向微创化和功能保留方向发展，除非恶性肿瘤已侵犯面神经且难以分离，腮腺手术中通过主动面神经解剖及保护，能有效保全面神经功能[2]。虽然面神经在腮腺内分支较多，且吻合复杂[3-6]，但面神经干及其主要分支的位置相对恒定，通过头面部的重要体表标志确定其位置，有助于临床医师更迅速、准确地寻

找和分离面神经干及其主要分支，降低腮腺手术的面神经损伤率。