面神经的应用解剖学研究进展

面神经颅外段由面神经核发出的躯体运动纤维构成,从茎乳孔穿出颅外,分支分布于面部的表情肌.按其与腮腺的毗邻关系,可将面神经颅外段分为腮腺前段、腮腺内段和腮腺后段.本文主要介绍面神经的腮腺后段.腮腺后段指由腮腺丛发出的5组分支,出腮腺以后至表情肌的一段.颞支、颧支和上颊支主要来自颞面干,下颊支、下颌缘支和颈支主要来自颈面干.熟悉面神经的走行方向、分支分布及其与周围组织的毗邻关系,对于保护面神经及其分支免受损伤非常重要.现就面神经各分支的解剖学研究进展综述如下.     

颏下逆行岛状皮瓣血管蒂与面神经分支的应用解剖

目的:研究颏下逆行岛状皮瓣血管蒂与面神经分支的解剖关系,为该皮瓣在临床的推广应用、提高手术成功率、减少面神经损伤提供解剖学依据.方法:利用福尔马林灌注固定的头颈部标本,解剖观测面动、静脉与面神经分支的交叉关系、交叉点至神经人肌点的距离、面神经各分支出腮腺处至入肌处的距离;模拟逆行蒂颏下瓣修复眼部缺损的手术过程.结果:面神经颈支从下颌角后方出腮腺向前下走行于颈阔肌深面而分布于该肌,该神经出腮腺处至面动、静脉与下颌缘交点处的距离为29.4 mm±4.0 mm;面神经下颌缘沿下颌骨下缘走行,与下颌骨之间常有淋巴结分隔,该神经均于面动、静脉浅面与其交叉,交叉点至下颌缘支入肌处的距离为16.9 mm±3.7 mm,下颌缘支出腮腺处至入肌处的距离为44.3 mm±5.1 mm;面神经颊支多以2干出腮腺,行程中各颊支之间及与下颌缘支、颧支之间互相吻合形成多个神经弓,在颊脂体表面常交织成丛,继而发出分支进入颧大肌、颊肌和笑肌,与面静脉形成2～4个交叉点,口角平面通常有一个交叉点,其余交叉点均在口角平面以上.结论:为了提高颏下逆行带蒂岛状皮瓣的转瓣点,须从面神经下颌缘支与下颌骨之间向上牵拉皮瓣,因此需充分分离神经与骨之间的间隙,以免牵拉皮瓣经过该间隙时损伤面神经下颌缘支;血管蒂旋转点不宜高于口角水平,以免损伤面神经颊支、口角诸肌和影响皮瓣的血供.     

腮腺区面神经的解剖及临床意义

目的:为腮腺区手术提供解剖学基础。方法:在25具50侧经防腐处理的完整头部标本上观测面神经干的长度、横径以及各个分支再分支前长度和各个分支的解剖特点。结果:颞支横径为(1.1±0.2)mm,分支有(1.7±0.8)支;颧支横径为(1.8±0.3)mm,分支有(1.6±0.6)支,位置恒定;颊支有上下颊支型、融为一支型和一支再分型3种类型,上下颊支多位于距腮腺导管上下0.5cm以内的浅层;下颌缘支横径为(1.2±0.4)mm;颈支横径为(0.9±0.2)mm,走行长度为(2.3±0.3)cm,分支有(1.1±0.4)支。结论:面神经与腮腺区关系密切,腮腺区手术时循颊支向后追踪面神经是比较安全有效的方法。     

面神经颊支和下颌缘支的解剖及临床应用研究进展

临床上吻合血管神经的游离肌肉移植或跨面神经移植整复面瘫时,都需要解剖健侧面神经的分支,其中常解剖的是颊支和下颌缘支。两组分支分别由面神经主干发出,并浅出腮腺缘,在走行过程中,其走行层次以及颊支与腮腺导管、下颌缘支与下颌骨下缘和面动脉关系都有一定的规律性。本文就面神经颊支和下颌缘支的解剖学及临床应用方面的进展作一综述,以指导临床手术,避免损伤神经分支引起继发性的功能障碍。1面神经颊支有学者[1￣3]在腮腺手术中观察到颊支有1￣2支,多数学者[4￣8]观察颊支有1￣4支,以2￣3支为主,占75%￣86.6%,可能与临床手术时术野暴露…     

面神经颞颧支临床应用解剖学研究

目的：观测面神经颞颧支及其分支的正常局部解剖,旨在为颧骨颧弓骨折开放复位内固定手术入路提供解剖学参数.方法：对11例（22侧）成人尸体面侧区及颞额区进行层次解剖,观察面神经颞颧支在颧弓区域分布与走向,测量面神经颞颧支各分支与颧弓间位置和距离.另对10例（10侧）颧骨颧弓联合骨折患者手术进行临床观测.结果：22侧颞支及分支均跨颧弓后端浅面上行,其中14侧含1～2分支位于颧弓后1/3段上缘0.8～2.0 cm处,呈20°～35°角斜向上行.颧支分支多且粗大,22侧中19侧（86.4%）颧支及分支位于颧弓后段下缘0.5～1.2 cm处前行,并于颧弓前中1/3段上跨颧弓表面,呈28°～45°角斜向上行,3侧（13.6%）位于颧弓表面或上缘0.5～0.8 cm 处向前行并斜向眼外眦.上颊支位于颧弓中1/3段下缘最短距离1～1.5 cm,最长距离2.3～2.8 cm.10侧手术野见颞支均位于颧弓根部上方跨过,沿后1/3段上缘1.2～2.5 cm斜向前上方;颧支位于颧弓后1/3段下缘前行,并于前中1/3段跨过颧弓斜向外眦.结论：掌握面神经颞颧支及其分支的解剖层次、分布走行以及与颧弓的位置关系,对于经头皮冠状切口入路颧骨颧弓骨折开放内固定复位术中避免损伤面神经颞颧支具有重要意义.     

面神经颧支的解剖及临床应用进展

正面神经为混合性神经,包含4种纤维成分,其中特殊内脏运动纤维主要支配面肌运动,构成面神经颅外部分,面神经颧支是面神经五大分支之一,该神经主要支配颧大肌、颧小肌、眼轮匝肌等~([1])。熟悉面神经颧支的走行层次、分支及其与周围组织结构的关系,对于除皱术中避免面神经颧支损伤,以及在腮腺切除术和治疗面瘫时行跨面神经移植术中准确寻找颧支有重要意义。目前解剖学教材对颧支缺乏详细描述,国内外关于颧支的研究报道尚不多见且达成共识的方面较少~([2-3])。随着美容与整     

透刺地仓的5组透穴局部层次解剖

目的:研究颊车透地仓、下关透地仓、迎香透地仓、水沟透地仓、承浆透地仓5组透穴穴区的解剖结构.方法:用成人男性头部标本36例,对相关穴位透刺后进行层次解剖.结果:支配5组透穴穴区感觉的神经为颈丛的皮支耳大神经,三叉神经的分支颊神经、眶下神经、颏神经.支配运动的神经为面神经颞支、颧支、颊支和下颌缘支,三叉神经分支咬肌神经.与5组透穴毗邻的动脉为面动脉、上唇动脉、下唇动脉、面横动脉;毗邻的面肌为咬肌、笑肌、颧大肌、提上唇肌、提上唇鼻翼肌、颧小肌、降下唇肌等.结论:口角轴的解剖结构应是地仓穴的物质基础.5组透穴与单穴刺激相比,刺激量大,协调局部神经与局部面肌运动的作用也较好.     

面神经分支的表盘定位及临床意义

目的：研究面神经分支的行程和分布及在外科手术中的意义。方法：用表盘在15个（30侧）人头部标本上进行面神经各分支的定位观察。结果：面神经各分支在表盘中位置较固定。左颞支位于11～12点间13例（86．7％），右支10例（66．7％）。左颧支位于10～11点间10例（66．7％），右支9例（60％）。左上颊支位于9～10点间12例（80％），右支14例（93％）。左下颊支位于8～9点间13例（86．7％），右支11例（73％）。左右下颌缘支位于6～7点间各有15例（100％）。结论：利用表盘对面神经各分支进行定位更具有可预见性，其结果对腮腺咬肌区解剖和外科手术寻找面神经分支具有参考价值。     

面神经颊支的应用解剖

目的：观测分析面神经颊支的分支类型及其与腮腺管之间的解剖关系，为腮腺区手术提供解剖学基础。方法：60例成人头部标本，观测面神经颊支的分支类型、行程、神经与腮腺管的位置关系。结果：面神经颊支以双干型多见(58．3％)，三干型次之(28．3％)。神经多行于腮腺管浅面(73．3％)。腮腺管走行在颊支之问的占61．7％，导管距上颊支垂直距离约4．86mm；腮腺管走行在神经下方者占11．7％，距下颊支的垂直距离约1．71mm；腮腺管走行在神经上方者占26．7％，距上颊支的垂直距离约2．56mm。结论：面神经颊支多行于腮腺管浅层，与腮腺管关系十分密切，腮腺区手术时循颊支向后追踪面神经是比较安全、有效的方法，容易掌握。     

面神经颞支的应用解剖

目的确定面神经颞支的数量、走行和分布情况,为涉及面侧区和颞区的美容外科手术提供解剖学资料。方法解剖33具(66侧)成人尸体标本,探明颞支支数及走行;测量面神经颞支各分支越过颧弓下缘、外眦角等部位的距离。结果面神经颞支有4个分支,分别称为颞支Ⅰ、Ⅱ、Ⅲ、Ⅳ。除颞支Ⅳ经腮腺前缘浅出外,其余均经上缘浅出。浅出后它们立即到达颧弓浅面,其中颞支Ⅰ主要发支到达额肌深面;颞支Ⅱ主要到达额肌与眼轮匝肌交界部深面。颞支Ⅲ、Ⅳ主要发支到达眼轮匝肌深面。测量得到面神经颞支各分支越过颧弓下缘处距外眦角的距离男性分别为3.8cm、3.5cm、2.9cm、和2.8cm;女性分别为3.6cm、3.3cm、2.7cm、2.6cm。面神经颞支各分支发出部位距颧弓下缘的距离男性分别为3.0cm、3.8cm、4.0cm、4.2cm;女性分别为2.7cm、3.3cm、3.3cm、3.7cm。结论面神经颞支根据性别具有基本确定的走行及分布,为相关的美容外科手术提供了解剖学依据。     

Variations in the anatomy of the posterior auricular nerve and its potential as a landmark for identification of the facial nerve trunk: a cadaveric study

The posterior auricular nerve (PAN) is the first extracranial branch of the facial nerve trunk. It innervates the posterior belly of the occipitofrontalis and the auricular muscles and contributes cutaneous sensation from the skin covering the mastoid process and parts of the auricle. This study was carried out to provide a detailed account of its anatomy and to ascertain its reliability as a surgical landmark for the facial nerve. Eleven facial sides from six formalin-fixed cadavers were dissected. The course and arborisation pattern of the PAN was observed, and its position of emergence from the facial nerve trunk (FNT) was measured. The PAN arose from the posterolateral aspect of the FNT 1.6-11.1 mm from the stylomastoid foramen (5.4 ± 3.3 mm). It arose as a single branch (45.4%), or from a common trunk that divided into two (36.4%) or three branches (18.2%), with the other branches passing into the parotid gland. The PAN continued deep (63%), or lateral to the mastoid process (9.1%), or through the tissue of the parotid gland (27.3%). In all cases the PAN ran in a consistent, superficial location posterior to the external auditory meatus. The PAN takes a variable course; however, its consistent location behind the external auditory meatus makes it easily identifiable in superficial dissection, and therefore a potential surgical landmark for identifying the FNT.     

婴幼儿腮腺血管瘤摘除术相关应用解剖及临床应用

目的：为婴幼儿腮腺血管瘤摘除术提供解剖学基础。方法：采用血管乳胶灌注、显微解剖的方法对婴幼儿腮腺血供来源及其与面神经的关系进行解剖学观察。结果：颈外动脉直接分支及耳后动脉、颞浅动脉、面横动脉等的分支旧腮腺主要的供血动脉;婴幼儿面神经分支类型与成人无明显差异,主干位置恒定,易寻找,各分支纤细。结论：婴幼儿腮腺血管瘤手术时,应先行颈外动脉中段结扎,然后寻找面神经主干,沿主干分离各分支,这样可降低手术难     

小儿面神经血供的应用解剖学研究

目的探讨小儿面神经的动脉来源及分布。方法10具小儿尸体头颈部标本经双侧颈总动脉插管,加压注入红色乳胶,观察面神经的动脉来源及分布。结果面神经颅外段营养动脉来源于茎乳动脉、颞浅动脉面神经支、面横动脉、颈外动脉上面神经支、颈外动脉下面神经支、面动脉后面神经支和面动脉前面神经支。面神经颅内段营养动脉来源于茎乳动脉、脑膜中动脉的岩支、迷路动脉。结论为面神经血供来源及分布提供形态学基础,避免手术时损伤。     

Variability in facial‐muscle innervation: A comparative study based on electrostimulation and anatomical dissection

Facial‐nerve palsy is the most common complication during facial surgery. However, there are few detailed reports on the distribution of the terminal branches of the facial nerve to the mimetic muscles. This also applies to the communicating branches. The aim of our study was to assess the variability of communicant and terminal branches of the facial nerve in humans. This prospective study involved anatomical dissections and intraoperative electric stimulation of facial nerves. We first performed 30 dissections to define the branching patterns of the extracranial facial nerve, with particular focus on the penetrating points into the mimetic muscles. We then studied and compared these preliminary data with 14 operative facial stimulations conducted during parotidectomies. Each trunk and branch received systematic electrostimulation. The electrostimulation and facial‐and‐neck movements were analyzed by two independent reviewers. The peripheral branching and intercommunication of the facial branches were highly variable. Combining electrostimulation and dissections, the frontalis muscle, the depressor labii inferioris and the platysma showed little nerve recuperation whereas the sphincter muscles (orbicularis ori and oculi) were anatomically protected. Facial‐muscle innervation differed among individuals. We found complex variations in the facial branching mode. Our study highlights the branches and corresponding areas that could be considered anatomically risky. Clin. Anat. 32:169–175, 2019. © 2018 Wiley Periodicals, Inc.     

The distribution and significance of aberrant ganglion cells in the facial nerve trunk of the cat

The distribution and peripheral connections of aberrant ganglion cells in the facial nerve trunk of the cat were studied by means of Klüver-Barrera staining and retrograde transport of horseradish peroxidase (HRP). By the Klüver-Barrera staining, aberrant ganglion cells were observed in the facial nerve trunk between the geniculate ganglion and the junction of the auricular branch of the vagus with the facial nerve trunk, although the number varied considerably with each animal. These cells were generally medium-sized and of round or oval shape, with densely stained Nissl substance, the features of which were essentially similar to those of the geniculate ganglion. In cases where HRP injections were made into the anterior wall of the auricle, several HRP-labeled cells were found ipsilaterally in the facial nerve trunk in addition to cell labeling of the geniculate ganglion. The present study in the cat demonstrated that at least some of the aberrant ganglion cells scattered in the facial nerve trunk are parental to the axons to the auricle, subserving the cutaneous sensory function.     

面神经局部缺血对面神经及面神经核的影响

目的　探讨面神经局部缺血对面神经及面神经核的影响,为临床腮腺切除术提供参考。方法选用家兔,采用同体对照的方法,模拟人腮腺切除手术。实验侧于手术显微镜下,游离面神经并破坏其外血管系,切除腮腺。术后家兔存活4周,观察以下指标：分别检测家兔实验侧和对照侧面神经颊支的传导速度、CMAP波幅和潜伏期;取双侧茎乳孔外面神经干,透射电镜下观察面神经超微结构的变化;取双侧面神经核,Western Blotting法检测面神经核乙酰胆碱转移酶（CHAT）表达的变化,PCR-ELISA法观察面神经核端粒酶活性的变化。 结果　实验侧面神经颊支的传导速度明显低于对照侧、潜伏期明显长于对照侧、波幅明显低于对照侧（P＜0.01,P＜0.05）。实验侧面神经超微结构发生明显变化,以轴索变性为主,包括轴索内微丝增生、断裂,线粒体肿胀、嵴断裂,变性轴索溶解等。实验侧面神经核CHAT的表达和端粒酶活性明显低于对照侧（P＜0.01,P＜0.05）。 结论　游离面神经破坏其外血管系切除腮腺,可导致面神经超微结构发生明显改变、面神经传导功能下降,进而导致面神经核神经元合成乙酰胆碱的含量下降、神经元凋亡增加;提示临床腮腺切除时,应尽可能保护面神经外血管系,以减少面瘫的发生。     

Branching patterns of the facial nerve and its communication with the auriculotemporal nerve

This study examines the anatomic relationships and variability of the facial nerve trunk and its branches, with emphasis on the intraparotid connections between the divisions. Microdissections were performed on 30 Korean half-heads, and the facial nerve trunks and branches were exposed. The average depth of the stylomastoid foramen from the skin surface was 21.0±3.1 mm, and the distance between the stylomastoid foramen and the bifurcation of the temporofacial (upper) and cervicofacial (lower) divisions was 13.0±2.8 mm. In 26 of 30 dissections (86.7%), the facial nerve trunk bifurcated into two main divisions, and a trifurcation pattern was seen in the other four cases (13.3%). According to the origin of the buccal branches, we classified the branching patterns of the facial nerve into four categories. In type I (13.8% of cases), the buccal branches arose from the two main divisions of the trunk but not from other branches of the facial nerve. In type II (44.8% of cases), the buccal branches arising from the two main divisions were interconnected with the zygomatic branch. In type III (17.3% of cases), the marginal mandibular branch sent nerve twigs to the buccal branch, which originated from the upper and lower divisions. In type IV (17.3% of cases), the nerve twigs from the zygomatic and marginal mandibular branches merged to the buccal branch arising from the two main divisions. Communications between the facial and auriculotemporal nerve branches, which are known as communicating auriculotemporal nerves, were observed in 28 of the 30 cases (93.3%). Familiarity with these common variations in the facial anatomy provides useful information for the surgeon in careful dissection, preservation of the facial nerve, and complete removal of the tumors in parotidectomies.     

Morphometric study of the cervical course of the hypoglossal nerve and its application to hypoglossal facial anastomosis

The hypoglossal nerve is used classically in salvage of facial paralyses in the absence of spontaneous recovery. A variety of ways of transferring and suturing the hypoglossal nerve to the distal segment of the facial nerve have been reported. In order to determine which mode of reconstruction is the best for neurotisation of the facial nerve, the caliber of the hypoglossal nerve was studied in ten subjects at the level of proximal and distal parts of the trunk and the cervical loop. The fascicular surface area of the cervical branch is inadequate for use. The distal extremity of the hypoglossal nerve has an ideal caliber to be sutured to the facial nerve trunk and the proximal part is large enough to allow partial harvesting of the hypoglossal nerve for neurotisation of the facial nerve.     

Skin reference point for the zygomatic branch of the facial nerve innervating the orbicularis oculi muscle (anatomical study)

Purpose

Direct access to the zygomatic branch of the facial nerve in the parotid is less invasive and more selective than first dissecting the nerve trunk and then finding the branches. The aim of this study was to confirm the point of reference on the skin which would give direct access to the zygomatic branch for the orbicularis oculi muscle. The skin reference point studied was on the intertragic notch/external canthus line, 2.5 cm in front of the intertragic notch.

Methods

Ten fresh cadavers, and thus 20 sides of faces were dissected. The zygomatic branch of the facial nerve innervating the orbicularis oculi muscle was accessed directly. The dissection was extended to temporofacial and cervicofacial branches and then to the trunk of the facial nerve by a retrograde path in the parotid.

Results

Twenty dissections of the parotid area confirmed the validity of the anatomical reference point of the zygomatic branch for the orbicularis oculi muscle considered.

Conclusions

The simplicity and reliability of this landmark is important in clinical practice and has numerous potential applications in surgery for rehabilitation of facial paralysis associated with VII healthy and VII affected neurorraphies, in facial paresis for superneurotizations and in traumatology.     

面神经下颌缘支的应用解剖

目的了解面神经下颌缘支的正常层次解剖位置,为涉及面侧区和颌下区的美容外科手术提供临床应用解剖学资料。方法解剖33具（共66例）成人尸体标本的头颈部标本,观察了面神经下颌缘支的分支类型、走行、与面动脉的位置关系以及穿出腮腺处和与面动脉的交叉处的体表位置。结果面神经下颌缘支为1-2支,以单干型居多,约占58%,大多行于下颌骨下缘上方约占44%,行于骨下缘下方者占5%。未发现面神经下颌缘支不与面动脉交叉,位置在均下颌角下缘上、下方约0.5-1 cm范围内。面神经下颌缘支经过面动脉的浅面和深面者分别占89%和6%;面神经下颌缘支穿出腮腺处的体表位置分别在下颌角上方和下颌支后缘前方1 cm交点附近,面神经下颌缘支与面动脉交处距下颌支后缘约4 cm,距下颌骨下缘约1 cm。结论面神经下颌缘支的毗邻和行程关系较为复杂,了解其与周围结构的重要位置关系,可以减少美容外科手术因神经损伤造成下唇及口角功能障碍的发生。