舌神经在下颌第三磨牙区的毗邻关系及其临床意义

本文在53侧成人头部标本上对舌神经在下颌第三磨牙区的毗邻关系进行了研究。舌神经在第三磨牙后区多为扁圆形,在第三磨牙舌侧多为扁平形,平均横径为1.7mm,舌神经距第三磨牙槽嵴的垂直距离为11.2mm、距第三磨牙远中距离为9.0mm、距牙槽骨舌侧骨板的水平距离为3.0mm、距下颌舌骨肌附着缘的距离为6.2mm。对拔除第三磨牙时,损伤舌神经的解剖学原因进行了探讨并提出防止其损伤的建议。     

舌神经至不同下颌磨牙牙龈缘距离的关系分析

目的探讨舌神经至不同下颌磨牙牙龈缘的距离,为患者进行相关手术治疗提供可靠临床依据,尽量避免患者术后发生舌神经损伤情况,提高患者生活质量。方法在本院2000年至2012年之间所收集的成人头部标本中随机选取20例进行解剖,所有标本均已进行防腐固定措施,使用专用测量工具对标本左侧舌神经、右侧舌神经与下颌第1、2、3磨牙牙龈缘距离分别进行测量,记录测量结果并进行统计学分析,得出结论。结果左侧舌神经与右侧舌神经相距下颌第1、2、3磨牙牙龈缘水平距离、垂直距离以及45度角距离相近,且P>0.05,左侧舌神经与右侧舌神经相距下颌第1磨牙牙龈缘距离无统计学意义。结论在对患者进行下颌磨牙舌侧骨嵴修整术或阻生智齿拔除术治疗时,应根据人体舌神经解剖学知识,以及舌神经至不同下颌磨牙的牙龈缘距离范围,尽量避免对患者舌神经造成伤害,从而有效预防患者术后发生暂时性或永久性舍感觉丧失并发症,提高患者生活质量。     

下颌第三磨牙根尖与下颌管的位置关系

本文对50侧96例成人下颌骨第三磨牙根尖与下颌管的位置关系等进行了观测,下颌管在根尖下方者占86.5%,在根尖外侧者占8.3%,在根尖内侧者占5.2%。第三磨牙根尖至下颌管间的距离在2mm以内占35.4%.根尖与下颌管之间的位置关系及距离可供临床应用参考。     

下颌管的应用解剖及临床意义

目的:为下颌牙种植术等临床口腔外科提供解剖学基础.方法:选取下颌骨标本10例、新鲜下颌骨标本10例和成人全牙下颌骨标本20例,分别暴露出下颌管截面、下牙槽神经血管束和下颌管与下颌后牙牙根.观察下颌管的形态、走行和下牙槽神经、血管的排列关系,用游标卡尺测量下颌后牙牙根尖至下颌管上壁的距离.结果:下颌管呈椭圆形,自磨牙牙根尖舌侧和前磨牙牙根尖颊侧的下方走行;下颌管内的下牙槽血管位于下牙槽神经上方.下颌后牙牙根至下颌管的距离以第2磨牙最近,由近及远依次为第2磨牙、第1磨牙、第3磨牙、第2前磨牙和第1前磨牙;下颌磨牙的远中根至下颌管的距离均较近中根近.第1前磨牙、第2前磨牙、第1磨牙、第2磨牙、第3磨牙牙根至下颌管上壁的最短距离分别为(8.19±0.87) mm(左)和(8.29±0.88) mm(右)、(7.38±0.85) mm、(3.30±0.66) mm、(2.98±0.77) mm(左)和(2.92±0.75) mm(右)、(3.82±0.63) mm(左)和(3.86±0.64) mm(右).结论:下颌管的应用解剖对选择适宜长度的牙种植体,避免牙种植体损伤下牙槽神经等具有重要意义.     

下颌神经管的解剖结构

背景:在下颌后牙种植术中,由于下颌神经管走行于下颌骨体内,有时可损伤下齿槽神经,因而制约了牙种植术的应用。 因此,牙种植术的应用需详细了解下颌神经管的解剖结构。 目的：观察下颌神经管在下颌骨内的走行及管内的解剖结构。 方法：共纳入15具成人牙下颌骨标本与4具新鲜下颌骨动脉灌注标本。纳入对象均牙列完整,后牙无缺失,牙槽骨无吸收。测量15具成人牙下颌骨标本下颌管走行及其管腔各径长度,包括下颌管横径与纵径,下颌管至上下内外缘距离。观察4具新鲜下颌骨动脉灌注标本管内下颌神经管内神经、血管位置关系。 结果与结论：下颌管内缘至舌侧骨板的距离比下颌管外缘至颊侧骨板距离短(P < 0.01);下颌管上缘至牙槽嵴顶的距离较下颌管下缘至下颌骨下缘的距离大(P < 0.01)。表明下颌管在下颌骨体部走行中偏舌侧、偏下颌骨下缘。下颌神经管在下颌骨体部的部分横径小于纵径(P < 0.05),亦即下颌管截面形态为上下径略长的椭圆形。神经管横纵径于前后牙位区差异无显著性意义。实验还发现在暴露的下颌管腔中下牙槽神经及伴随血管有一层被膜包绕成神经血管束,血管位于神经上方,而且位置恒定,并发出小分支包绕神经。结果提示,下牙槽血管神经束在下颌管内走行中血管位于神经之上。     

口外翼下颌阻滞麻醉的应用解剖

在４０侧头颈部正中矢状切开标本和６０侧下颌骨标本上，按口外翼下颌阻滞麻醉的设计要求，解剖观察了下牙槽神经、舌神经翼下颌间隙的位置。测量了从下颌骨下缘点和下颌角点行口外翼下颌阻滞麻醉时的进行深度和角度。对采用该法行口外阻滞麻醉的解剖学要点、优缺点亦作了讨论。     

下颌神经二处变异一例

正笔者在解剖一侧成年男性标本时,发现其下颌神经存在2处变异。为积累解剖学资料,现报道如下。该侧下牙槽神经在发出下颌舌骨肌神经前2.69mm处发出异常分支(直径为0.63mm)。该神经在走行6.82mm后,穿入下颌支内行走7.00mm后穿出下颌骨,紧贴下颌骨与舌神经伴行至翼内肌下缘,跨过舌神经后,穿过下颌第2磨牙后缘对应的下颌舌骨肌,继续走行一段距离后发出2个终支:1支(直径为     

下颌管与下颌后牙的位置关系及临床意义

目的: 为下颌牙种植术等临床口腔外科提供解剖学基础。方法：选取新鲜下颌骨标本10例、成人全牙下颌骨标本18例和20名全牙志愿者,分别暴露出下牙槽神经血管束、下颌管与下颌后牙牙根和CT连续扫描后进行三维重建。观察下牙槽神经、血管的排列关系,用游标卡尺和CT三维重建工作站分别测量下颌后牙牙根至下颌管上壁的距离。结果：下颌管自牙槽窝下方走行,其舌侧骨板较厚;下颌管内的下牙槽血管位于下牙槽神经上方。下颌磨牙的远中根至下颌管的距离均较近中根近。在标本及影像上的第1前磨牙、第2前磨牙、第1磨牙、第2磨牙、第3磨牙牙根至下颌管上壁的距离分别为(8.36±2.34)　mm和(8.42±2.42)mm、(7.36±2.21)mm和(7.52±2.18)mm、(3.22±1.40)mm和(3.36±1.85)mm、(2.96±1.54)mm和(2.84±1.55)mm、(3.64±1.72)mm和(3.88±1.76)mm。结论：（1）下颌后牙至下颌管的距离以第2磨牙最近,由近及远依次为第2磨牙、第1磨牙、第3磨牙、第2前磨牙和第1前磨牙。（2）对选择适宜长度的牙种植体,避免牙种植体损伤下牙槽神经等具有重要意义。     

下颌神经颅外段的应用解剖

目的：为下颌神经手术提供形态学基础。方法：解剖观测２１例（男１３，女８）４２侧成人标本。结果：下颌神经（颅外段）主干长（出卵圆孔至分支处的距离）为１．３±０．４ｃｍ；宽度４．９±１．３ｍｍ，厚度１．９±０．６ｍｍ。还测量了下颌神经各分支起始处的长、宽和厚度。结论：本文结果为切断下颌神经后股和颊神经下（长）支的手术提供了形态学资料。     

舌的静脉引流形态学研究

目的：为中医舌诊和外科舌瓣提供舌的静脉引流规律。方法：用３２具成年尸体进行观测，其中有７具为新鲜尸体的静脉腐蚀铸型标本。结果：舌的静脉引流，按管径及引流范围的大小，依次为舌下神经伴行静脉、会厌谷静脉、舌神经伴行静脉、舌根静脉和舌动脉伴行静脉。结论：中医舌诊所见的舌脉基础为舌下神经伴行静脉及舌神经伴行静脉；舌瓣的蒂部必须保留一个较通畅的静脉引流渠道。     

Distribution pattern of the human lingual nerve

The tongue is an intricate organ with many functions. Despite the knowledge of the presence of muscular and neural connections in the tongue, a detailed neuroanatomical depiction of the nerves' topography in the tongue has not been demonstrated. The topography, branching patterns and neuronal interconnections of the lingual nerve were studied in five postmortem human tongues. They were stained with Sihler's stain, a technique that renders most of the tongue tissue translucent while counterstaining nerves. The lingual nerve reaches the tongue posterolaterally. There are two main branches off of the main trunk: the medial branch sends 2-4 small branches to the medial part of the ventrolateral tongue and the lateral branch runs along the lateral tongue border and sends 3-4 large branches to the anterior tip of tongue. Each subdivision gives off 2-5 distal branches. Both medial and lateral branches have interconnections with the proximal part of the hypoglossal nerve. One of the unexpected discoveries in this study was the high density of nervous fibers in the lateral aspect of the tongue as compared to the midline region. The average diameter of the main trunk of the lingual nerve is 3.5 mm. The medial and lateral branches average 1 mm in diameter, the more distal subdivisions measure 0.5-0.75 mm, and the lingual-hypoglossal interconnections measure 0.125-0.250 mm. In summary, this study provides the first detailed depiction of the topography of the human lingual nerve and its branches in situ, confirmation of lingual-hypoglossal nerve connection, and the first depiction of the high density of lingual nerve innervation in the lateral tongue.     

舌下络脉诊法的组织学基础

为阐明中医舌下络脉的实质,采用连续组织切片结合解剖追踪观察了舌腹面粘膜下静脉及肌层血管,并与犬和大白鼠相对照.结果:舌下络脉在舌腹面外带为舌神经伴行静脉及其属支;内带为舌下神经伴行静脉及其属支;舌边细络为舌神经伴行静脉与舌根静脉的属支,它们均分布在粘膜下层近肌层,犬与大白鼠有相同分布.舌静脉有丰富的静脉瓣和瓣窦,有双瓣、单瓣、静脉隔等类型,舌下神经伴行静脉及舌神经伴行静脉中末段尤多,有连续呈葫芦串者.     

Anatomy of the lingual nerve: Application to oral surgery

The purpose of this research is to obtain morphological information about the traveling route, branching pattern, and distribution within the tongue of the lingual nerve, all of which are important for oral surgical procedures. Using 20 sides from 10 Japanese cadaveric heads, we followed the lingual nerve from its merging point with the chorda tympani to its peripheral terminal in the tongue. We focused on the collateral branches in the area before reaching the tongue and the communication between the lingual and hypoglossal nerves reaching the tongue. The collateral branches of the lingual nerve were distributed in the oral mucosa between the palatoglossal arch and the mandibular molar region. Two to eight collateral branches arose from the main trunk of the nerve, and the configuration of branching was classified into three types. More distally, the lingual nerve started to communicate with the hypoglossal nerve before passing the anterior border of the hyoglossus muscle. Nerve communications were also found in the main body and near the apex of the tongue. A thorough understanding of the collateral branches near the tongue, and the communication with the hypoglossal nerve inside the tongue, will help to prevent functional disorders from local anesthesia and oral surgical procedures associated with the lingual nerve. Clin. Anat. 32:635–641, 2019. © 2019 Wiley Periodicals, Inc.     

Nerve fiber analysis for the lingual nerve of the human adult subjects

The neuro-motor control of the human tongue musculature had not been investigated in detail. This study identified first that the lingual nerve should play the neuro-motor control of some lingual muscles. Six en bloc samples (12 sides), including the tissues from the skull base to the hyoid bone, and three whole tongues were obtained from adult human cadavers. The former samples were used for the study of nerve fiber analysis of the lingual nerve with the aid of binocular stereomicroscope, and the latter samples were used for histological study by serial section method. On nerve fiber analysis of the lingual nerve from the trigeminal ganglion to the tongue musculature, we found that the motor- root of the trigeminal nerve gave off its supply to the lingual nerve and traveled into the lingual nerve, and branched to the superior and the inferior longitudinal muscles. On histological study, it was revealed that in the anterior part of the tongue the superior and the inferior longitudinal muscles surrounded the other lingual musculature and combined with the sub-mucosal connective tissues closely like the cutaneous muscle, for example, the facial muscles. The lingual nerve entered the inner side of the space between the genioglossus and the inferior longitudinal muscles with the lingual artery. These findings suggested that the superior and the inferior longitudinal muscles should be innervated by the motor fibers traveled into the lingual nerve from the motor root of the trigeminal nerve, and do not originate from the myotome originating in occipital somites but branchial muscles.     

Spatial relationships between lingual nerve and mandibular ramus: original study method,clinical and educational applications

Lingual nerve damage complicating oral surgery would sometimes require electrographic exploration. Nevertheless, direct recording of conduction in lingual nerve requires its puncture at the foramen ovale. This method is too dangerous to be practiced routinely in these diagnostic indications. The aim of our study was to assess spatial relationships between lingual nerve and mandibular ramus in the infratemporal fossa using an original technique. Therefore, ten lingual nerves were dissected on five fresh cadavers. All the nerves were catheterized with a 3/0 wire. After meticulous repositioning of the nerve and medial pterygoid muscle reinsertion, CT-scan examinations were performed with planar acquisitions and three-dimensional reconstructions. Localization of lingual nerve in the infratemporal fossa was assessed successively at the level of the sigmoid notch of the mandible, lingula and third molar. At the level of the lingula, lingual nerve was far from the maxillary vessels; mean distance between the nerve and the anterior border of the ramus was 19.6 mm. The posteriorly opened angle between the medial side of the ramus and the line joining the lingual nerve and the anterior border of the ramus measured 17°. According to these findings, we suggest that the lingual nerve might be reached through the intra-oral puncture at the intermaxillary commissure; therefore, we modify the inferior alveolar nerve block technique to propose a safe and reproducible protocol likely to be performed routinely as electrographic exploration of the lingual nerve. What is more, this original study protocol provided interesting educational materials and could be developed for the conception of realistic 3D virtual anatomy supports.     

Entrapment of the lingual nerve due to an ossified pterygospinous ligament.

During a routine dissection course at the University of Muenster (Germany) an unusual course of the lingual nerve was found with entrapment of the nerve between a widely ossified pterygospinous ligament and the medial pterygoid muscle. Furthermore, the nerve's mobility was restricted by a more distal anastomosis with the inferior alveolar nerve. Although incomplete or complete ossification of the pterygospinous ligament is not uncommon, the combination with a medial course of the lingual nerve has not been described before. Besides practical importance for surgeons and anesthetists, the entrapment of the lingual nerve may lead to lingual numbness and pain associated with speech impairment.     

胎儿舌神经内神经细胞的观察

实验用尼氏染色法对11例胎儿22条舌神经内的神经细胞进行观察.共观察到神经细胞10382个,其中左侧8132个,右侧2250个,平均每个胎儿944个.神经细胞位于被膜下或神经纤维之间,成群或分散分布.神经细胞主要为多角形,并有一大而浅染、偏位的核,核内有一染色较深的核仁.神经细胞周围可见被囊细胞.本文同时对舌神经内神经细胞的性质及其来源和临床意义进行了初步探讨.