额颞及额颞颧入路中面神经额颞支的保护

目的了解国人面神经额颞支在颞区的显微解剖。并结合此显微解剖学特点在临床额颞及额颞颧开颅中对面神经额颞支进行保护。方法应用国人成人头颅湿标本10例(20侧),模拟额颞颧入路进行面神经额颞支显微解剖学研究。对临床中24例利用筋膜间皮瓣技术进行额颞及额颞颧开颅的患者进行回顾分析。结果所有标本中,颞区均存在三层筋膜及三层脂肪垫。在颞区前下角的弧形区域内,颞浅筋膜与颞深筋膜浅层间存在粘连,失去了正常的疏松腱膜下组织层,而被粘连的纤维脂肪层所取代,面神经额颞支则穿行于此层。而在眶上外侧角水平以上,由于帽状腱膜完整且无粘连,面神经额颞支完全行走于帽状腱膜浅层。所有24例实施了筋膜间皮瓣技术的患者,术后均达到面神经额颞支功能保留。结论在额颞及额颞颧开颅时采用筋膜间皮瓣技术是进行面神经额颞支功能保护的有效方法。

Preservation of the frontotemporal branch of the facial nerve in frontotemporal and frontotemporal and transzygomatic craniotomy

Objectives To study the microanatomy of the frontotemporal branch of the facial nerve and preservation of the frontotemporal branch of the facial nerve in frontotemporal and frontotemporal -transzygomatic craniotomy. Methods A microanatomical study was conducted in 10 cadaveric heads using frontotemporal -transzygomatic craniotomy. A retrospective review of 24 patients by using the interfascial temporalis flap technique for frontotemporal and frontotemporal -transzygomatic craniotomy was undertaken. Results Three fascial layers and three fat pads were identified in the temporal region in all specimens. The superficial temporal fascia adheres to the superficial layer of the deep temporal fascia along a curved line on the anterior and inferior angle of the temporal region. At this area of adherence, the loose cellular layer is lost and is replaced by a fibrofatty tissue. The frontotemporal branch of the facial nerve in its course above the zygomatic arch runs in this tissue layer. Over the superolateral angle of the orbital rim, the galea is compact without subgalea adhesions. The frontotemporal branch of the facial nerve courses above the galea. The interfascial temporalis flap techniques has been used in 24 patients. There were no evidence of frontotemporal branch paralysis. Conclusion The interfascial temporalis flap techniques for frontotemporal and frontotemporal -transzygomatic craniotomy is the most effective method to preserve the frontotemporal branch of the facial nerve.