翼点锁孔入路中面神经额支保护的实验研究

目的通过研究面神经额支与发际的相对位置关系,设计既能满足手术暴露需要,又不损伤面神经,同时符合美容要求的翼点锁孔入路切口。方法在14例(28侧)10%甲醛溶液固定的成人尸头上解剖面神经额支,测量面神经额支、发际在耳上基点-外眦线(AE)、额颧点-翼点线(FP)上的位置,测量鬓角、面神经额支入额肌最高点到FP的垂直距离。结果在AE线上,面神经额支最后支从发际内的前部(耳上基点前39.3 mm)穿过,面神经在其后的向上走行过程中与发际无交叉。结论以蝶骨嵴根部的体表投影为中心,作起于鬓角,沿发际前缘弧形向下,止于耳上基点前39 mm,位于发际内的长约5 cm的翼点锁孔入路切口,是不损伤面神经的理想切口。

Experimental study on preservation of the frontal branch of the facial nerve in the pterional keyhole approach

Objective To design a proper skin incision via pterional keyhole approach for both providing an excellent operative field and safely preserving the neighboring facial nerve,and besides,for meeting the cosmetic demands by studying the spatial relationship between the frontal branch of the facial nerve and hairlines.Methods Frontal branch of facial nerve was carefully dissected in fourteen adult cadaveric heads(28 sides) fixed by 10% formaldehyde solution.Two special lines,one connecting the otobasion superius and lateral canthus(AE),and the other connecting the frontozygomatic point and the pterion(FP),were marked.The intersections of the frontal branch of the facial nerve and the two lines were measured respectively.Similarly,the crosspoints of the hairline and the two lines were also measured respectively.Moreover,the perpendicular distances from the temples and the highest point,where the nerve enters the frontal muscle,of the frontal branch of the facial nerve to the FP line were recorded as well.Results On the AE line,the facial nerve went across the anterior portion inside the hairline(39.3 mm anterior to the otobasion superius).On the upper region of the AE line,there was no intersection between the facial nerve and the hairline.Conclusion Along the hairline,one arc-shaped incision about 5 cm in length with a center at the surface projecting point of the sphenoid ridge root,extending from the temples to the point 39 mm anterior to the otobasion superius,is an ideal skin incision via the pterional keyhole approach with intact frontal facial nerve.