经口腔外下牙槽神经舌神经和颊神经阻滞麻醉点的应用解剖

目的　为临床上摸索口腔外下牙槽神经、舌神经和颊神经阻滞麻醉点提供解剖基础。方法　使用解剖和模 拟穿刺和实验性穿刺等方法,在32侧成人头颅标本上观察翼颌间隙中3支神经的位置以及与周围结构的毗邻关系。结果 　下牙槽神经和舌神经穿出翼外肌下头处关系密切,两者间距平均2mm左右,在该处的稍下方,两者间距平均也只有5 mm左右;颊神经从翼外肌上、下头的起点附近穿出,穿过翼颌间隙后,于下颌支前缘的深面穿出下颌支,没入颊肌。实验 发现,下牙槽神经和舌神经穿翼外肌下缘稍下方,颊神经穿下颌支前缘处,均处于耳垂 鼻翼最低点连线平面上。结论　 解剖和模拟穿刺和实验性穿刺均发现在耳垂 鼻翼最低点连线平面上,从下颌支前缘进针,能比较准确地穿刺到达3支神 经干的附近,从该平面进针,可同时麻醉3条神经。

Applied anatomy of a new pathway of the inferior alveolar, lingual and buccal nerves under extra-oral anesthesia

Objective To supply the anatomical data for investigating an extra-oral block anesthesia point of the inferior alveolar, lingual and buccal nerves. Methods The location and relationship of three nerves in the pterygomanbibular space on 32 sides of adult cadaver heads were observed by means of the anatomical methods, modeling puncture, and experimental puncture. Results At the point where the inferior alveolar nerve and the lingual nerve passed through the inferior border of the lateral pterygoid muscle, the average space between two nerves was about 2.0 mm. A little lower from this point, the average space between two nerves was only 5 mm. The buccal nerve came across the space between the upper head and lower head of the lateral pterygoid muscle, then passed through the pterygomanbibular space and went through the deep of the anterior border of the mandibular ramus, and at last submerged into the buccinator. A fact was found that the location a little lower from the points where the inferior alveolar nerve and the lingual nerve passed through the lower head of the lateral pterygomandibular muscle, and crossing point of the buccal nerve with the anterior border of the mandibular ramus, were placed on the plane formed by the lowest points of the auricular lobule and alae nasi. Conclusion On the plane formed by the lowest points of the auricular lobule and alae nasi, the needle inserted along the anterior border of the mandible ramus could accurately reach to the spaces near the three nerves. If an anesthesia needle is punctured into the pterygomandibular space along this plant, three nerves would be easily blocked.