以面动脉为蒂逆行下颌缘皮瓣修复鼻缺损的应用解剖

目的 :为以面动脉为蒂逆行下颌缘皮瓣修复鼻缺损提供解剖学基础。方法 :3 6侧灌注红色乳胶成人头面部及 8侧铸型标本 ,详细解剖观测下颌缘皮瓣血供、下颌下缘平面至口角平面动静脉长度、面神经下颌缘支和面动脉交点处距下颌下缘距离。结果 :下颌缘皮瓣血供主要来源于面动脉及其分支 ,同时亦接受枕动脉及甲状腺上动脉的分支营养 ,并互相吻合。平下颌骨下缘平面 ,面动脉距下颌角距离为 2 .8± 0 .3 ( 2 .4～ 3 .5 )cm ,动脉前壁与静脉后壁距离 0 .7± 0 .2 ( 0 .4～ 1.2 )cm ,动脉后壁与静脉前壁距离 0 .4± 0 .2 ( 0～ 0 .9)cm。口角平面 ,动脉前壁与静脉后壁距离 1.4± 0 .4( 0 .5～ 1.9)cm ,动脉后壁与静脉前壁距离 0 .9± 0 .4( 0 .3～ 1.5 )cm ,两平面间面动静脉长 4.5± 0 .3 ( 4.1～ 5 .4)cm。面神经下颌缘支多为 1～ 2支 ,与面动脉的关系恒定 ,多走行于动脉的浅面 ( 83 .3 % )。另有 8%的下颌缘支弓状行于下颌骨下缘下方 1cm范围内。结论 :以面动脉为蒂的下颌缘皮瓣逆行转位修复全鼻缺损 ,具有推广应用价值     

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.     

面动脉岛状皮瓣的研究进展

面部修复要求转移的皮肤应与面部皮肤颜色、质地非常接近。以面动脉及其分支血管为供血动脉形成的岛状皮瓣(ｆａｃｉａｌａｒｔｅｒｙｉｓｌａｎｄｆｌａｐ)具有:①皮瓣的颜色、质地与被修复区组织相似;②血供丰富;③岛状皮瓣,有足够长的血管蒂且与修复区邻近,转移灵活等优点,已广泛用于颌面部多种缺损的修复整形。现以将面动脉或其分支为蒂岛状皮瓣的血供基础、皮瓣设计及临床应用有关文献进行综述。1　面动脉的走行、分支及吻合1.1　面动脉的走行面动脉由颈外动脉发出,于下颌骨下方咬肌前缘进入面部,于颊肌及其他表情肌之间经口角、鼻翼外…     

口周岛状皮瓣动脉构筑的显微解剖学研究

目的　为口周岛状皮瓣切取提供更精准的解剖学资料。 方法　采用63例（126侧）头颈部铸型标本,观察口周动脉的来源、走行、分支分布、变异和动脉构筑特点。 结果　口周的血供主要来自上唇动脉、下唇动脉、唇颏动脉和颏下动脉升支。上唇动脉多于口角平面以上（68.25%）或以下（22.22%）起自面动脉,形成面动脉的1条分支（44.44%）或终支（49.21%）,左、右侧呈对称（51.59%）或不对称（46.83%）分布;偶见缺如（1.59%）。下唇动脉多于下颌骨下缘上方（43.65%）或口角平面下方（28.89%）起自面动脉,形成面动脉的1条分支（61.90%）或终支（25.40%）,呈对称（44.44%）或不对称（47.62%）分布;缺如者占（7.94%）。两侧上、下唇动脉相互吻合,围绕口裂形成动脉环,营养口裂、鼻区及颏区。唇颏动脉于下颌下缘附近起自面动脉,多为1支（约55%）或缺如（约30%）,也可见2支（约10%）或3支（约5%）。颏下动脉在颏下中部发出2 ~ 12支升支,与下唇动脉降支和唇颏动脉形成唇颏血管丛,营养颏部皮肤。 结论　口周区域血供来源较多、吻合丰富,在口周形成动脉环及动脉网。但口周动脉的起始、走形和分布变异较大,动脉构筑形式不定,在切取口周岛状皮瓣时,术前超声探查十分必要。     

口周岛状皮瓣动脉构筑的显微解剖学研究

目的为口周岛状皮瓣切取提供更精准的解剖学资料。方法采用63例(126侧)头颈部铸型标本,观察口周动脉的来源、走行、分支分布、变异和动脉构筑特点。结果口周的血供主要来自上唇动脉、下唇动脉、唇颏动脉和颏下动脉升支。上唇动脉多于口角平面以上(68.25%)或以下(22.22%)起自面动脉,形成面动脉的1条分支(44.44%)或终支(49.21%),左、右侧呈对称(51.59%)或不对称(46.83%)分布;偶见缺如(1.59%)。下唇动脉多于下颌骨下缘上方(43.65%)或口角平面下方(28.89%)起自面动脉,形成面动脉的1条分支(61.90%)或终支(25.40%),呈对称(44.44%)或不对称(47.62%)分布;缺如者占(7.94%)。两侧上、下唇动脉相互吻合,围绕口裂形成动脉环,营养口裂、鼻区及颏区。唇颏动脉于下颌下缘附近起自面动脉,多为1支(约55%)或缺如(约30%),也可见2支(约10%)或3支(约5%)。颏下动脉在颏下中部发出2～12支升支,与下唇动脉降支和唇颏动脉形成唇颏血管丛,营养颏部皮肤。结论口周区域血供来源较多、吻合丰富,在口周形成动脉环及动脉网。但口周动脉的起始、走形和分布变异较大,动脉构筑形式不定,在切取口周岛状皮瓣时,术前超声探查十分必要。     

大体解剖学

面神经下颌缘支的应用解剖学目的：为颌面部手术切口定位提供解剖学依据。材料和方法：观测了33具（66例）成人尸体标本面神经下颌缘支的分支类型、行程、神经与面动脉的位置关系以及神经穿出腮腺处和与面动脉交叉处的体表位置。结果：①面神经下颌缘支单干型居多,占57．6％;双干型占2巳7％;合干型占16．7％;②面神经下颌缘支走行于下颌骨下缘的上方者占76．6％,走行于骨下缘的下方者占23．4％;分别走行于骨下缘的上、下方1．5cm范围内;③面神经下颌缘支经过面动脉的浅面和深面者分别占92．6％和7．4％;④面神经下颌缘支穿出腮腺处…     

前臂筋膜远端蒂岛状皮瓣的血供依据及临床应用

根据前臂筋膜皮肤血管的解剖特点，设计了前臂筋膜远端蒂岛状皮瓣。经皮肤明道切口逆行转位修复手部软组织缺损６例，获得较好效果。认为由穿动脉、筋膜下动脉和皮下动脉构成的前臂筋膜动脉网是本皮瓣存活的解剖基础；皮瓣利用前臂主干血管的穿支和深、浅筋模膜的细小血管为血供来源，具有对手部主要供血动脉无损伤的优点。文中对皮瓣切取方法、适应症和手术要点进行了介绍和讨论。     

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。     

颈后动脉变异一例及术中处理

我们为一39岁男性患者行小腿内侧岛状皮瓣逆行翻转术修复小腿前面溃疡,解剖血管蒂时发现:胫后动脉在腘肌下缘与腓动脉分开后,在趾长屈肌与比目鱼肌之间下行,逐渐变细,在内踝上方浅出深筋膜后逐渐消失,走行过程中发许多分支分布于小腿内侧皮肤。腓动脉先走行于腓骨后内侧,在小腿下1/3段逐渐向内侧走行,经内踝后方到足底。胫神经在小腿中、上段与胫后动脉伴行、前者在后者外侧,在内踝后方与腓静脉伴行,神经在内,动脉在外。在内踝后方,腓动脉发出数支分布于内侧     

膝降动脉穿支皮瓣修复肢体创面的临床应用

目的　报道应用膝降动脉穿支皮瓣修复肢体创面的临床效果。 方法　根据膝降动脉的走行、分支与吻合的解剖学特点,在膝关节内侧上部设计膝降动脉穿支皮瓣,带血管蒂移位修复小腿上1/3前内侧、膝关节前内侧皮肤软组织缺损5例;游离膝降动脉穿支皮瓣修复手部创面4例。 结果　临床应用共9例,皮瓣均成活,创面一期愈合。经1~24个月随访,皮瓣质地优良、色泽接近正常,外形美观,肢体功能恢复良好。 结论　膝降动脉穿支皮瓣解剖位置恒定、血液供应良好、手术方法简单,是修复肢体创面的可选方法之一。     

The anatomical features and surgical usage of the submental artery

The skin characteristics make the submental region an available flap site for facial and intraoral reconstructions. For this reason, the anatomy of the submental region and the submental artery (SA) has gained in importance recently. The SA branches out from the facial artery at the level of superior edge of the submandibular gland. The SA runs anteromedially below the mandible and superficial to the mylohyoid muscle. It gives off some perforating branches to the overlying platysma and underlying mylohyoid muscle during its course. The terminal branches continue toward the midline, crossing the anterior belly of digastric muscle either superficially or deep, and end at the mental region in general. Some perforating arteries from the terminal branches supply the anterior belly of digastric muscle. This study aimed to describe the anatomical features of the SA and its branches to help in the preparation of submental arterial flaps.     

A bilateral and symmetrical variation of the anterior belly of the digastric muscle

We observed a bilateral and symmetrical variation of the anterior belly of the digastric muscle during the dissection of a 35-year-old female cadaver. The accessory muscle bundles were arranged in a cross. These bundles were found superficial to the mylohyoid muscle and deep in the platysma. Such a variation from perfect symmetry has not been previously reported. To avoid misinterpretation of radiological tests, it is important to be aware of bilateral and symmetrical variations of the anterior belly of the digastric muscle when examining the floor of the mouth and the submental region.     

Anastomosis between the inferior alveolar artery branches and submental artery in human mandible

The mental artery displays several branches internal to the anterior region of the mandible as confirmed by macroscopic observation and computed tomography. The inferior alveolar artery formed complex branches and divided into mental and incisive branches, which were found in the right internal side of the mandible of one male cadaver (88 years old). The branches of these two arteries ran through the bony lingual canal to the lingual foramen between the canine and premolar region of the inner surface of the mandible body, where they emerged to enter the mylohyoid and anterior belly of the digastric muscles and communicate with the submental artery. The observation of the anastomotic artery is considered important for surgical placement of dental implants in the mandibular region.     

Median accessory digastric muscle: radiological and surgical correlation

A median accessory digastric muscle was revealed during a dissection of the submental region. The muscle was located between the anterior bellies of the digastrics, external to the mylohyoid and deep to the platysma. It appeared as a flat quadrilateral sheet. Its base arose from the front of the body of the hyoid bone near its upper border. Lower portion of the fibers, at the right base of the muscle, initially traveled perpendicular to the lower fibers of the right mylohyoid. The rest of the muscle had a median course, with the cranial end inserting into the mandible between the digastric fossae. The muscle elevated the hyoid bone and depressed the mandible when appropriate stress was applied. No other morphologic abnormalities were found in this region. Aberrant anterior bellies of the digastric muscles are uncommon and occur bilaterally or unilaterally. This observation of a median accessory digastric muscle has not previously been reported. Knowledge of this variant will help to avoid confusion with pathological conditions of the floor of the mouth and the submental region. It is relevant both for the interpretation of radiological images and during surgical procedures such as dissection of the anterior belly of the digastric for a malignant disease and graft positioning.     

Abnormal anterior belly of the digastric muscle: a proposal for the classification of abnormalities

We recognized an abnormal anterior belly of the digastric muscle in an 83-year-old male cadaver. Three muscle bundles were observed on the left anterior belly: (i) attached to the left digastric fossa; (ii) attached to the right digastric fossa; and (ii) attached to the raphe of the mylohyoid muscle. Four muscle bundles were recognized on the right anterior belly: (i) attached to raphe of the mylohyoid muscle; (ii, iii) attached to the exterior surface on the base of the mandible from the raphe of the mylohyoid muscle; and (iv) attached to the interior surface on the base of the mandible from the raphe of the mylohyoid muscle. The raphe of the mylohyoid muscle was curved significantly to right and the four abnormal bundles found on the right anterior belly (see above) were attached to its curved point.     

The facial artery of the lion (Panthera leo)

An investigation was made of the facial artery in 3 heads of the lion (Panthera s. Felis leo) in the possession of the authors' department. The heads were injected with acryl plastic via the common carotid artery and were examined from the standpoint of the comparative anatomy. Five sides of these 3 heads were prepared to vascular corrosion casts and the remaining side to a dessection specimen preserved in formalin solution. The facial artery of the lion arose independently from the anteroinferior wall of the external carotid artery between the styloglossus and digastricus muscles and between the origins of the lingual and the posterior auricular arteries at a position where the external carotid curved laterally anterior to the tympanic bulla. The facial artery gave rise to the mandibular glandular branch posterosuperiorly immediately after its origin and passed forwards medial to the insertion of the masseter along the superior margin of the digastricus and bent anteroinferiorly giving off the sublingual glandular branch after the divergence of a thick, masseteric branch. The facial artery reached the posterior margin of the mylohyoideus muscle, where it gave rise to the submental artery anteroinferiorly from its inferior wall. The submental artery passed forwards along the inferior margin of the mandible, giving off the digastric and the mylohyoid branches, up to the intermandibular synchondrosis, where it anastomosed with the opposite fellow after giving off the genioglossal branch. The main stream of the facial artery, after giving off the submental artery, reached the face through the facial vascular notch of the mandible. The facial artery passed anterosuperiorly along the anterior margin of the masseter muscle, giving off the buccal, the cutaneous and the mandibular marginal branches, up to a position posterior to the oral angle, where it terminated to the inferior labial and the posterior superior labial arteries. Similarities between the lion and the cat were found in terms of both the origin and ramifications. However, the inferior labial artery was more developed than that of the cat, whereas the peripheral ramifications of the submental artery were underdeveloped and supplemented by the lingual artery.     

The facial artery of the common marmoset (Callithrix jacchus)

The facial artery and its ramifications in 7 adult common marmosets (Callithrix jacchus) were studied by the plastic injection method. The findings obtained are discussed in comparison with those for other primates. In the submandibular region, the facial artery arose from the external carotid artery at the height of the atlas via the linguofacial trunk on 10 of the total of 14 sides examined and independently on the other 4 sides. This common trunk always gave rise to the superior thyroid artery. The facial artery passed anterolaterally between the styloglossus muscle and the intermediate tendon of the digastricus muscle, giving off the styloglossal and the submandibular glandular branches, and anteroinferiorly medial to the pterygoideus medialis muscle. In a position anterior to this muscle, the submental artery and masseteric branch were derived. The submental artery gave off the medial pterygoid, the digastric, the cutaneous, the sublingual glandular and the mylohyoid branches, and then continued up to the median line, where it terminated to supply the genioglossus muscle. In the facial region, the facial artery passed anterosuperiorly along the anterior margin of the masseter muscle on 12 sides and away from it forwards on 2 sides, giving off the premasseteric branch in one of these 2 sides. It gave rise to the cutaneous, the buccal and the buccinator branches, the inferior labial artery and the communicating branch with the zygomatic artery. It terminated to divide into the superior labial and the naris lateral arteries, although the latter was lacking on 4 sides. The inferior labial artery gave off the mandibular marginal, the inferior labial marginal and the inferior labial glandular branches and terminated to anastomose with the mental artery. The superior labial artery divided into the superficial and deep branches, each of which continued as a nasal septal branch. The facial artery of the common marmoset usually ascended along the anterior margin of the masseter muscle and did not reach the medial angle of the eye.     

颏下动脉穿支皮瓣的数字解剖学研究

目的为颏下动脉穿支皮瓣的设计和安全切取提供解剖学基础。方法应用红色乳胶灌注新鲜尸体标本2具;使用改良了的明胶--氧化铅血管造影技术,灌注新鲜尸体标本8具。后者中的2具尸体,使用螺旋CT进行扫描并通过相应的软件存储扫描得到的图像,并三维重建。然后,对10具尸体层次解剖追踪颏下区外径≥0.5 mm的穿支,测量其走行、分支、分布情况并拍摄X线片。同时应用ScionImage软件对颏下动脉营养区域的表面积进行计算。结果颈前区和下颌前区皮肤和肌肉的营养主要通过:甲状腺上动脉、舌动脉、颏下动脉、颏动脉、面动脉等几个主要动脉的穿支供应。颏下动脉从面动脉起始处的直径为(1.7±0.4)mm,沿途发出(1.8±0.6)支穿支营养颏下区的皮肤。颏下动脉营养皮肤的范围为(45±10.2)cm2。其最大的一个穿支出现于二腹肌前腹内侧缘的后面。同时,面动脉、颏下动脉、舌下动脉的穿支之间存在丰富的吻合。结论本文阐述了颏下皮瓣的解剖学基础,并结合重建的三维可视化模型对皮瓣血供和皮瓣设计提供了依据。     

Abnormal digastric muscle with unilateral quadrification of the anterior belly

During dissection of the submental region we observed that the anterior belly of the left digastric muscle had four separate insertions. These muscle bands united in a common tendon as they continued with the posterior belly. This is an anatomical variation in the mylohyoid digastric muscle group in the floor of the mouth. When an asymmetry in the floor of the mouth is detected during diagnostic procedures, such as radiologic studies, anomalies of the anterior belly of the digastric muscle should be considered besides other reasons of asymmetry. Additionally, possible occurrence of such anomalies should be remembered during surgical procedures involving the submental region. This unique variation has not been reported in the literature.     

Double innervation of the anterior belly of the digastric muscle

We came across a very rare case in which the anterior belly of the digastric muscle was innervated by the twigs of the facial nerve in addition to those of the mylohyoid nerve. The anomaly was discovered in the cadaver of an 84-year-old Japanese male bequeathed for a training seminar in gross anatomy at Kumamoto University in 2003. One twig issued from the marginal mandibular branch of the facial nerve and entered the central region of the anterior belly of the digastric muscle on the lower surface. The other twig issued from the stylohyoid branch of the facial nerve, descended along the lateral margin of the stylohyoid muscle and entered the anterior belly of the digastric muscle on the lower surface near the intermediate tendon. The twig from the marginal mandibular branch was distributed to the shallow (lower) and central region near the medial margin of the anterior belly. The twig from the stylohyoid branch was distributed to the shallow and lateral region of the anterior belly. These two twigs communicated with the mylohyoid nerve at several peripheral parts. Textbooks on general anatomy make mention of only one nerve, the mylohyoid, supplying the anterior belly of the digastric muscle. However, the present case manifests that the anterior belly receiving twigs from the mylohyoid and facial nerves is formed with the second brachial component as well as the first.