颞肌颅骨外板骨瓣转位修复下颌骨缺损的应用解剖

对40侧成尸颅顶区和颞区的动脉来源及其分布进行了观测,认为以颞肌为蒂的颅顶骨外板骨瓣可作为修复下颌骨缺损的良好骨源。并对其制作要点及术中注意的事项等进行了讨论,为临床应用提供有实用意义的解剖学资料。     

带蒂颞深筋膜肌瓣修补前颅窝低缺损的应用解剖及临床

目的：为前颅窝低缺损修复选用带蒂颞深筋部肌瓣，方法：在５０个头部标本上对颞深，浅筋膜和颞肌的形态及血供进行了观测。结果：设计了带蒂的深筋膜肌瓣，并对３例外伤性性颅窝低缺损患者施行了修复术，介绍了手术操作与解剖学有关的要点，结论：这种新型的筋膜肌瓣血供好，操作易，抗感染力强，防脑脊液漏性能确实。     

带蒂颞深筋膜肌瓣修补前颅窝底缺损的应用解剖及临床

目的：为前颅窝底缺损修复选用带蒂颞深筋膜肌瓣。方法：在５０个头部标本上对颞深、浅筋膜和颞肌的形态及血供进行了观测。结果：设计了带蒂的颞深筋膜肌瓣，并对３例外伤性前颅窝底缺损患者施行了修复术。介绍了手术操作与解剖学有关的要点。结论：这种新型的筋膜肌瓣血供好、操作易、抗感染力强、防脑脊液漏性能确实。     

颞肌复合组织瓣的临床解剖学研究

颞肌复合组织瓣是整形修复外科常选用的组织供区,Ｍｕｌｌｅｒ(１８９０)首次报道了颞区颅骨瓣修复颅骨缺损,Ｒｕｂｉｎ(１９７０)则是颞肌瓣的推广和普及者。象原料厂一样,颞肌复合组织瓣广泛     

转位鼻中隔软骨瓣的应用解剖

目的:探讨鼻中隔软骨瓣转位应用的可能性.方法:在30例成人湿性尸头标本上对鼻中隔软骨瓣进行解剖学测量.结果:鼻中隔软骨膜瓣上边长(44.19±5.82)mm,鼻中隔软骨膜瓣下边长(56.83±6.65)mm,鼻中隔软骨上下径(27.93±3.48)mm,鼻中隔软骨前后径(20.83±2.12)mm.鼻中隔软骨膜瓣转位到鼻颅底可修复范围为(27.22±4.91)mm×(13.03±3.44)mm.鼻中隔软骨膜瓣转位到眶内侧壁可修复范围为(28.19±3.27)mm×(27.93±3.48)mm.结论:鼻中隔软骨瓣转位可用于鼻内镜下修复鼻颅底和眶内侧壁的缺损.     

颞筋膜瓣的应用解剖

观测了30侧颞区筋膜的形态和血供.颞区筋膜主要分为颞浅筋膜和颞深筋膜.颞浅筋膜位于毛囊和皮下纤维脂肪层的深面,与前方的额肌、上方的帽状腱膜和后方的枕肌相互延续,共同组成了皮下肌腱膜系统,颞深筋膜位于颞肌表面,致密坚韧,面积约9×11cm.颞浅筋膜的血供来自颞浅动脉,颞深筋膜的血供来自颞中动脉本文对颞筋膜瓣的命名,设计等进行了讨论.     

肩胛提肌瓣的应用解剖

在34侧成人尸体上,观察测量了肩胛提肌的形态、血供和神经支配。测得肌前缘长12.9cm;后缘长13.8cm。肌的血供:上1/2主要来自颈升动脉的分支,下1/2来自颈横动脉和颈浅动脉的分支。神经来自颈神经2～5前支的分支。根据观察结果我们认为肩胛提肌瓣移位修复口底缺损或在颈部行放射治疗时用来复盖颈部大血管等术中,是一块较为理想的供肌。     

肩胛提肌瓣的应用解剖

作者在22具(男9、女13)成人尸体上对44侧肩胛提肌的形态、血供和神经进行了解剖和测量.肩胛提肌长129.13±3.06mm,中部宽19.01±0.60mm,厚6.90±0.31mm.共发现有141支营养该肌的分支动脉,平均3.20支,上中部主要来自颈升动脉(51支),下部主要来自颈横动脉(43支)和肩胛上动脉(27支).神经支配主要是肩胛背神经.肩胛提肌瓣可用作颈部肿瘤根治术后覆盖和保护颈动脉及修复口咽部和面颊部缺损.     

以副神经斜方肌上支为蒂肌瓣转位修复面瘫的应用解剖

在30侧成人尸体标本上,解剖观察了副神经在斜方肌内分布的上支及其与血管的关系。上支可分离长度为6.2cm,横径为0.6mm,与上支神经伴行的血管可游离长为11.3cm,外径(起始处2.5mm,入肌处0.9mm)。根据解剖观察结果,可设计以副神经斜方肌上支及其伴行血管为蒂的斜方肌瓣转位修复面瘫的新术式。     

The deep belly of the temporalis muscle: an anatomical, histological and MRI study

In order to achieve a better functional and clinical knowledge of a masticatory muscle called the sphenomandibularis that is suspected to be responsible for headaches by compressing the maxillary nerve, bilateral dissections of the infratemporal fossa were performed on ten human cadavers and completed by histological and radiological studies of the same areas. Both macroscopic and microscopic observations obviously showed that the so-called sphenomandibularis muscle corresponds to the deep portion of the temporalis muscle, since there is no epimysial septum between these two structures, which previously have been described as being completely independent from each other. In spite of the close topographic relationship between the deep belly of the temporalis and the lateral pterygoid muscle, as well as their similar innervation pattern, the sphenomandibularis in fact has to be considered functionally as an original but non-isolated positional fascicle of the temporalis muscle itself. Our observations, correlated with MR images, suggest indeed that the deep belly of the temporalis muscle is of functional importance in the masticatory movements, but is not involved by its neurovascular vicinity in the genesis of specific headaches. Its surgical release, however, should be discussed in the case of a temporal myoplasty.     

Task-related behaviour of motor units in the human temporalis muscle

Muscle activity patterns in some complex human jaw muscles appear to be task sensitive. However, it is presently uncertain how changes in motor task affect motor unit (MU) behaviour in the human temporalis muscle. In this study, activity was recorded from 40 MUs in the anterior region of the muscle. The lowest sustainable firing frequency (LSFF) was reached by slow increases and decreases in firing rate, then firing was maintained at the lowest possible rate without significant pauses. An array of consecutive interspike intervals (ISI) were sampled digitally and used to measure the LSFF for each task associated with the MU. In a controlled paradigm, MU reflex inhibition was measured during the performance of different tasks. Single electrical pulses of non-noxious intensity were delivered to the gingiva near the maxillary canine tooth. During continuous MU firing at a controlled firing frequency of 10 Hz, series of pulses were delivered with increasing delays, after preselected spikes. The MUs fired continuously during the performance of 1–4 postural and tooth-contact tasks. There were significant differences in LSFFs between tasks in those MUs associated with multiple tasks. In the reflex study, all MUs were inhibited, but the magnitude of the inhibition was highly task dependent. Thus, both LSFF and reflex inhibition of temporalis MUs appear to vary with the motor task and are sensitive to the position of the jaw and the direction and location of tooth contact along the tooth row. This behaviour most likely reflects task-related changes in output from orofacial and muscle afferents.     

Brain tissue oxygenation during transnasal endoscopic skull base procedures

PurposeWe aimed to study brain tissue oxygenation during the period of controlled reduction of arterial blood pressure – a maneuver often used in extended endoscopic skull base surgery for bloodless operative field.MethodsIntracranial pressure, arterial blood pressure and the resultant cerebral perfusion pressure were measured during extended endoscopic skull base surgery in 5 patients with diagnosed tumors of the skull base and arterial hypertension. Simultaneously, in those patients, we measured partial pressure of oxygen in the brain parenchyma (PbtO₂).ResultsValues of PbtO₂ lower than 15 mm Hg (risk of brain ischemia) were observed in 3 patients for periods of 40 min, 110 min and 123 min, respectively. In 2 of these patients, no hypotension (mean arterial pressure <65 mm Hg) was necessary for bloodless operative field. Another 2 patients had PbtO₂ above 30 mm Hg at the time when their mean arterial pressure was below 65 mm Hg. The time course of PbtO₂ followed that of cerebral perfusion pressure with a time lag of 40–60 s in all patients.ConclusionModerate reduction of arterial pressure, often used to obtain bloodless operative field during extended endoscopic skull base surgery, may in patients with the medical history of arterial hypertension be associated with critically low values of partial oxygen pressure in brain tissue.     

数字儿童颅底及颈部可视化模型建立研究

目的 对儿童颅底及颈部进行数字化三维重建,创建三维可视化模型。 方法 通过冷冻数控铣切及数字摄影技术获取1例中国6岁男童连续高精度超薄断层标本数字解剖图像数据集,选取从颅底至T1上缘之间的横断面,利用PhotoShop.2021逐张进行手动分割,使用三维重建软件Digihuman Reconstruction System将手动分割的结构重建,再导入3-matic Research 13.0软件进行调整和修改。 结果 成功建立首例中国男童的颅底及颈部三维可视化模型,多方位多角度清晰再现所分割结构三维形态及空间位置关系,完成对颅底及颈部椎骨、血管、神经及肌肉的详细观察,对颈部动静脉神经及椎体相关数据测量,分析解剖结构特点及手术注意事项。 结论 利用数字儿童颅底及颈部三维可视化模型,可多方位立体直观地显示详细解剖结构及毗邻关系,结合对颈部血管神经及椎体结构数据测量,为儿科临床诊治、虚拟手术、医学教学提供重要参考依据。     

Innervation analysis of the small muscle bundles attached to the temporalis: truly new muscles or merely derivatives of the temporalis?

Detailed examinations were performed in ten temporal muscles from five cadavers to identify the muscle bundle arrangements of the temporalis and their innervation. Three additional muscle bundles were clearly observed in the main part of the fan-shaped temporalis: the anteromedial, anterolateral, and mid-lateral muscle bundles. Based on the origins, insertions and detailed innervation patterns, these bundles were considered as parts of the temporalis rather than independent muscles, although the anteromedial and anterolateral bundles had been recently reported as newly described muscles. A possible schematic model of the origins of these muscle bundles is proposed. We also report a branch from the posterior deep temporal nerve which was distributed to the temporal fascia and to the skin of the temporal region.     

The arterial supply of the temporalis muscle

Owing to the diverse applications of the temporalis muscle in reconstructive surgery, the study of its arterial supply is becoming an issue of great importance nowadays. The material of the present study consisted of 44 specimens, four obtained from two stillbirths and 40 dissected from 20 embalmed cadavers after injecting the external carotid artery with lead oxide solution. Direct branches from the second part of the maxillary artery and the middle temporal artery proved to be constantly furnishing the muscle from its superficial and deep surfaces. The muscular branch of the middle temporal artery supplied the middle and posterior thirds of the superficial surface and the posterior third of the medial surface of the muscle. The superficial temporal artery participated in supplying the muscle from its lateral surface, while the anterior and posterior deep temporal arteries lay deep to the anterior and the middle thirds of the muscle, respectively. The temporal branches of the middle meningeal artery anastomosed with the deep temporal arteries, thereby contributing to the supply of the temporalis muscle. An arterial pedicle arising from the third part of the maxillary artery constituted an additional supply in 9.1% of the specimens, providing an additional arterial pedicle for temporalis-muscle-flap elevation.     

Anatomic study of the tendinous insertion lamina of the temporalis muscle

Lengthening temporalis myoplasty is indicated in long-standing and congenital facial paralysis. Its principle is the transfer of the coronoid tendinous insertions onto the lip and the nasolabial fold. Knowledge of the anatomy of this strong and wide tendon is necessary for successful use of its anatomic advantages. A study on 10 cadavers (20 temporalis muscles) confirmed the surgical anatomy found during lengthening temporalis myoplasty procedures: the strong tendon, when freed from the coronoid process, is 4–6 cm wide.     

The anatomical basis for ultrasonography of the lateral pterygoid muscle and the infratemporal fossa

Summary The infratemporal fossa and its contents (particularly the pterygoid muscles) is a region difficult to explore, in spite of its importance in odontostomatological pathology. In order to reduce the indications that justify examination by computed tomography and magnetic resonance imaging, for reasons of economy of health, the authors describe by application of orientated anatomical slices the way in which ultrasonography can be performed. Only the posterior approach between the mandible laterally and the mastoid process medially provided consistently adequate exploration of the infratemporal fossa and the pterygoid muscles.Communication presented at the French Section of the European Association of Clinical Anatomy meeting, Bobigny, France, June 20, 1992     

Plagiocephaly: morphometry of skull base asymmetry

The aim of this study was to perform a morphometric analysis of the skull base to understand the mechanism of asymmetry between malformational and deformational plagiocephaly. Since 1988, we have carried out 102 CT scans with three-dimensional reconstruction of the endocranial side of the skull base. There were 20 cases of malformational plagiocephaly, consisting of 18 unicoronal synostoses (UCS) and two unilambdoid synostoses (ULS), and 82 cases of plagiocephaly without synostosis, made up of 60 cases of frontal plagiocephaly (FP) and 22 of occipital plagiocephaly (OP). The skull base asymmetry was analyzed in three ways: (1) the hemibases and the cranial fossa angles were compared with each other; (2) the structural asymmetry of the chondrocranium was calculated; and (3) the architectural asymmetry was measured in relation to the medio-labyrinthine plane. The skull base asymmetry of malformational plagiocephaly was located in the anterior and middle cranial fossae for UCS and in the posterior and middle cranial fossae for ULS. The asymmetry was the result of a localized structural anomaly of the chondrocranium. The asymmetry of deformational plagiocephaly corresponded to a distortion in relation to the medio-labyrinthine plane while the chondrocranium remained symmetric. The skull base asymmetry of malformational plagiocephaly is secondary to a localized malformation of the chondrocranium, and that of the deformational plagiocephaly is secondary to an architectural deformation.

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Electronic Supplementary Material The french version of this article is available in the form of electronic supplementary material and can be obtained by using the Springer Link server located at .

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Les plagiocéphalies: morphométrie de l'asymétrie de la base du crâne

Résumé Le but de cette étude était de réaliser une analyse morphométrique de la base du crâne pour comprendre les mécanismes de l'asymétrie entre les plagiocéphalies malformatives et déformatives. Depuis 1988, 102 reconstructions 3D de la surface endocrânienne de la base et al. âne ont été réalisées. Il s'agissait de 20 plagiocéphalies malformatives, 18 synostoses unicoronales (SUC) et 2 synostoses unilambdoïdes (SUL), et de 82 plagiocéphalies sans synostose, 60 plagiocéphalies frontales (PF) et 22 occipitales (PO). L'asymétrie de la base du crâne était analysée de trois manières: (1) les hémi-bases et les fosses crâniennes étaient comparées les unes aux autres, (2) l'asymétrie structurale du chondrocrâne était calculée, et (3) l'asymétrie architecturale était mesurée par rapport au plan médio-labyrinthique. L'asymétrie de la base du crâne des plagiocéphalies synostotiques était localisée aux fosses crâniennes antérieure et moyenne pour les SUC et aux fosses crâniennes postérieure et moyenne pour les SUL. L'asymétrie était secondaire à une anomalie de structure localisée du chondrocrâne. L'asymétrie des plagiocéphalies sans synostose correspondait à une distorsion autour du plan médio-labyrinthique alors que le chondrocrâne restait symétrique. L'asymétrie de la base du crâne des plagiocéphalies malformatives est secondaire à une malformation localisée du chondrocrâne, et celle des plagiocéphalies déformatives est secondaire à une déformation architecturale.