以颞中静脉为标记定位面神经额支

目的探讨除皱术中以颞中静脉为标记,定位面神经额支的方法,以预防损伤。方法对12具防腐成人头部标本和2具新鲜成人灌注头部标本,进行显微解剖,观察颞中静脉与面神经额支的位置关系。结果①额支位于颞浅筋膜深面和颞深筋膜浅层之间的组织内;颞中静脉位于颞深筋膜浅、深层之间的颞浅脂肪垫内。有颧颞中静脉和颧颞侧静脉两个分支,收集眶周深层的静脉血,回流到颞浅静脉。与上、下睑静脉、眼静脉、睑外侧静脉形成交通。另外,与颞深静脉吻合,并借此与翼静脉丛相通。②在耳屏点与额骨颧突的连线上,颞中静脉的交点,距耳屏点的平均距离是(18.2±2.3)mm。颞中静脉与最近额支的距离是(9.3±4.3)mm;最远额支的距离是(23.5±3.6)mm。结论在耳屏点与额骨颧突的连线上,距颞中静脉5.0~27.1mm的区域,是面神经额支所在的“危险区”。     

Anatomic variation of the relation between the facial nerve and the retromandibular vein during superficial parotidectomy: A rare case report

IntroductionIdentification and preservation of the facial nerve (FN) is a major challenge when performing parotidectomy. Anatomic variations of the relation between the FN and the retromandibular vein (RMV) pose a high risk of nerve injury and bleeding during the operation.Presentation of caseAn unusual anatomic variation of the relation between the FN and the RMV was unexpectedly detected during superficial parotidectomy. The operation was uneventful. A meticulous review of the recent literature was conducted as well.DiscussionVariations of the relation between the FN and the RMV are mainly identified during the operation, since when performing parotidectomy, surgeons typically detect all the FN branches by locating the RMV. Such kind of variations, are not as rare as considered and their presence complicates parotid surgery and increases the potentiality of nerve injury and hemorrhage.ConclusionSurgeons’ deep knowledge and perpetual awareness concerning the probable anatomic variations of the relation between the FN and the RMV combined with detailed exposure of the operative field and of the relationship between these adjacent anatomical structures lead to safe parotid surgery.     

快速和缓慢面神经延长的实验研究

目的 对快速和缓慢面神经延长进行比较研究,验证快速面神经延长的可行,为临床应用神经处长术修复面神经缺损提供依据。方法 用自制的神经延长器以不同速度延长面神经颊支,快速延长组１０ｍｍ／１０ｍｉｎ,缓慢延长组１．５～２．０ｍｍ／ｄ,在不同时间点检测颊肌肌电图（ＥＭＧ）、神经传导速度（ＮＣＶ）,并观察神经的病理形态学改变,在延长结束后切除一再做端端外膜缝合,设神经移植组作为对照,自处长开始计时,第１５周     

两种不同术式治疗合并肩胛上神经损伤的巨大肩袖撕裂后神经恢复的临床对比研究

目的对比传统双排修复术与阔筋膜移植术两种术式治疗合并肩胛上神经损伤的巨大肩袖撕裂患者的功能恢复情况。 方法回顾性分析2013年1月至2018年1月因巨大肩袖撕裂损伤于本院行关节镜肩袖损伤修复术患者20例,其中传统双排缝合组（A组）10例,阔筋膜移植组（B组）10例。所有患者术前均经肩关节MRI及肌电图诊断为巨大肩袖损伤合并神经损伤。术后1个月、6个月定期随访患者。比较手术前后两组患者的疼痛视觉模拟评分（visual analogue scale,VAS）、美国加州大学洛杉矶分校（University of California at Los Angeles,UCLA）评分、Constant-Murely肩关节功能评分的变化情况。术后6个月复查肌电图及MRI评估肩袖愈合及神经恢复情况。 结果20例患者均获得随访,随访时间6~18个月。术后6个月A组VAS评分从术前（7.4±0.8）分下降到（2.3±1.7）分,差异有统计学意义（P<0.01）,UCLA评分从术前（11.5±1.4）分上升到（28.3±5.8）分,差异有统计学意义（P<0.01）,Constant-Murely评分从术前（45.6±6.2）分上升到（79.0±11.7）分,差异有统计学意义（P<0.01）。B组VAS评分从术前（7.9±0.6）分下降到（2.7±1.8）分,差异有统计学意义（P<0.01）,UCLA评分从术前（10.1±1.4）分上升到（26.9±6.9）分,差异有统计学意义（P<0.01）,Constant-Murely评分从术前（39.0±3.4）分上升到（72.9±9.4）分,差异有统计学意义（P<0.01）。术后6个月时两组患者VAS评分比较差异无统计学意义（P>0.05）,两组患者UCLA评分比较差异无统计学意义（P>0.05）,两组患者Constant-Murely评分比较差异无统计学意义（P>0.05）。术后6个月复查肌电图,A组患者无肩胛上神经损伤,B组患者中有5例患者仍有肩胛上神经损伤（P<0.01）。 结论关节镜下巨大肩袖损伤传统双排修复术及阔筋膜移植术均能改善患者肩关节功能,双排缝合对于肩胛上神经功能恢复的短期效果要比阔筋膜移植组好,但再撕裂可能性大。     

Large facial nerve schwannomas without facial palsy: case reports and review of the literature

Although approximately 30% of facial nerve schwannoma cases present with no facial palsy, a large facial nerve schwannoma extending to the middle and posterior cranial fossa quite rarely presents without facial palsy. The authors encountered two patients with large facial nerve schwannoma who presented with only hearing impairment and no facial palsy. The first patient was a 64-year-old woman who presented with right auditory impairment without facial palsy. MR images demonstrated a dumbbell-shaped tumor in the cerebellopontine angle. Another patient, a 40-year-old woman, also presented with vertigo and right tinnitus without facial palsy. MR images demonstrated a huge tumor expanding into both the posterior cranial fossa and middle cranial fossa. In both cases, intraoperative findings confirmed that the tumors had grown from the facial nerve. Facial nerve schwannoma can be easily diagnosed if detailed neurological evaluations and appropriate neuroimagings are conducted. However, in spite of such huge tumoral size and expanding pattern, the facial nerve function was relatively preserved. Anatomical features of the facial schwannoma are discussed. A tumor extending to the middle and posterior cranial fossa should remind neurosurgeons to consider facial nerve schwannomas even in the absence of facial palsy.     

腮腺切除术中面神经的解剖和观测

为了探讨面神经颅外段的走行,对120例由于各种原因进行保留面神经的腮腺腺叶切除术的患者,在术中对其面神经出颅后的走行、分支及其与邻近组织的关系等进行了解剖测量观察。观测包括面神经主干的长度、宽度以及各个分支发出的部位,各个分支的解剖特点。结果表明:颞支位置深在,分支较多;颧支位置深在,较粗大,分支相对较少,位置恒定;颊支分为①上下颊支型;②融为一支型;③一支再分型三种情况;下颌缘支位置较表浅,较细且走行长,分支多为2～3支。对手术时如何利用邻近解剖关系正确地寻找面神经进行了分析。     

面神经额支的分布与面部上提术的关系

目的明确面神额支在颧弓及颢部的软组织走行层次和分布。方法对9具尸头(18侧)颜面行大体解剖观察。结果面神经额支的分支数目为3～7支,平均5支,无恒定的行径及体表投影。将颧弓均分成三段,统计跨过各段表面的额支分支数,发现额支并非仅限于颧弓的中后段,而是近全颧弓均有额支分支跨过,其分布密度以中1/3段最高,占总数的44.44%(40/90);前1/3段次之,占38.89%(35/90);后1/3段又次之,占16.67%(15/90)。额支分布于颧弓和颞部的浅筋膜层(即 SMAS)的深面,其前段表面分支支配下外侧的眼轮匝肌,中段表面分支支配外侧的眼轮匝肌及少部分额肌,后段表面分支支配额肌和耳前肌。结论行骨膜下剥离面部上提术时,为减少面神经额支的损伤,应注意辨认颞部和颧弓部位的软组织层次,并非靠限制颧弓部位的解剖范围。     

面动、静脉的彩色多普勒超声图像研究

目的 测定面血管的管径及面动、静脉的相互位置关系，研究面动脉（特别是远心段）的血流动力学，并探讨彩色多普勒超声血流图像仪在轴型组织设计中的价值。方法 采用美国产的DiasonicVST彩色多普勒超声仪对12例成人双侧面动、静脉进行检查。结果 面动、静脉在下颌下缘相互靠近，在口角周围和鼻翼基底下方相互远离。阻断面动脉向上的血流后，在口角周围和鼻翼基底下方，面动脉的逆行血流速度为阻断前的1／4－1／2。结论 面动、静脉相互位置关系的变化为面管轴型组织瓣的设计和手术操作提供了新的解剖学依据。面动脉远心段逆行血流动力学的研究为面血管逆行岛状组织瓣的设计提供了新的血流动力学依据。彩色多普勒超声血流图像仪对轴型组织瓣的设计具有重要的价值。