鼻唇沟区域解剖学研究

目的对颌面整形美容外科提供形态学依据。方法对20侧成人新鲜尸头行10%福尔马林血管灌注固定后,在手术放大镜下进行形态学观测。结果①首次对少数国人与鼻唇沟区域相关的各表情肌逐块进行长、宽、厚的显微解剖测量。②测得鼻唇沟内侧脂肪厚度为1.3mm,外侧为4.5mm。③鼻唇沟内侧真皮层有肌纤维附着,外侧也有稀少肌束附着。④面部表浅肌肉之间不但存在腱膜,还由筋膜、肌肉、腱膜共同构成一个立体网状结构。结论进一步证实了有关SMAS 中央腱的理论假说。     

鼻唇沟区域解剖学研究

目的对颌面整形美容外科提供形态学依据。方法对２０侧成人新鲜尸头行１０％福尔马林血管灌注固定后,在手术放大镜下进行形态学观测。结果①首次对少数国人与鼻唇沟区域相关的各表情肌逐块进行长、宽、厚的显微解剖测量。②测得鼻唇沟内侧脂肪厚度为１３ｍｍ,外侧为４５ｍｍ。③鼻唇沟内侧真皮层有肌纤维附着,外侧也有稀少肌束附着。④面部表浅肌肉之间不但存在腱膜,还由筋膜、肌肉、腱膜共同构成一个立体网状结构。结论进一步证实了有关ＳＭＡＳ中央腱的理论假说。     

鼻唇沟区域解剖学研究

目的 对颌面整形美容外科提供形态学依据。方法 对20例成人新鲜尸头行10％福尔马林血管灌注固定后，在手术放大镜下进行形态学观测。结果 ①首次对少数国人与鼻唇沟区域相关的各表情肌逐块进行长、宽、厚的显微解剖测量。②测得鼻唇沟内侧脂肪厚度为1．3mm，外侧为4．5mm。③鼻唇沟内侧真皮层有肌纤维附着，外侧也有稀少肌束附着。④面部有浅肌肉宰不但存在腱膜，还由筋膜、肌肉、腱膜共同构成一个立体网状结构。结论 进一步证实了有关SMAS中央腱的理论假说。     

鼻唇沟解剖及相关面部年轻化治疗的最新研究进展

鼻唇沟是鼻翼外侧延伸至口角的面部凹陷性区域.鼻唇沟的解剖层次由浅至深为皮肤层、脂肪室、表浅肌肉腱膜系统、纤维连接层和肌肉层;因产生机制不同可将鼻唇沟分为五型:皮肤型、脂肪垫型、肌肉型、下颌后移型和综合型.对于不同类型的鼻唇沟需采用差异化的治疗方法.因此掌握其解剖结构、准确评估并正确分类,对面部年轻化治疗至关重要.现对鼻...     

保留耳前鬓角形态并预防脱发的颞颊部除皱术

目的:介绍一种保留耳前鬓角形态并且预防术后脱发的颞颊部除皱术式。方法:颞部切口位于发际缘后方5cm左右并与鼻唇沟平行,耳前切口位于鬓角后缘。颞部于颞浅筋膜深面剥离至发际缘,切开颞浅筋膜于其浅面剥离至眼轮匝肌浅面。耳前于表浅肌肉腱膜浅面剥离至咬肌前缘。垂直于颞部切口向外上方悬吊颞浅筋膜,垂直于鼻唇沟向外上方悬吊腮腺浅面的表浅肌肉腱膜。结果:2008年以来应用该法治疗颞颊部面部老化患者24例,效果满意,未发生严重并发症。结论:该术式保留了耳前鬓角的自然形态,术后切口瘢痕隐蔽,无明显脱发,避免了重要神经、血管的损伤。     

指背腱膜的解剖学研究

目的 探讨指背腱膜的构成特点及临床意义。方法 在30只成人尸体手标本上，通过模拟手术，对指背腱膜的构成特点进行了应用解剖学观测。结果 指背腱膜的构成复杂，其中的外侧腱束、外侧束、外侧腱和中央束在手指畸形的发生中有着特殊的临床意义。外侧腱束主要形成伸近节指间关节的功能解剖机制；其与外侧束形成的密切纤维联系而具有协同外侧腱的功能；该腱束与屈肌腱鞘有联系又使其具有平衡屈肌和伸肌肌力的作用。中央束在指背腱膜的整体协调、畸形的发生及矫正过程中起着重要的功能。结论 通过对指背腱膜的解剖研究，可以解释因指屈、伸肌腱平衡被破坏后所形成的畸形。     

46例面神经瘫痪筋膜悬吊术的护理

４６例面神经瘫痪筋膜悬吊术的护理浙江省皮肤病防治研究所叶宏芬面神经是支配面部表情肌的运动神经。当一侧神经的颊支及下颌支受累，所支配的口轮匝肌、提上唇肌、口角提肌以及颊部肌肉等丧失运动功能，致患侧口角低垂、歪斜、鼻唇沟消失，鼻端偏向健侧，致面部畸形。若...     

鼻表浅肌肉腱膜系统的解剖研究与临床应用

目的　探讨鼻表浅肌肉腱膜系统的存在及其临床意义。方法　对 3 0具成人尸体行大体解剖观察。结果　表浅脂肪层、肌肉腱膜层由肌肉层和包绕肌肉层表面的深浅两层腱膜组织构成。这样 ,鼻部肌肉和其表面的腱膜从解剖角度上可视为一个特定的结构单位 ,在此称之为鼻部表浅肌肉腱膜系统(NasalSMAS)。且发现鼻部表浅肌肉腱膜系统与面部表浅肌肉腱膜系统的相应结构层次移行。所以 ,又可认为鼻部表浅肌肉腱膜系统是面部表浅肌肉腱膜系统之一部分。其中的鼻部诸肌相互协调 ,共处在一个均衡的结构体系之中。表浅肌肉腱膜系统下方组织疏松 ,无重要血管神经走行是理想的剥离平面。结论　鼻表浅肌肉腱膜系统的完整对外鼻的形态维持具有重要意义 ,鼻部整形手术理想的剥离平面应位于鼻表浅肌肉腱膜系统的深面。     

肘管综合征临床治疗进展

尺神经在肘部通过尺神经沟时受到腱膜、异常的肌肉或骨性改变的压迫而产生的症候群称肘管综合征。它是第二位常见的上肢神经卡压症，仅次于腕管综合征，发病率相当于腕管综合征的1/2。1958年Feindel和Stratford首先使用了肘管综合征这个术语。Bozentka[1]认为肘管前界是肱骨内上髁，外侧界为肘关节内侧的尺肱韧带，后侧界为尺侧腕屈肌两个头之间形成的纤维弓，管顶由尺骨鹰嘴延伸到肱骨内上髁的纤维束组成。１致病因素由于尺神经在肘部独特的解剖特点，即位置表浅、相对固定、位于肘关节屈伸轴的后方，因此极易受到损伤。它周围的组织如St…     

睑袋成形术后轻度睑外翻的矫治

2002年5月以来，我院对5例睑袋整形术后出现的轻度睑外翻，采用外眦外侧局部表浅肌肉腱膜系统（SMAS）瓣提紧的方法进行矫治，取得较满意效果，现报告如下。[第一段]     

Independent effect of various facial mimetic muscles on the nasolabial fold

The independent effect of the contraction of various facial mimetic muscles on the nasolabial fold was defined through study of cadaver dissections. The four major lip elevator muscles were identified and the effect of traction of these muscles on the nasolabial fold was studied. This study identified the levator alae muscle (levator labii superioris alaeque nasi) as the primary facial muscle responsible for creating the medial nasolabial fold. The levator labii superioris muscle was found to define the middle nasolabial fold. These two facial muscles may be significant in the etiology of the prominent nasolabial fold that occurs with aging.     

Improving the acute nasolabial angle and medial nasolabial fold by levator alae muscle resection.

An acute nasolabial angle and a prominent nasolabial fold are two features that are often associated in the aging face. A new technique is presented that simultaneously addresses both of these features. Levator alae (levator labii superioris alaeque nasi) muscle resection, performed through a subciliary incision, improves the acute nasolabial angle without concomitant rhinoplasty. At the same time, levator alae muscle resection softens the medial nasolabial fold. Partial levator labii superioris muscle resection has occasionally been added to further weaken the middle nasolabial fold. Fresh cadaver dissections were performed to define the anatomy and to plan the surgical approach. This report describes a series of 10 patients who underwent this procedure, with improvement of the acute nasolabial angle and softening of the medial nasolabial fold.     

Anatomy of the SMAS Revisited

Despite the relevance of the superficial musculoaponeurotic system (SMAS) in facial rejuvenation a clear anatomic definition of the SMAS is still lacking. Therefore, the morphology of the SMAS in 18 cadavers was investigated using different macroscopic and microscopic techniques. The region-specific anatomy of the SMAS is described in the forehead, parotid, zygomatic, and infraorbital regions, the nasolabial fold, and the lower lip. The SMAS is one continuous, organized fibrous network connecting the facial muscles with the dermis. It consists of a three-dimensional scaffold of collagen fibers, elastic fibers, and fat cells. Two different types of SMAS morphology were demonstrated: type 1 SMAS architecture is located lateral to the nasolabial fold with relatively small fibrous septa enclosing lobules of fat cells, whereas type 2 architecture is located medial to the nasolabial fold, where the SMAS consists of a dense collagen–muscle fiber meshwork. Overall, it was demonstrated that different facial regions show specific morphological characteristics, and thus region-specific surgical interventions may be necessary in facial rejuvenation.     

鼻唇沟的解剖学研究

目的 从解剖学角度对鼻唇沟做出准确描述和定义,为解剖学和整形外科学、美容外科学、颌面外科学提供理论基础.方法 对10具（20侧）成人新鲜尸头行福尔马林血管灌注固定后,在10倍手术放大镜下进行形态学观测.结果 （1）鼻唇沟是面中部多脂肪区与无脂肪区的分界.（2）鼻唇沟起于鼻肌横部在鼻翼上缘皮肤的止点,终止于口角降肌在口角外下方皮肤的止点.（3）从解剖学角度可将鼻唇沟分为上、中、下3段,上段（Ⅰ）：为鼻肌横部区,长（20.38±0.74）mm;中段（Ⅱ）：为上唇提肌区,长（17.13±0.57）mm;下段（Ⅲ）：为蜗轴区,长（20.81±0.70）mm.（4）鼻唇沟是7种表情肌在皮肤上止点形成的连线区域,表层肌腱膜系统（SMAS）与组成鼻唇沟的7块表情肌同属同一层次.结论 鼻唇沟是7种表情肌在皮肤上止点形成的连线区域,不分年龄.永恒存在.不同于面部老化形成的鼻唇沟皱褶和面部老化或表情变化形成的鼻唇沟脊.     

改良旋转鼻唇沟皮瓣用于上唇缺损的亚单位修复

目的 探索改良旋转鼻唇沟皮瓣用于上唇亚单位缺损修复的临床效果。方法 自2013年6月至2015年10月,对10位病损位于上唇,范围大于所在上唇亚单位的50%,激光治疗无效或疤痕瘢痕形成的葡萄酒色斑/血管瘤患者,进行改良的旋转鼻唇沟皮瓣修复上唇亚单位缺损。结果 所有鼻唇沟皮瓣均存活,未出现皮瓣尖端坏死,瘢痕均隐藏于鼻旁、鼻唇沟、鼻基底、人中嵴和上唇处,效果满意。结论 利用改良的旋转鼻唇沟皮瓣可以从功能、美观两个方面进行上唇表浅组织缺损的亚单位修复,是一种理想且可靠的上唇修复方法。     

Reconstruction of orbicularis oris and levator labii superioris muscles in secondary repair of unilateral cleft lip.

We devised a new method to repair the depression of the nasal floor and inferolateral displacement of the alar base and to reconstruct the philtrum in the secondary repair of unilateral cleft lip. Depression of the nasal floor and inferolateral displacement of the alar base were corrected by advancing a lump of the levator labii superioris, the levator labii superioris alaeque nasi, and the upper part of the superficial orbicularis oris muscles to the anterior nasal spine. When the depression of the nasal floor was too severe to repair using these muscles only, a cranially-based de-epithelialised flap of the scar region on the upper lip was inserted under the nasal floor. The lower, greater part of the superficial orbicularis oris muscle was dissected to the nasolabial fold, brought towards the midline, and laid on the surface of the same muscle on the medial side to be sutured. When the depression of the nasal floor was not severe, the lower, greater part of the superficial orbicularis oris muscle was passed through a tunnel pierced beneath the de-epithelialised scar tissue and sutured to the corresponding components on the medial side to reinforce the philtral ridge. In both cases, if the deep orbicularis oris muscle in the vermilion had been interrupted, it was reconstructed by end-to-end anastomosis. Operative results were evaluated in 76 patients using photographs taken preoperatively and postoperatively. Elevation of the nasal floor and correction of the alar base were achieved in most patients, while reconstruction of the philtrum was achieved in cases in which the skin tension at the suture line was weak.     

RECONSTRUCTION OF ORBICULARIS ORIS AND LEVATOR LABII SUPERIORIS MUSCLES IN SECONDARY REPAIR OF UNILATERAL CLEFT LIP

We devised a new method to repair the depression of the nasal floor and inferolateral displacement of the alar base and to reconstruct the philtrum in the secondary repair of unilateral cleft lip. Depression of the nasal floor and inferolateral displacement of the alar base were corrected by advancing a lump of the levator labii superioris, the levator labii superioris alaeque nasi, and the upper part of the superficial orbicularis oris muscles to the anterior nasal spine. When the depression of the nasal floor was too severe to repair using these muscles only, a cranially-based de-epithelialised flap of the scar region on the upper lip was inserted under the nasal floor. The lower, greater part of the superficial orbicularis oris muscle was dissected to the nasolabial fold, brought towards the midline, and laid on the surface of the same muscle on the medial side to be sutured. When the depression of the nasal floor was not severe, the lower, greater part of the superficial orbicularis oris muscle was passed through a tunnel pierced beneath the de-epithelialised scar tissue and sutured to the corresponding components on the medial side to reinforce the philtral ridge. In both cases, if the deep orbicularis oris muscle in the vermilion had been interrupted, it was reconstructed by end-to-end anastomosis. Operative results were evaluated in 76 patients using photographs taken preoperatively and postoperatively. Elevation of the nasal floor and correction of the alar base were achieved in most patients, while reconstruction of the philtrum was achieved in cases in which the skin tension at the suture line was weak.     

上唇动脉逆行鼻唇沟岛状皮瓣的临床应用

目的 探讨扩大鼻唇沟皮瓣旋转范围的新术式。方法 解剖上唇动脉的走行与观察鼻唇沟区域皮肤血供关系，设计上唇动脉逆行岛状鼻唇沟皮瓣移转修复面部软组织缺损。结果 6例皮瓣均一期成活，外形满意。结论 以上唇动脉为蒂的逆行鼻唇沟岛状皮瓣扩大了鼻唇沟皮瓣的旋转范围。该皮瓣血管蒂恒定，血供丰富，有较好的应用价值。