耳大神经及腮腺筋膜解剖的再认识与腮腺切除手术的改良

目的：对耳大神经及腮腺筋膜解剖进行再认识，由此改良腮腺切除手术方法。方法：解剖成人尸体10侧，术中活体解剖20侧，对耳大神经和腮腺筋膜的解剖要素进行观察。根据观察结果进行改良腮腺切除术14例，即在腮腺筋膜表面翻瓣后，由前向后另翻腮腺筋膜瓣，切除腮腺后将筋膜瓣复位缝合，完整保留耳大神经和腮腺筋膜。结果：耳大神经在下颌角水平之上0-2cm依次分耳后、耳垂、耳前支，神经主干末段和分支起始段均分布于腮腺筋膜浅层表面，后者致密，其致密纤维包裹在神经周围。改良手术后2例（14．3％）发生轻度Frey’s综合征，无1例发生术区皮肤长期麻木、长期面瘫、涎瘘及肿瘤复发。结论：耳大神经各分支和腮腺筋膜具有不可代替的解剖生理功能，改良术式能将两者完好保留，显著降低术后并发症。

Modified parotidectomy based on anatomical re-observation of the great auricular nerve and parotid gland fasciae

Objective: To modify the traditional parotidectomy based on re-observing the great auricular nerve(GAN) and parotid gland fascia(PGF) anatomically. Methods:The GAN and PGF were anatomically examined in 5 cadavers(10 sides) and 20 cases who underwent parotidectomy. Based on that, a modification was made for parotidectomy. After flap raising, the PGF was elevated from anterior margin of parotid gland to form a fascial flap. And then the gland was exposed and resected with the fascial flap repositioning. Such modification reserved both the GAN and PGF integrately. Results:The GAN trifurcated into posterior auricular, lobular and anterior auricular branches at the level 0-2cm above the mandibular angle. The PGF was pyknic and covered the gland totally. The terminal part and the three branches of the GAN run with fibrous adherence on the fascia surface. After the modified operation, 2 cases(14.3%)suffered from slight Frey's syndrome, no case suffered from permanent numbness, facial palsy, salivary fistula, or tumor recurrence. Conclussions: The GAN and PGF have particular anatomical and physiological functions. Both of them are reserved during the modified operation, and then the complications decrease significantly.