面神经-舌下神经吻合术面神经干的显微解剖研究

目的观测面神经干的显微解剖,为面神经-舌下神经吻合术提供解剖学资料。方法解剖9例18侧福尔马林固定成人尸头,分别利用二腹肌后腹作为标志,在肌肉内侧寻找面神经干;在腮腺上作切口分离,寻找面神经干;以茎突作为标志追踪至颈乳孔,于茎乳孔处寻找面神经干的3种不同方法暴露面神经干。观测面神经干长度、深度、直径、分支及与周围结构的关系。结果面神经均由茎乳孔出颅。茎乳孔处面神经干直径为2.57±0.60mm,距皮肤的最小距离为22.62±2.88mm,面神经干长度为15.71±1.97mm,面神经干分叉至乳突尖的距离为18.20±4.41mm,分叉至下颌角的距离为39.91±8.38mm。乳突尖端至茎乳孔的距离为17.91±2.68mm,面神经干分叉前的主要分支有耳后神经、二腹肌神经和茎突舌骨肌神经。结论以茎突作为标志追踪至颈乳孔,在茎乳孔处寻找面神经干的方法安全可靠,面神经-部分舌下神经吻合是可行的。

MICROSURGICAL ANATOMY OF THE FACIAL NERVE TRUNK IN FACIAL-HYPOGLOSSAL NERVE ANASTOMOSIS

OBJECTIVE: To study the microsurgical anatomy of the facial nerve (FN) trunk and provide some important morphometric data about facial-hypoglossal nerve anastomosis (FHA). METHODS: Bilateral microsurgical dissection was performed on the heads of 9 cadarers fixed with formalin with three different methods. In the first method, the posterior belly of the digastric muscle was used as a mark, and the FN trunk was identified on the medial side of this muscle. In the second method, dissection was initiated at the parotid gland, the FN trunk was identified at its entrance into the parotid gland. In the third method, the styloid process was identified and traced back to the stylomastoid foramen (SMF). The FN trunk was identified on its emergence from the SMF. In every dissection, the whole FN trunk was exposed; its diameter and depth at the the SMF and its length were measured; its relationship, with other structures was studied. RESULTS: The FN invariably emerged from the cranial base through the SMF. Its diameter upon its emergence from the foramen was 2.57 +/- 0.60 mm. The mean minimal distance of the FN trunk from the skin surface in this area was 22.62 +/- 2.88 mm. The length of the FN trunk was 15.71 +/- 1.97 mm. The distance between the bifurcation and the mastoidale was 18.20 +/- 4.41 mm. The distance between the bifurcation and the mandibular angle was 39.91 +/- 8.38 mm. The distance between the mastoidale and the SMF was 17.91 +/- 2.68 mm. The branches from the FN trunk proximal to its bifurcation were the posterior auricular nerve, the digastric muscle nerve and the stylohyoid muscle nerve. CONCLUSION: The third method to expose the FN trunk on its emergence from the SMF is safe and reliable. It is feasible to use only part of the hypoglossal nerve fibers for anastomosis with the FN trunk.