现代面中除皱术的面神经解剖学研究

目的 明确ＳＭＡＳ与面神经的关系。方法 对１２具（２４例）成人尸头行大体解剖观察。结果 ＳＭＡＳ分布于面中部，向前逐渐变薄，于口角水平外侧水小范围的“洞区”。面神经出腮腺后，并非在ＳＭＡＳ深面。而是在咬肌筋膜深面走行。面神经额支在颧弓以下０．５ｃｍ区域穿出深筋膜，跨过颧弓。在颊脂肪垫区，大部分神经分支走行在垫内，小部分分支形成面神经丛，分布于其表面。在颧大肌表面上１／３恒定有一颧支跨过，支配眼轮匝

Anatomical basis for the newly developed facelifting]

OBJECTIVE: To investigate the relationship between the SMAS and the facial nerve divisions in the cheek area. METHOD: We dissected 12 cadaver heads(24 sides). RESULTS: 1. SMAS distributed over the middle face. It became thinner as it extended forward and there was a small aperture lateral to the mouth. The branches of facial nerve lay directly beneath the parotidomassetric fascia after emerging from the parotid gland. 2. The frontal branch penetrated the deep fascia to the SMAS at about 0.5 cm below the zygomatic arch. 3. Some buccal branches went through the cheek fat pad while the others lay on its surface directly under the thin SMAS. 4. There was constantly a zygomatic ramus went into the upper one third of the zygomaticus. It innervated the lower and lateral orbicularis oculi muscle in 9 of 24 sides (37.5%) of the cadaver heads, zygomaticus major and minor and orbicularis oculi muscle in 8 of 24 sides (33.3%), and the zygomaticus major and minor in 7 of 24 sides (29.2%). CONCLUSION: During facelifting, wide dissection of the SMAS should be done directly above the parotidomassetric fascia and 0.5 cm below the zygomatic arch. While approaching the middle face, the dissection should be limited to the lower two third of the zygomaticus, followed by elevating the zygomatic fat. The authors dissect the nasolabial fold through the lower eyelid incision, then the dissection should go downwards, under the orbicularis oculi muscle, to the nasolabial area. In a clinical situation, care must be taken not to damage the facial nerve trunk, and dissection of the upper one third of the zygomaticus should be avoided.