头皮冠状切口不同位置切开骨膜对面神经的影响

目的:研究头皮冠状切口手术时,行表浅肌肉腱膜系统(superficial muscle aponeurotic system,SMAS)下分离,不同位置切开骨膜暴露骨折的位置,对面神经颞支、颧支损伤的影响。方法:对27例面中部骨折行头皮冠状切口患者分别采用,方法Ⅰ:沿SMAS下分离至眶上缘上2cm处和颧弓上1.5cm处,先在此切开骨膜和颞深筋膜浅层,分离暴露骨折;方法Ⅱ:沿SMAS下分离至眶上缘和颧弓处,然后再在眶上缘上2cm和颧弓上1.5cm切开直至暴露骨折;方法Ⅲ:同方法Ⅱ分离至眶上缘及颧弓处并直接切开骨膜,暴露骨折。术后7d、1个月、半年随访,对比三种方法的优劣。结果:方法Ⅱ和方法Ⅲ在术后出现不同程度面神经颞支、颧支受损症状,方法Ⅰ术后未出现面神经损伤症状。结论:头皮冠状切口行SMAS下分离至眶上缘上2cm处和颧弓上1.5cm处,切开暴露骨折,是一种临床安全可行的方法。

Coronary Incision of the Scalp and Trauma to the Facial Nerve

Objective： The aim of this study was to discuss how to protect the temporal and zygomatic branches of facial nerve during surgical reduction of midface fractures by coronary incision of the scalp. Methods： 27 patients with 3 different approaches were included in this study. ①Separate under the SMAS to 2.0 cm above the supraorbital edge and 1.5 cm above zygomatic arch, where the periosteum and superficial layer of deep temporal fascia were incised to expose fracture; ②Separate under the SMAS to the supraorbital edge and zygomatic arch, and then as in method 1, incise at 2.0 cm above the supraorbital edge and 1.5 cm above zygomatic arch to expose fracture. ③As in method 2, separate under the SMAS to the supraorbital edge and zygomatic arch, and then incise the periosteum directly to expose fracture. Injuries to facial nerve branches were checked at one week, one month and 6-month after operation. Results： Facial nerve injury to a varying degree appeared in method 2 and method 3 after the operation, but cases with method 1 there was no facial nerve damage symptom. Conclusion： Dissection under the SMAS to 2.0 cm above the supra-orbital edge and 1.5 cm above zygomatic arch to incise periosteum and superficial layer of deep temporal fascia to expose fracture, is a safe feasible way in clinical practice.