肌骨瓣眶颧入路的应用解剖学研究

摘要

目的：对肌骨瓣眶颧入路进行解剖学研究，减少因传统眶颧入路造成的面神经颞支损伤及术后颞肌萎缩、颞窝塌陷的发生。方法：20侧尸头模拟肌骨瓣眶颧手术入路，观察术区面神经颞支和颞浅动脉额颞支的位置关系并测量二者之间的最短距离，测量MacCarty孔中心至额蝶缝的垂线距离和垂直点距额蝶缝末端的距离。结果：术区中面神经颞支均在颞浅动脉额颞支前下方走行，二者之间的最短距离为(4.80±2.40)mm， MacCarty孔位于额蝶缝上方，MacCarty孔中心距额蝶缝的垂直距离为(6.10±2.32)mm，垂直点至额蝶缝末端的距离为(22.42±4.12)mm。结论：颞浅动脉额颞支可做为筋膜间入路的解剖学标志；肌骨瓣血管神经保持完整降低了颞肌和骨萎缩的风险。%Objective:To reduce the incidence of temporal branch of facial nerve injury, temporal muscle atrophy and temporal fossa collapse induced by traditional orbitozygomatic approach.Methods:The muscle bone flap of orbitozygomatic approach was simulated in 20 sides cadaver heads.The relationship between temporal branch of facial nerve and frontotemporal branch of superficial temporal artery was observed and the shortest distance between them was measured. The vertical distance from the center of MacCarty keyhole to spheno-frontal suture, and the distance between the vertical point and the end of spheno-frontal suture were measured. Results:In surgical site, all the temporal branch of facial nerve ran anteroinferior to the frontotemporal branch of superficial temporal artery, and the shortest distance between them was (4.80±2.40)mm. The MacCarty keyhole was superior to the spheno-frontal suture, the vertical distance between the center of MacCarty keyhole and the spheno-frontal suture was (6.10±2.32)mm, the distance between the vertical point and the end of spheno-frontal suture was (22.42±4.12)mm.Conclusions:Frontotemporal branch of superficial temporal artery can be acted as the sign of interfascial pterional approach;Integrity of blood vessels and nerves of the muscle bone flap can lower the risk of temporal muscleatrophyandtemporalfossacollapse.