Pekar L, Bláha M, Schwab J, Melechovský D
Neurochirurgické oddĕlení FN Motol, Praha.
Rozhl Chir. 2004 May;83(5):205-8.
The surgical anatomy of the temporal branch of the facial nerve was studied in the anatomical laboratory. The temporal branch divides into an anterior, middle (frontal), and a posterior ramus after it pierces the parotid fascia. The anterior ramus innervates orbicularis oculi and corrugator supercilii muscles; the middle branch is for the ipsilateral frontalis muscle. The posterior branch innervates the anterior and superior auricular and tragus muscles. Below the zygomatic arch, the temporal branch of the facial nerve is located in the subcutaneous tissue. Above the arch, it continues in the subgaleal space with the superficial temporal fascia deeply. The terminal twigs of the temporal branch penetrate the galea to reach their target muscles that are all located superficial to the galea. There is a significant variability in the course of the temporal branch of the facial nerve. Occasionally, the terminal twigs of the middle ramus may penetrate superficial layer of superficial temporal fascia and run in the intrafascial fat pad before entering the frontalis muscle. There are four available operative techniques in this anatomical location. The subgaleal dissection of a temporofrontal scalp flap is associated with a high incidence of postoperative palsy of the temporal branch of the facial nerve and cosmetically bothersome results. Reflecting the scalp and temporalis muscle together as a single layer is the safest procedure. Unfortunately, this technique can not be used for the transzygomatic approaches and the bulky temporalis muscle may compromise basal exposure in the pterional route. Third technique was described and propagated by Yasargil. He proposed a subgaleal dissection up to the anterior one-fourth of the temporalis muscle where the dissection has to be deepened between the two layers of the superficial temporal fascia (in the interfascial fat pad). This approach may also infrequently injure the temporal branch in case of anatomical variation. The last available operative technique raises the superficial temporal fascia together with the scalp.
在解剖实验室对面神经颞支的手术解剖进行了研究。面神经颞支穿出腮腺筋膜后分为前支、中支（额支）和后支。前支支配眼轮匝肌和皱眉肌；中支支配同侧额肌。后支支配耳前肌、耳上肌和耳屏肌。在颧弓下方，面神经颞支位于皮下组织中。在颧弓上方，它与颞浅筋膜深层一起延续于帽状腱膜下间隙。颞支的终末分支穿过帽状腱膜到达其目标肌肉，这些肌肉均位于帽状腱膜浅层。面神经颞支的走行存在显著变异。偶尔，中支的终末分支可能穿透颞浅筋膜浅层并在筋膜内脂肪垫中走行，然后进入额肌。在这个解剖部位有四种可用的手术技术。颞额头皮瓣的帽状腱膜下分离术术后面神经颞支麻痹的发生率较高，且美容效果不佳。将头皮和颞肌作为单层一起翻转是最安全的手术方法。不幸的是，这种技术不能用于经颧弓入路，而且肥厚的颞肌可能会影响翼点入路的基底暴露。第三种技术由亚萨吉尔描述并推广。他提出在帽状腱膜下分离至颞肌前四分之一处，在此处必须在颞浅筋膜的两层之间（在筋膜间脂肪垫中）加深分离。在解剖变异的情况下，这种方法也可能偶尔损伤颞支。最后一种可用的手术技术是将颞浅筋膜与头皮一起掀起。
