Totonchi Ali, Pashmini Nazly, Guyuron Bahman
Division of Plastic Surgery, Case Western Reserve University, and the American Migraine Center, Cleveland, Ohio, USA.
Plast Reconstr Surg. 2005 Jan;115(1):273-7.
This study was conducted to determine the site of emergence of the zygomaticotemporal branch of the trigeminal nerve from the temporalis muscle and to identify the number of its accessory branches and their locations. A pilot study, conducted on the same number of patients, concluded that the main zygomaticotemporal branch emerges from the deep temporal fascia at a point on average 17 mm lateral and 6 mm cephalad to the lateral palpebral commissure, commonly referred to as the lateral canthus. These measurements, however, were obtained after dissection of the temporal area, rendering the findings less reliable. The current study included 20 consecutive patients, 19 women and one man, between the ages of 26 and 85 years, with an average age of 47.6 years. Those who had a history of previous trauma or surgery in the temple area were excluded. Before the start of the endoscopic forehead procedure, the likely topographic site of the zygomaticotemporal branch was marked 17 mm lateral and 6 mm cephalad to the lateral orbital commissure on the basis of the information extrapolated from the pilot study. The surface mark was then transferred to the deeper layers using a 25-gauge needle stained with brilliant green. After endoscopic exposure of the marked site, the distance between the main branch of the trigeminal nerve or its accessory branches and the tattoo mark was measured in posterolateral and cephalocaudal directions. In addition, the number and locations of the accessory branches of the trigeminal nerve were recorded. On the left side, the average distance of the emergence site of the main zygomaticotemporal branch of the trigeminal nerve from the palpebral fissure was 16.8 mm (range, 12 to 31 mm) in the posterolateral direction and an average of 6.4 mm (range, 4 to 11 mm) in the cephalad direction. On the right side, the average measurements for the main branch were 17.1 mm (range, 15 to 21 mm) in the lateral direction and 6.65 mm (range, 5 to 11 mm) in the cephalic direction. Three types of accessory branches were found in relation to the main branch: (1) accessory branch cephalad, (2) accessory branch lateral, and (3) accessory branches in the immediate vicinity of the main branch. This anatomical information has proven colossally helpful in injection of botulinum toxin A in the temporalis muscle to eliminate the trigger sites in the parietotemporal region and surgical management of migraine headaches triggered from this zone.
本研究旨在确定三叉神经颧颞支从颞肌穿出的部位，并明确其副支的数量及位置。一项针对相同数量患者进行的初步研究得出结论，三叉神经颧颞主支从颞深筋膜穿出，位于外眦角（通常称为外眼角）外侧平均17毫米及上方6毫米处。然而，这些测量数据是在颞区解剖后获得的，导致研究结果的可靠性降低。本研究纳入了20例连续患者，其中19例女性，1例男性，年龄在26至85岁之间，平均年龄为47.6岁。排除有颞区既往创伤或手术史的患者。在内镜前额手术开始前，根据初步研究推断的信息，在眶外侧角外侧17毫米及上方6毫米处标记出颧颞支可能的地形学位置。然后使用蘸有亮绿的25号针将该体表标记转移至更深层。在内镜暴露标记部位后，测量三叉神经主支或其副支与纹身标记在前后外侧及头尾方向的距离。此外，记录三叉神经副支的数量和位置。在左侧，三叉神经颧颞主支穿出部位距睑裂的平均距离在前后外侧方向为16.8毫米（范围为12至31毫米），在头侧方向平均为6.4毫米（范围为4至11毫米）。在右侧，主支的平均测量值在外侧方向为17.1毫米（范围为15至21毫米），在头侧方向为6.65毫米（范围为5至11毫米）。发现与主支相关的三种类型的副支：（1）头侧副支，（2）外侧副支，（3）紧邻主支的副支。这一解剖学信息已证明在颞肌注射A型肉毒毒素以消除顶颞区的触发点以及对该区域引发的偏头痛进行手术治疗方面非常有帮助。
