Campero Alvaro, Socolovsky Mariano
Department of Neurosurgery, Hospital de Clínicas, University of Buenos Aires School of Medicine, Buenos Aires, Argentina.
Neurosurgery. 2007 Sep;61(3 Suppl):41-9; discussion 49-50. doi: 10.1227/01.neu.0000289710.95426.19.
The goal of this study was to determine the various anatomical and surgical relationships between the facial and hypoglossal nerves to define the required length of each for a nerve transfer, either by means of a classical hypoglossal-facial nerve anastomosis or combined with any of its variants developed to reduce tongue morbidities.
Five adult cadaver heads were bilaterally dissected in the parotid and submaxillary regions. Two clinical cases are described for illustration.
The prebifurcation extracranial facial nerve is found 4.82 +/- 0.88 mm from the external auditory meatus, 5.31 +/- 1.50 mm from the mastoid tip, 15.65 +/- 0.85 mm from the lateral end of C1, 17.19 +/- 1.64 mm from the border of the mandible condyle, and 4.86 +/- 1.29 mm from the digastric muscle. The average lengths of the mastoid segment of the facial nerve and the prebifurcation extracranial facial nerve are 16.35 +/- 1.21 mm and 18.93 +/- 1.41 mm, respectively. The average distance from the bifurcation of the facial nerve to the hypoglossal nerve turn is 31.56 +/- 2.53 mm. For a direct hypoglossal-facial nerve anastomosis, a length of approximately 19 mm of the hypoglossal nerve is required. For the interposition nerve graft technique, a 35 mm-long graft is required. For the technique using a longitudinally dissected hypoglossal nerve, an average length of 31.56 mm is required. Exposure of the facial nerve within the mastoid process drilling technique requires 16.35 mm of drilling.
This study attempts to establish the exact graft, dissection within the hypoglossal nerve, and mastoid drilling requirements for hypoglossal to facial nerve transfer.
本研究的目的是确定面神经与舌下神经之间的各种解剖和手术关系，以确定通过经典的舌下-面神经吻合术或结合为减少舌部病变而开发的任何变体进行神经移植时，每条神经所需的长度。
对5个成人尸体头部的腮腺和颌下区域进行双侧解剖。描述了2例临床病例以作说明。
结果：颅外面神经分叉前距外耳道4.82±0.88mm，距乳突尖5.31±1.50mm，距C1外侧端15.65±0.85mm，距下颌骨髁突边缘17.19±1.64mm，距二腹肌4.86±1.29mm。面神经乳突段和颅外面神经分叉前的平均长度分别为16.35±1.21mm和18.93±1.41mm。面神经分叉至舌下神经转弯处的平均距离为31.56±2.53mm。对于直接的舌下-面神经吻合术，需要约19mm长的舌下神经。对于神经移植技术，需要35mm长的移植物。对于使用纵向解剖舌下神经的技术，平均需要31.56mm的长度。在乳突钻孔技术中暴露面神经需要16.35mm的钻孔长度。
本研究试图确定舌下神经至面神经移植的确切移植物、舌下神经内的解剖以及乳突钻孔要求。
