Lettieri Salvatore
Division of Plastic Surgery, Mayo Clinic, Rochester, MN 55905, USA.
Aesthet Surg J. 2008 Mar-Apr;28(2):143-6. doi: 10.1016/j.asj.2007.12.011.
Risks to the frontal branch of the facial nerve, especially at the juncture of the zygomatic arch, have been well studied in connection with aesthetic procedures. The use of bicoronal incisions led to the observation that there is a second area in which injury to the frontal branch of the facial nerve is at risk: the transition plane between the area over the temporalis muscle and the pericranial region.
A study was conducted to map out the frontal branch of the facial nerve as it passes through the dense galeal temporal fascia, because this is a zone of potential injury.
Ten fresh frozen cadaver halves were dissected by use of a standard surgical bicoronal approach with surgical instrumentation and loupe magnification x 2.5.
In the area of interest, which included the region overlying the zygomatic arch, as well as the galeal frontalis fusion point, the nerve was found to be deep and within the fusion point. The nerve was cephalad to the sentinel vein in each instance, and the tissue was freely dissected medial and lateral to the fusion point of the galea and the temporal fascia. The fusion plane was dense and in a direct line in the vertical direction with the loose areolar plane on either side.
The dense tissue within the galeal temporal region needs to be approached with caution, avoiding electrocautery and using sharp dissection. The cadaver study demonstrates the close proximity of the nerve in the deeper portion of the elevated superficial flap.
在美容手术中，面神经额支的风险，尤其是在颧弓交界处的风险，已得到充分研究。双冠状切口的使用导致观察到存在面神经额支受伤风险的第二个区域：颞肌上方区域与颅骨膜区域之间的过渡平面。
进行一项研究，以描绘面神经额支穿过致密的颞肌帽状腱膜时的情况，因为这是一个潜在的损伤区域。
使用标准手术双冠状入路，借助手术器械和2.5倍放大镜，对10个新鲜冷冻的尸体半侧进行解剖。
在感兴趣的区域，包括颧弓上方区域以及额肌帽状腱膜融合点，发现神经位于深部且在融合点内。在每种情况下，神经都位于哨兵静脉的头侧，并且在帽状腱膜和颞筋膜融合点的内侧和外侧进行了自由解剖。融合平面致密，在垂直方向上与两侧的疏松结缔组织平面成直线。
处理颞肌帽状腱膜区域内的致密组织时需要谨慎，避免电灼并采用锐性解剖。尸体研究表明，在掀起的浅筋膜瓣较深部分中神经位置很近。
