Division of Plastic Surgery, University of Louisville School of Medicine, Kentucky 40292, USA.
Aesthet Surg J. 2011 Mar;31(3):286-9. doi: 10.1177/1090820X11398352.
Marginal mandibular nerve injuries are more likely to be symptomatic than other facial nerve injuries following facelift procedures. The marginal mandibular nerve courses over the facial artery in the region of the mandible. The nerve is most susceptible to injury in this location because it lies superficial to the anterior facial artery.
The authors describe the location of the marginal mandibular nerve based on superficial anatomic landmarks as it crosses the facial artery above the mandibular border, in order to help surgeons avoid injury to this nerve during facelift procedures.
Eighteen cadaveric facial halves were dissected with the aid of loupe magnification. The distance from the facial artery to the palpable masseteric tuberosity at the angle of the mandible was measured. The distance from the masseteric tuberosity to the mental midline was also measured to determine a ratio of the facial nerve from the masseteric tuberosity to the mental midline.
The facial artery was found to be an average of 3.05 ± 0.13 cm anterior to the masseteric tuberosity along the mandible. The marginal mandibular nerve crossed the facial artery along the mandibular border approximately 3 cm anterior to the masseteric tuberosity. The distance from the masseteric tuberosity to the mental midline averaged 11.3 ± 0.54 cm. Therefore, the marginal mandibular nerve courses superficial to the facial artery at approximately one-fourth of the distance from the masseteric tuberosity to the mental midline.
Knowledge of the masseteric tuberosity and mental midline landmarks of the facial artery can provide a reliable and safe approach to surgery of the lower face.
在面部提升手术后，相较于其他面神经损伤，下颌缘支神经损伤更有可能出现症状。下颌缘支神经在颏部走行于面动脉之上。由于神经位于面动脉的浅层，因此在此位置最容易受伤。
作者根据浅部解剖标志描述了下颌缘支神经在越过下颌缘上方的面动脉时的位置，以帮助外科医生在面部提升手术中避免损伤该神经。
在放大镜的辅助下解剖了 18 个尸体面部半侧。测量了从面动脉到下颌角可触及的咬肌粗隆的距离。还测量了从咬肌粗隆到正中矢状面的距离，以确定从咬肌粗隆到正中矢状面的面神经比率。
面动脉平均位于下颌缘前方 3.05±0.13cm 处的咬肌粗隆处。下颌缘支神经沿着下颌缘在大约距咬肌粗隆 3cm 处越过面动脉。从咬肌粗隆到正中矢状面的平均距离为 11.3±0.54cm。因此，下颌缘支神经在距咬肌粗隆至正中矢状面四分之一的位置位于面动脉的浅层。
对面动脉咬肌粗隆和正中矢状面标志的了解，可以为下面部手术提供可靠和安全的方法。
