Hwang Kun, Huan Fan, Ki Sae Hwi, Nam Yong Seok, Han Seung Ho
Department of Plastic Surgery, and Center for Advanced Medical Education by BK21 Project, Inha University School of Medicine, Incheon, Korea.
J Craniofac Surg. 2012 Sep;23(5):1488-90. doi: 10.1097/SCS.0b013e3182587d93.
The aim of this study was to elucidate the exact location of the mandibular branch of the facial nerve according to different neck positions. Twenty-two hemifaces of 11 fresh human cadavers were used (age range, 53-89 y; mean age, 72.3 ± 10.5 y; 8 men and 3 women). Working through skin windows, the distance from the mandibular border to the mandibular branch of the facial nerve (border-nerve distance or BND) was measured at 3 points: (1) the mandible angle (gonion or Go point), (2) the point where the mandibular branch of the facial nerve crosses the facial artery (FA point), and (3) the one-fourth point from the gonion to the menton (1/4 point). Threads were hung on the skin windows along the mandibular border. With the neck in the neutral position and then full flexion (15 degrees), extension (15 degrees), and left and right rotations (30 degrees), the distance of the mandibular branch from the thread of the mandibular border was measured using calipers. In the neutral position, the mandibular branch was 3.50 ± 2.82 mm above the mandibular border at the Go point, 5.34 ± 2.98 mm above the mandibular border at the FA point, and 5.28 ± 1.86 mm above the mandibular border at the 1/4 point. At all 3 points, flexion or extension of the neck did not significantly move the mandibular branch. At the Go point and FA point, there was no significant difference between the ipsilateral rotation position and the contralateral rotation. Yet at the 1/4 point, the BND decreased (4.32 ± 2.60 mm) with the neck in ipsilateral rotation and the BND increased (5.97 ± 2.62 mm) with the neck in contralateral rotation. There was a significant difference between the ipsilateral rotation position and the contralateral rotation position (P = 0.020, t-test). Surgeons should keep in mind that at the 1/4 point, the mandibular branch of the facial nerve moves downward 1.10 ± 1.42 mm with the neck in ipsilateral rotation and moves upward 0.49 ± 1.84 mm with the neck in contralateral rotation.
本研究的目的是根据不同的颈部位置阐明面神经下颌支的确切位置。使用了11具新鲜人类尸体的22个半侧面部（年龄范围53 - 89岁；平均年龄72.3±10.5岁；8名男性和3名女性）。通过皮肤窗口，在下述3个点测量从下颌缘到面神经下颌支的距离（边缘 - 神经距离或BND）：（1）下颌角（角点或Go点），（2）面神经下颌支与面动脉交叉处的点（FA点），以及（3）从角点到颏下点的四分之一点（1/4点）。沿着下颌缘在皮肤窗口悬挂线绳。颈部处于中立位，然后进行完全屈曲（15度）、伸展（15度）以及左右旋转（30度），使用卡尺测量面神经下颌支与下颌缘线绳之间的距离。在中立位时，在Go点面神经下颌支位于下颌缘上方3.50±2.82mm，在FA点位于下颌缘上方5.34±2.98mm，在1/4点位于下颌缘上方5.28±1.86mm。在所有3个点，颈部的屈曲或伸展均未使面神经下颌支明显移动。在Go点和FA点，同侧旋转位置与对侧旋转位置之间无显著差异。然而在1/4点，颈部同侧旋转时BND减小（4.32±2.60mm），颈部对侧旋转时BND增大（5.97±2.62mm）。同侧旋转位置与对侧旋转位置之间存在显著差异（P = 0.020，t检验）。外科医生应牢记，在1/4点，颈部同侧旋转时面神经下颌支向下移动1.10±1.42mm，颈部对侧旋转时面神经下颌支向上移动
