Manhattan Eye, Ear, and Throat Hospital/Lenox Hill Hospital, New York, New York, USA.
Aesthet Surg J. 2013 Jan;33(1):19-23. doi: 10.1177/1090820X12469625.
An estimated 116 086 facelifts were performed in 2011. Regardless of the technique employed, facial flap elevation carries with it anatomical pitfalls of which any surgeon performing these procedures should be aware. Injury to the great auricular nerve (GAN) is the most common of these injuries, occurring at a rate of 6% to 7%.
We report our findings on the location of the GAN on the basis of anatomical landmarks to aid surgeons with planning their surgical approach for safe elevation of rhytidectomy skin flaps in the lateral neck region.
Sixteen fresh cadaveric heads were dissected under loupe magnification. All specimens were dissected in a 45-degree (facelift) position in which a mid-sternocleidomastoid (SCM) incision was used for exposure. Measurements from the bony mastoid process, bony external auditory canal, external jugular vein, and anterior border of the SCM to the GAN were taken in each cadaver.
The GAN follows a consistent course over the mid-body of the SCM before bifurcating into anterior and posterior branches and terminal arborization. Regardless of the length of the SCM, the GAN at its most superficial location was found to be consistently at a ratio of one-third the distance from either the mastoid process or the external auditory canal to the clavicular origin of the SCM.
Knowledge of the anatomy, course, and location of the GAN along the surface of SCM muscle based on anatomic landmarks and distance ratios can facilitate a safer dissection in the lateral neck during rhytidectomy procedures.
2011 年，估计有 116086 例面部提升术。无论采用何种技术，面部皮瓣抬高都存在解剖学上的陷阱，任何进行这些手术的外科医生都应该了解。其中最常见的损伤是耳大神经（GAN）损伤，发生率为 6%至 7%。
我们根据解剖学标志报告 GAN 的位置发现，以帮助外科医生规划手术入路，安全地抬高颈部外侧除皱术皮瓣。
在放大镜下解剖了 16 个新鲜的尸体头颅。所有标本均以 45 度角（除皱术）位置进行解剖，采用胸骨舌骨肌（SCM）中切口进行暴露。在每个标本中，从骨性乳突、骨性外耳道、颈外静脉和 SCM 前缘测量到 GAN 的距离。
GAN 在 SCM 的中体上沿着一个一致的路径走行，然后分叉成前支和后支以及终末分支。无论 SCM 的长度如何，GAN 在其最浅表的位置都位于从乳突或外耳道到 SCM 锁骨起点的三分之一距离处。
基于解剖标志和距离比例，了解 GAN 在 SCM 表面的解剖、走行和位置，可以在除皱术中更安全地进行颈侧解剖。
