基于临床解剖学的中耳手术中面神经精准定位研究

Tang Y K, He G, Fan J G, Zhu W

Department of Otorhinolaryngology Head and Neck Surgery, Sichuan Provincial People's Hospital, the Affiliated Hospital, University of Electronic Science and Technology of China, Chengdu, 610000, China.

Department of Anatomy, West China Medical College of Sichuan University.

Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2017 Sep 5;31(17):1334-1337. doi: 10.13201/j.issn.1001-1781.2017.17.009.

To investigate the methods of locating facial nerve precisely in middle ear surgery through the observation and measurement of the facial nerve and surrounding anatomical structures and to provide reference for the middle ear surgery.Combined surgical approach on 15 cases (30 sides) fresh adult cadaveric specimens were dissected, observed the characteristics of facial nerve and its shape and spatial relationship of the surrounding structures, and measured the distance between the facial nerve and its surrounding structures.The shortest distance from the midpoint of the posterior wall of external auditory canal (annulus level) to the vertical segment of the facial nerve was (3.37±0.34)mm, the shortest distance from the leading edge of the sigmoid sinus to the vertical segment of facial nerve was (7.40±0.71)mm, the shortest distance from the lateral margin of jugular bulb to the facial nerve was (5.58±0.79)mm, the shortest distance from Henle crest to the pyramidal segment of facial nerve was (12.76±1.24)mm, the shortest distance between the pyramidal segment of facial nerve and the posterior short limb of incus was (1.56±0.35)mm, the shortest distance between the pyramidal segment of facial nerve and the lower edge of posterior semicircular canal was (2.56±0.41) mm, the shortest distance between the lower edge of horizontal semicircular canal and the horizontal segment of facial nerve was (1.28±0.32) mm, the shortest distance between the upper edge of vestibular window and the horizontal segment of facial nerve was (0.67±0.15)mm.A good command of the anatomy of temporal bone as well as the methods of locating facial nerve will provide the key to reduce the probability of iatrogenic facial nerve injury in middle ear surgery.

通过对面神经及其周围解剖结构的观察和测量，探讨中耳手术中精确定位面神经的方法，为中耳手术提供参考。对15例（30侧）新鲜成人尸体标本采用联合手术入路进行解剖，观察面神经的特点及其与周围结构的形态和空间关系，并测量面神经与其周围结构的距离。外耳道后壁中点（鼓环水平）至面神经垂直段的最短距离为（3.37±0.34）mm，乙状窦前缘至面神经垂直段的最短距离为（7.40±0.71）mm，颈静脉球外侧缘至面神经的最短距离为（5.58±0.79）mm，鼓室嵴至面神经锥段的最短距离为（12.76±1.24）mm，面神经锥段与砧骨后短脚之间的最短距离为（1.56±0.35）mm，面神经锥段与后半规管下缘之间的最短距离为（2.56±0.41）mm，水平半规管下缘与面神经水平段之间的最短距离为（1.28±0.32）mm，前庭窗上缘与面神经水平段之间的最短距离为（0.67±0.15）mm。熟练掌握颞骨解剖结构以及面神经定位方法是降低中耳手术中面神经医源性损伤概率的关键。