Kriengkraikasem Krist, Kowitwibool Kritsada, Chanpoo Malee
Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Department of Anatomy, Phramongkutklao College of Medicine, Royal Thai Army, Bangkok, Thailand.
Plast Reconstr Surg Glob Open. 2018 Dec 17;6(12):e2000. doi: 10.1097/GOX.0000000000002000. eCollection 2018 Dec.
This study aimed to reveal the anatomical variation in the great auricular nerve (GAN) and the correlation between the size of the GAN and the facial nerve trunk (FNT), so as to aid surgeons to perform safe facelift surgery and parotidectomy.
Sixteen human cadavers were studied on 16 left and 15 right facial sides. The GAN's branching patterns, location, and the mean width of the GAN and FNT were measured.
The average distance where the nerve emerged from under the sternocleidomastoid muscle was 87.61 ± 12.13 mm when measured perpendicular to the Frankfort horizontal plane. The branching pattern of the GAN could be classified into 5 types of which the most common was type 3 (30.77%), where the GAN divided into the anterior (superficial) and posterior branches, and then the deep branch originated from the posterior branch of the GAN. The mean width of the GAN and FNT from all the dissections was 3.26 ± 0.67 mm and 3.36 ± 0.71 mm, respectively. There was a significant correlation between the width of the nerves on both facial sides (right: r =0.740, =0.002; left: r = 0.839, < 0.001).
This study revealed the anatomical variation and the width of the GAN, which can strongly predict the width of the FNT. This should be taken into consideration during facelift surgery and parotidectomy, especially in patients with a small GAN to prevent iatrogenic injury to the small FNT.
本研究旨在揭示耳大神经（GAN）的解剖变异以及GAN大小与面神经干（FNT）之间的相关性，以帮助外科医生进行安全的面部提升手术和腮腺切除术。
对16具人类尸体的16个左侧面部和15个右侧面部进行研究。测量了GAN的分支模式、位置以及GAN和FNT的平均宽度。
当垂直于法兰克福水平面测量时，神经从胸锁乳突肌下方穿出的平均距离为87.61±12.13mm。GAN的分支模式可分为5种类型，其中最常见的是3型（30.77%），即GAN分为前（浅）支和后支，然后深支起源于GAN的后支。所有解剖中GAN和FNT的平均宽度分别为3.26±0.67mm和3.36±0.71mm。两侧面部神经宽度之间存在显著相关性（右侧：r = 0.740，P = 0.002；左侧：r = 0.839，P < 0.001）。
本研究揭示了GAN的解剖变异和宽度，其可有力预测FNT的宽度。在面部提升手术和腮腺切除术中应考虑到这一点，尤其是对于GAN较小的患者，以防止医源性损伤细小的FNT。
