Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Poland.
Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA; Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA; Department of Anatomical Sciences, St. George's University, Grenada.
Ann Anat. 2020 Jul;230:151522. doi: 10.1016/j.aanat.2020.151522. Epub 2020 Apr 25.
The location and anatomical relationships of the superior oblique muscle make surgical intervention difficult. The aim of the present paper was therefore to supplement existing anatomical descriptions of this muscle. Its anatomical variability is particularly emphasized, including variations in muscle and tendon size and details of the innervation pattern.
The study was conducted on 78 orbits from 39 adult human cadavers of both sexes (18 males and 21 females). The roof and upper part of the medial and lateral walls of the orbit were carefully removed, which allowed the superior oblique muscle and trochlear nerve to be exposed along their entire course. Sihler's stain was applied to visualize the intramuscular distribution of the trochlear nerve.
The length of the muscle between the origin and trochlea ranged from 37.8 to 56.5mm, the length of the tendinous expansion ranged from 16.3 to 22.8mm, and the width of the scleral insertion of the muscle's tendon ranged from 5.4 to 9.6mm. In two cadavers, accessory muscular slips connecting the levator palpebrae superioris muscle to the trochlea of the superior oblique muscle were present unilaterally. The distance from the level of the trochlea attachment to the anteriormost endings of the intramuscular branches varied from 17.2 to 21.5mm.
The intramuscular nervous branches of the trochlear nerve form a tree-like pattern. Unexpected anatomical variations such as accessory muscular bands could be relevant during orbital imaging or surgeries.
上斜肌的位置和解剖关系使得手术干预变得困难。因此，本研究旨在补充该肌肉的现有解剖描述。特别强调了其解剖结构的变异性，包括肌肉和肌腱大小的变化以及神经支配模式的细节。
本研究对 39 具成人尸体（18 名男性和 21 名女性）的 78 个眼眶进行了研究。仔细去除眶的顶壁和内、外侧壁的上部，使上斜肌和滑车神经能够沿着其整个行程暴露出来。应用 Sihler 染色来显示滑车神经在肌肉内的分布。
肌肉起点和滑车之间的长度范围为 37.8 至 56.5mm，肌腱扩张的长度范围为 16.3 至 22.8mm，肌肉肌腱的巩膜插入宽度范围为 5.4 至 9.6mm。在 2 具尸体中，单侧存在连接上直肌和上斜肌滑车的附加肌束。从滑车附着处到肌内分支的最前端的距离范围为 17.2 至 21.5mm。
滑车神经的肌内神经分支呈树状模式。在眼眶成像或手术中，可能会遇到诸如附加肌束等意外的解剖变异。
