Jirawatnotai Supasid, Kaewpichai Kitipong, Tirakotai Wuttipong, Mothong Wilaiwan, Kaewsema Atitaya, Sriswadpong Papat
Department of Surgery, Plastic and Reconstructive Surgery Unit, Lerdsin Hospital, Bangkok, Thailand.
Department of Neurosurgery, Prasat Neurological Institute, Bangkok, Thailand.
Asian J Neurosurg. 2020 Aug 28;15(3):516-520. doi: 10.4103/ajns.AJNS_90_20. eCollection 2020 Jul-Sep.
In facial reanimation surgery, higher donor facial nerve axonal load yields a superior outcome. Nerves supplying the zygomaticus major muscle are primary donors for the grafting procedure; however, their topography has not been studied in detail. This study identified potential donor nerves by quantifying axon loads of the zygomaticus major muscle through histological analysis of cadaveric specimens.
Forty-three hemifaces from 26 fresh human cadavers were studied. Branching patterns of nerves were classified according to their shapes. All branches of interest were sectioned and stained for an axon count. The potential donors were mapped into each tributary of nerves supplying the zygomaticus major.
Branching patterns were categorized into five types: Y-type (28%), X-type (28%), H-type (19%), E-type (14%), and F-type (11%). The mean number of axons in the most superiorly and proximally located main branches was 1387.33 ± 406.59 in Y-type, 1021.42 ± 187.79 in X-type, 1222.75 ± 193.82 in H-type, 1496.17 ± 364.567 in E-type, and 1353.40 ± 256.07 in F-type ( > 0.05). A topographic relation between facial nerves supplying the zygomaticus major muscle and their mean axonal load was illustrated. The zygomatic/buccal branches were found within 5 mm from Zuker's point in 100% of X-, Y-, H-, and E-type and 75% of F-type specimens.
Most proximal facial nerve branches supplying the zygomaticus major, arising at the anterior border of a parotid gland, contained over 900 axons in all five branching types. The primary subbranches may be used in selected cases if donor weakness is a concern. Further, our study provides evidence that demonstrates the precision of Zuker's point.
在面部重建手术中，更高的供体面神经轴突负荷会产生更好的效果。支配颧大肌的神经是移植手术的主要供体；然而，它们的解剖结构尚未得到详细研究。本研究通过对尸体标本进行组织学分析，量化颧大肌的轴突负荷，从而确定潜在的供体神经。
研究了来自26具新鲜人类尸体的43个半侧面部。根据神经的形状对神经分支模式进行分类。对所有感兴趣的分支进行切片并染色以进行轴突计数。将潜在的供体映射到支配颧大肌的每条神经分支中。
分支模式分为五种类型：Y型（28%）、X型（28%）、H型（19%）、E型（14%）和F型（11%）。Y型中最上方和最近端主分支的平均轴突数量为1387.33±406.59，X型为1021.42±187.79，H型为1222.75±193.82，E型为1496.17±364.567，F型为1353.40±256.07（P>0.05）。阐述了支配颧大肌的面神经与其平均轴突负荷之间的解剖关系。在100%的X型、Y型、H型和E型以及75%的F型标本中，颧/颊支位于距祖克点5毫米范围内。
支配颧大肌的大多数最近端面神经分支起源于腮腺前缘，在所有五种分支类型中均含有超过900条轴突。如果担心供体肌无力，在某些情况下可以使用主要分支。此外，我们的研究提供了证据，证明了祖克点的精确性。
