Wang Xu, Chen Ge, Song Gang, Liang Jiantao, Bao Yuhai, Li Mingchu
Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; International Neuroscience Institute (China-INI), Beijing, China; Samii Clinical Neuroanatomy Research and Education Center of Xuanwu Hospital, Beijing, China.
Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; International Neuroscience Institute (China-INI), Beijing, China; Samii Clinical Neuroanatomy Research and Education Center of Xuanwu Hospital, Beijing, China.
World Neurosurg. 2023 Apr;172:e599-e604. doi: 10.1016/j.wneu.2023.01.095. Epub 2023 Jan 28.
To establish a new method for fast exposure of the facial nerve and hypoglossal nerve during facial nerve anastomosis surgery.
Dissection of 12 formalin-fixed cadaveric specimens was performed to explore the positional relationship between the posterior belly of digastric muscle (PBD) and the facial nerve and hypoglossal nerve. We retrospectively reviewed patients who underwent facial nerve reconstruction surgery between 2015 and 2020 at Xuanwu Hospital, Capital Medical University, and the optimized surgical strategy based on the PBD was proposed.
The trunk of the hypoglossal nerve runs across the external carotid artery after giving off the descendens hypoglossi located within the 1-cm scope deep to the junction of the tendon and belly of the PBD. The mean depth difference between the hypoglossal nerve and the junction of the tendon and belly of the PBD was 5.48 ± 2.24 mm (range, 1.88-9.27 mm). The stylomastoid foramen segment of the facial nerve was revealed after the parotid gland was dissected within the angle between the anterior margin of the mastoid tip and the inferior margin of the cartilage of the external acoustic meatus.
The facial nerve and hypoglossal nerve can be rapidly identified using the PBD as an anatomical landmark. The end-to-end facial-descendens hypoglossi anastomosis is a reliable facial nerve reconstruction method for patients whose facial nerve was damaged during operation.
建立一种在面神经吻合手术中快速暴露面神经和舌下神经的新方法。
对12例福尔马林固定的尸体标本进行解剖，以探究二腹肌后腹（PBD）与面神经和舌下神经之间的位置关系。我们回顾性分析了2015年至2020年在首都医科大学宣武医院接受面神经重建手术的患者，并提出了基于PBD的优化手术策略。
舌下神经干在发出舌下神经降支后穿过颈外动脉，舌下神经降支位于PBD肌腱与肌腹交界处深1 cm范围内。舌下神经与PBD肌腱与肌腹交界处的平均深度差为5.48±2.24 mm（范围为1.88 - 9.27 mm）。在乳突尖前缘与外耳道软骨下缘之间的夹角内解剖腮腺后，可显露面神经的茎乳孔段。
以PBD作为解剖标志可快速识别面神经和舌下神经。面神经-舌下神经降支端端吻合术是一种可靠的面神经重建方法，适用于术中面神经受损的患者。
