Salas E, Ziyal I M, Bejjani G K, Sekhar L N
Department of Neurological Surgery, The George Washington University Medical Center, Washington, District of Columbia 20037, USA.
Neurosurgery. 1998 Sep;43(3):563-8; discussion 568-9. doi: 10.1097/00006123-199809000-00089.
Many studies have been conducted of the surgical anatomy of the frontotemporal branch of the facial nerve (FTBFN). However, very few have addressed the indications for interfascial dissection. When the zygomatic arch needs to be exposed, the interfascial approach is recommended to protect the FTBFN. With the transbasal or subfrontal approaches, however, when a bicoronal skin incision is used, the need for the interfascial approach is not clear.
We studied 10 temporal regions (5 cadaveric heads). We dissected the recognized fascial layers of the temporal region and the FTBFN. We performed a histological study in a sixth specimen.
We observed the following. 1) The galea and the superficial layer of the deep temporal fascia become fused in a curved line from the lateral orbital border 2.8 cm above the zygomatic arch to a point 3 cm posterior to the inferolateral angle of the orbit. 2) After this transitional area of adherence, the subgaleal loose cellular layer is lost and is replaced by a fibrofatty tissue. 3) The FTBFN in its course above the zygomatic arch runs in this tissue layer without being protected by the galea. 4) Over the superolateral angle of the orbital rim, the galea protects FTBFN, and there are no subgaleal adhesions in that area.
Ahove the zygomatic arch, the FTBFN is not protected by the galea. During bicoronal approaches, if only the superolateral angle of the orbital rim needs to be exposed and not the zygomatic arch, there is no need to protect the FTBFN using an interfascial approach.
关于面神经颞支（FTBFN）的手术解剖已经进行了许多研究。然而，很少有研究涉及筋膜间分离的适应证。当需要暴露颧弓时，建议采用筋膜间入路以保护FTBFN。然而，采用经基底或额下入路且使用双冠状皮肤切口时，是否需要筋膜间入路尚不清楚。
我们研究了10个颞区（5个尸体头部）。我们解剖了颞区公认的筋膜层和FTBFN。我们在第6个标本上进行了组织学研究。
我们观察到以下情况。1）帽状腱膜和颞深筋膜浅层在从颧弓上方2.8 cm处的眶外侧缘至眶下外侧角后方3 cm处的一点的曲线上融合。2）在这个粘连过渡区之后，帽状腱膜下疏松细胞层消失，取而代之的是纤维脂肪组织。3）FTBFN在颧弓上方走行于该组织层中，未受到帽状腱膜的保护。4）在眶缘的外上角上方，帽状腱膜保护FTBFN，该区域无帽状腱膜下粘连。
在颧弓上方，FTBFN不受帽状腱膜保护。在双冠状入路过程中，如果仅需暴露眶缘的外上角而不是颧弓，则无需采用筋膜间入路保护FTBFN。
