摘要
目的阐明人咬肌神经来源及进入咬肌前后分支走行的分布情况，为治疗咬肌肥厚提供解剖学和形态学的理论基础。方法对人咬肌区进行大体解剖，逆行探查并阐明咬肌神经的来源及走行情况；对咬肌进行精细解剖和Sihler’s染色，并对整个实验过程进行文字和图像记录。结果（1）咬肌神经在下颌切迹区域恒定出现，距离下颌骨下颌支后缘的距离为（23．5±3．5）mm；距离下颌切迹最低点所在直线的距离为（11．5±4．6）mm。（2）咬肌分为浅、中、深3层，咬肌神经走行于深层和中层咬肌之间，以中层咬肌前缘为界，咬肌神经主干发出的神经分支分为后上组、后下组、前上组和前下组，共4组。后上组和前上组主要支配深层咬肌；后下组支配中层咬肌、浅层咬肌后部；前下组支配浅层咬肌前中部。（3）在整块咬肌中，咬肌神经分布最密集的区域为下半咬肌正中1／3部分，整块咬肌最厚区域亦位于下半咬肌正中1／3区域，该区域主要为浅层咬肌。结论（1）人咬肌神经在下颌切迹稳定存在。（2）A型肉毒毒素注射咬肌减容治疗，安全有效地注射部位为下半咬肌的正中1／3区域。
Objective To clarify the masseteric neural source, its branch running before and after entering the masseter muscle, thus providing anatomical and morphological theory foundation for the therapy of masseter hypertrophy. Methods Gross macroscopic dissection was performed on the masseteric region to find the point where the nerve enters masseter muscle, then a retrograde probe was made to illuminate the source of masseterie nerve. The inside of each masseter muscle was explored and every masseter muscle was stained by Sihler＇s staining to elucidate the precise course of masseteric nerve. Photographic and written records were made along the whole experiment. Results Masseterie nerve located anteriorly and inferiody to masseteric nerve at mandibular norch. The trunk of masseter verve was found （23.5 ± 3.5） mm horizonlally from the posterior border of wandibular ramus and （ 11.5 ±4.6） mm above mandibular north. Masseter muscle could be divided into the deep, middle and superficial layers, and masseterie nerve descended between the middle and deep layer. If the anterior margin of the middle layer of the muscle was taken as reference, the masseteric nerve divides into four groups of nerve branches, consisting of posterosuperior, posteroinferior, anterosuperior, and anteroinferior. The nerve branches originated from postosuperior and anterosuperior groups innervated the deep layer, and branches from postoinferior supplied the middle layer, and the posterior part of superficial layer of the muscle, and the nerve branches from anteroinferior innervated the anterior and middle parts of superficial layer of masseter muscle. The richest arborization of masseteric nerve branches was the middle 1/3 part of lower masseter muscle, where also were the thickest zone of the whole muscle, and most tissue of this zone was superficial layer of masseter muscle. Conclusion It is at the mandibular notch that the existence of massetefie nerve is constant. The most safe and effective site of betulihum （BTX） injection is the middle 1/3 part of lower masseter muscle.
出处
《中国美容整形外科杂志》
CAS
2015年第12期750-754,共5页
Chinese Journal of Aesthetic and Plastic Surgery
关键词
咬肌肥厚
咬肌神经
解剖
Masseter hypertrophy
Masseterie nerve
Anatomy
