保护性解剖面神经下颌缘支在颌下入路手术中的积极作用.doc

保护性解剖面神经下颌缘支在颌下入路手术中的积极作用 彭德华，高老庄，干露露，陈一 （河南宏力医院口腔颌面外科，河南 新乡 453400） [摘要]目的：探讨面神经下颌缘支在颌下入路手术中的显露方式，为临床提供安全、可靠、有效的预防面神经功能障碍的手术入路。方法：选择下颌骨及颌下区疾病患者45例，其中下颌骨疾病27例，颌下区者18例，种类涵盖创伤、肿瘤、囊肿、感染等疾病，均采用保护性解剖下颌缘支的颌下入路。结果：所有纳入病例中，仅2例结核性淋巴结炎患者发生轻度的下颌缘支功能障碍，并于3月内恢复。结论：保护性解剖面神经下颌缘支的颌下入路可有效避免神经功能损伤，尤其适用于低位髁状突、下颌升支、下颌角及下颌体后部疾病，在单纯颌下腺切除手术中，与传统显露方式相比，优越性不明显。熟练的局部解剖基础和规范的手术操作可减少下颌缘支损伤的发生。 关键词：颌下入路；下颌骨；面神经；保护性解剖 The positive effects of protectively dissecting the marginal mandibular branch in submandibular operation approach PENG Bu-qiang GAO Zhen-jie SHEN Lu-lu CHEN Xian-li (Department of Oral and Maxillofacial Surgery, the Honliv Hospital of Henan ,Xinxiang 453400,Henan Province,China) [Abstract]Objective: To discuss the way of exposing marginal mandibular branch in operations via submandibular approach，and to supply a safetyreliable and effective ideal and method for clinical operations. Methods: 45 patients with mandibular (27 cases)or submandibular area diseases (18 cases)which contain traumatic 、neoplastic、cystic and infectious diseases were choosed,whose operations were all carried out via submandibular approach with protectively dissecting the marginal mandibular branch.Results: Only two patients with tuberculous lymphnoditis was found the marginal mandibular branch was injured during the operation and with a mild functional disorder,which finally recovered in 3 months .Conclusion: Protectively dissecting the marginal mandibular branch in submandibular approach can effectively prevent facial nerve injuries,especially for operations at the subcondylar、ramus、angle and body of the mandible.However, compared with the traditional methods,the superiority is unconspicuous during the simple resection of the sunmandibular gland.Both good knowledge of topographic anatomy and standard procedure play a important role in preventing the injury of the marginal mandibular branch . [Keyword]submandibular approach;mandible;facial nerve;protective dissection 面神经下颌缘支（以下简称为下颌缘支）的走行有许多变异[1]，口腔颌面-头颈外科经