目的:咬肌神经在面瘫康复手术中的应用。这项研究的目的是确定咬肌神经的形貌,并推断和预测精确且可重复的解剖簇,以促进其在V-VII神经化手术中的临床鉴定。
方法:出于这项工作的目的,对31个半面进行了尸体研究。所有解剖都是双侧和比较的,以下旨在模拟的步骤,尽可能接近,通过V-VII吻合术进行面部麻痹康复的临床状况。
结果:关于咬肌神经的鉴定,使用骨骼参考点,即,颞下颌关节(TMJ)和下巴点(CT)。在TMJ和CT之间绘制了虚拟轴,然后将确定最小长度h的距离[TMJ-MN]与确定最大长度H的距离[TMJ-CT]作图,因此允许计算h/H比例比(PR),该比例表示来自TMJ的咬肌神经的近端部分。TMJ和NM之间的平均长度h为TMJ的3.5厘米(±0.1厘米),即,h/h[TMJ-MN]/[TMJ-CT]的平均比值为28.1%4.0,距离[TMJ-CT]的中值比值为28.6%。
结论:我们的研究为促进其识别和使用开辟了新的视角,为从业者提供了一种工具,使V-VII神经化程序不那么复杂,随着结合成像的微创手术的最终前景,手术,和增强现实。
OBJECTIVE: The use of the masseteric nerve develops in the surgery of facial paralysis rehabilitation. The objective of this study was to determine the topography of the masseteric nerve and to deduce and predict a precise and reproducible anatomical cluster to facilitate its clinical identification during V-VII neurotization surgery.
METHODS: For the purpose of this work, a cadaveric study was performed on 31 hemi-faces. All dissections were performed bilaterally and comparatively, following steps aiming at simulating, as close as possible, the clinical conditions of a facial palsy rehabilitation by V-VII anastomosis.
RESULTS: For the identification of the masseteric nerve, bony reference points were used, i.e., the temporomandibular joint (TMJ) and the chin point (CT). A virtual axis was drawn between the TMJ and the CT, and the distance [TMJ-MN] determining the smallest length h was then plotted against the distance [TMJ-CT] determining the largest length H, thus allowing the calculation of an h/H proportion ratio (PR) indicating the proximal part of the masseteric nerve from the TMJ. The average length h between the TMJ and the NM was 3.5 cm (± 0.1 cm) from the TMJ, i.e., an average ratio h/H [TMJ-MN]/[TMJ-CT] of 28.1% 4.0 and a median ratio of 28.6% of the distance [TMJ-CT].
CONCLUSIONS: Our study opens new perspectives for facilitating its identification and use, offering practitioners a tool to make V-VII the neurotization procedure less complex, with the eventual prospect of a minimally invasive procedure combining imaging, surgery, and augmented reality.