面部和颈前部皮神经的Sihler’s染色及意义

The Sihler’s staining of facial and anterior cervical cutaneous nerves and its significance

摘要:

目的： 通过改良的Sihler’s染色法揭示肉眼可见的面部和颈前部皮神经的整体分支分布模式。方法： 经福尔马林固定的12具成年和6具儿童中国人尸体。取下含皮下脂肪的面部和颈前部皮肤标本，行改良的Sihler’s染色。结果： 解剖发现面部皮肤除了接受三叉神经支配外，还广泛接受面神经的分支支配；颈前部皮肤除了受颈前皮神经支配外，还接受来自穿过肌肉后的神经支配。面部和颈前部标本Sihler’s染色后，大体解剖不能展示的皮神经整体分支分布模式肉眼可见。每条皮神经的走行、树枝样的神经分支及分布范围清晰可见。面神经分支与三叉神经分支在额颞交界区、眶下区和颏区等处形成广泛交通。在中线处，左右侧的神经支间存在交通。颈横神经与锁骨上神经分布范围相对较大，两者间也有交通，颈横神经还支配到下唇区。结论： 本研究结果可为颌面外科、整形与美容术免于皮神经损伤，感觉重建的选材匹配，以及局部麻醉阻滞等提供形态学指导。

Abstract:

Objective: To reveal the whole branches and distribution pattern of facial and anterior cervical cutaneous nerves visible to the naked eye via improved Sihler’s staining. Methods: Chinese formalin-fixed cadavers, including 12 adults and 6 children, were used. Skin specimens containing subcutaneous fat were taken from the facial and anterior cervical regions and were stained with modified Sihler’s staining. Results: It was found that the facial skin was not only innervated by trigeminal nerve, but also by branches of facial nerve. The anterior cervical skin was innervated by branches of nerve from muscles besides the anterior cervical cutaneous nerve. After Sihler’s staining of the facial and anterior cervical specimens, the overall distribution pattern of cutaneous nerve branches, which was not able to be shown by gross anatomy, was visible to the naked eye. The passage of each cutaneous nerve, arborized branches and distribution range were clearly visible. In frontotemporal junction area, infraorbital area and mental area, close link between facial nerve branches and trigeminal nerve was obvious. At the midline, there existed links between left and right nerve branches. The distribution range of transverse cervical nerve and supraclavicular nerve was relatively large, and both of them were linked. The transverse cervical nerve was able to innervate the lower lip area. Conclusion: These results can provide morphological guidance for maxillofacial surgery, plastic surgery and cosmetic surgery to avoid cutaneous nerve injury, for material selection and matching of sensory reconstruction, and local anesthesia blocking.