頜面部神經(jīng)之面神經(jīng),(第七版),第七章口腔頜面頸部神經(jīng),頜面部神經(jīng)之面神經(jīng),面神經(jīng),FacialNerve,頜面部神經(jīng)之面神經(jīng),facialnerveparalysis,頜面部神經(jīng)之面神經(jīng),主要內(nèi)容：一、概述二、面神經(jīng)行程及其分支三、面神經(jīng)解剖特點的臨床意義,問題1：面神經(jīng)損傷為什么會出現(xiàn)這些臨床癥狀？,頜面部神經(jīng)之面神經(jīng),一概述,面神經(jīng)(facialnerve)屬十二對腦神經(jīng)中的第七對。,頜面部神經(jīng)之面神經(jīng),為混合性神經(jīng)，含四種神經(jīng)纖維運動纖維支配面部表情肌、頸闊肌、鐙骨肌、二腹肌后腹、莖突舌骨肌副交感（分泌）纖維支配淚腺、腭腺、舌下腺、下頜下腺的分泌味覺纖維經(jīng)鼓索加入舌神經(jīng)，司舌前2/3的味覺。感覺纖維支配外耳道及小部分耳后皮膚感覺,頜面部神經(jīng)之面神經(jīng),面神經(jīng)的纖維成分示意圖,運動纖維,副交感纖維,味覺纖維,頜面部神經(jīng)之面神經(jīng),面神經(jīng)行程及分段示意圖,管段：莖乳孔以上,顱外段：莖乳孔以外,頜面部神經(jīng)之面神經(jīng),（一）面神經(jīng)管段,面神經(jīng)管段,頜面部神經(jīng)之面神經(jīng),面神經(jīng)管段的分支,（一）巖大神經(jīng)(greaterpetrosalnerve)布于淚腺、鼻和腭黏膜的腺體（二）鐙骨肌神經(jīng)(stapedialnerve)在鼓室后壁處發(fā)出至鐙骨肌（三）鼓索(chordatympani)穿巖鼓裂至顳下窩并入舌神經(jīng),鼓索,鐙骨肌神經(jīng),巖大神經(jīng),頜面部神經(jīng)之面神經(jīng),(二)面神經(jīng)顱外段,面神經(jīng)顱外段,頜面部神經(jīng)之面神經(jīng),1面神經(jīng)主干,面神經(jīng)主干,莖乳孔至面神經(jīng)分叉處的一段經(jīng)外耳道軟骨與二腹肌后腹間越過莖突根部的淺面進入腮腺新生兒及兒童乳突尚未發(fā)育完全面神經(jīng)位置表淺，手術(shù)時易受傷,頜面部神經(jīng)之面神經(jīng),2面神經(jīng)腮腺前的分支,（1）耳后神經(jīng)耳支支配耳后肌，枕支支配枕肌（2）二腹肌支支配二腹肌后腹（3）莖突舌骨肌支常與二腹肌支共干發(fā)出,耳后神經(jīng),二腹肌支,莖突舌骨肌支,頜面部神經(jīng)之面神經(jīng),3面神經(jīng)腮腺內(nèi)分支,于腮腺深淺兩葉間行至頸外動脈外側(cè)于下頜支后方分為顳面干和頸面干兩大分支,顳面干,頸面干,頜面部神經(jīng)之面神經(jīng),面神經(jīng)顱外段分支與腮腺關(guān)系示意圖,顳面干,頸面干,temporalbranches,zygomaticbranches,buccalbranches,marginalmandibularbranches,cervicalbranches,頜面部神經(jīng)之面神經(jīng),面神經(jīng)顱外段及其分支,顳支,顴支,頰支,下頜緣支,頸支,額紋消失眼瞼閉合不全鼻唇溝變淺鼓腮無力食物存留于頰部口角下垂歪斜,頜面部神經(jīng)之面神經(jīng),三、面神經(jīng)解剖特點的臨床意義：1.如何進行面神經(jīng)損傷的定位？2.頜面部的手術(shù)中如何避免損傷面神經(jīng)分支？,頜面部神經(jīng)之面神經(jīng),面神經(jīng)損傷的定位示意圖,鼓索以下受損：同側(cè)面肌麻痹,管段或面神經(jīng)核受損：同側(cè)面肌麻痹+舌前2/3味覺喪失+唾液分泌障礙+聽覺改變+淚腺分泌障礙,頜面部神經(jīng)之面神經(jīng),周圍性面神經(jīng)麻痹的定位診斷癥狀及體征面神經(jīng)損傷部位單純面癱鼓索以下，莖乳孔以外（面神經(jīng)顱外分支受損）面癱味覺喪失唾液分泌障礙鼓索與鐙骨肌神經(jīng)之間（鼓索受損）面癱味覺喪失唾液分泌障礙聽覺改變鐙骨肌神經(jīng)與膝狀神經(jīng)節(jié)之間（鐙骨肌神經(jīng)受損）面癱味覺喪失唾液淚腺分泌障礙聽覺改變膝狀神經(jīng)節(jié)與腦橋之間（巖大神經(jīng)受損）,面神經(jīng)解剖特點的臨床意義,頜面部神經(jīng)之面神經(jīng),面神經(jīng)應(yīng)用解剖(application),面神經(jīng)的保護切口選擇頜面部尋找面神經(jīng)的標(biāo)志,頜面部神經(jīng)之面神經(jīng),手術(shù)切口,頜面部神經(jīng)之面神經(jīng),頜面部神經(jīng)之面神經(jīng),vs,centralfacialparalysis,peripher