| Part one: The distribution of facial nerve in the orbicularis muscle region and the control mode of the orbicularis muscleObjective: Using modern science and technology of adult facial eye round dissect and observe the peripheral nerve trying to study all parts of the orbicularis oculi muscle at the mercy of the way,providing anatomical basis for subsequent nerve blocking the way.Materials and Methods: The average age of 10 adult cadavers with a 10%concentration of formaldehyde solution were analyzed,with an average age of(35.46±11.35)years.The modified Sihler’s staining technique and macroscopic microanatomy were used to observe the lateral orbital nerve of the body.The specific observation indicators were: facial nerve staining specimen analysis,the distribution of zygomatic branches,the distribution of the zygomatic branches,the walking and the dominant facial muscles,the recording of the camera with the camera;According to the relevant data,the dominant mode of the peripheral nerves of the orbicularis orbicularis was summarized.Results: The lateral nerve direction and distribution of the orbital region: all the branches of the facial nerve are located at the deep surface of the aponeurotic system,with an average of 2~4 temporal nerve branches passing through the zygomatic arch.There are 3 medial branches,1~2 middle branches and 2 lateral branches;Most branches enter into the deep part of the orbicularis oculi muscle,which is the lateral entry of the orbicularis muscle,which governs the normal contractile movement of the main lateral lower part.The average distance between the anterior branch and the ear root was(19.88 ± 2.09)millimeter,and the mean distance from the posterior branch was(10.83 ± 1.77)mm.The orbicularis oculi muscle is divided into two parts: one is the part near the eye socket,which is called the orbital part.The orbital distribution is mainly voluntary muscle,which coordinates the closing and opening of the eyes.The second is the part near the eyelid,called the eyelid,which is mainly distributed as involuntary muscle,mainly controlling the slight closed state of the eyes.The musclefibers on the outside of the orbicularis oculi muscle intersect.The nerve branches of the orbicularis oculi.When the branches of the zygomaticus and the temporal branches enter the orbicularis oculi muscle,they show a smaller branch,and control the peripheral of the orbicularis muscle and the orbicularis oculi muscle.The lowest point of the insertion point is point A(26.50 ± 2.45,-31.33 ± 4.80)mm,and the Angle of the horizontal direction is about 55 degrees.Along the way there are multiple nerves that govern the corresponding muscles of the present.Before the temporal branch from the trunk at that level for(27.66 ± 3.45)mm,outside the horizontal line,temporal before entering the orbicularis oculi muscle’s highest point coordinates of point B(19.88 ± 2.00,2.00 ± 1.88)mm,and the horizontal Angle approximately 40 to.The shortest distance linear r =(20.89 ± 2.88)mm,which its internal appear a certain degree of nerve injuries,will not lead to orbital upper facial nerve damage,the patients won’t appear the phenomenon of facial paralysis;Conclusions: The research and analysis of the orbital facial nerve can understand the direction and distribution of facial nerve more accurately,and it is of great value for the application of high selective nerve blocking in the later stage.Part two: The rationality,effectiveness,operability,safety and long-term effect of high selective nerve dissection and wrinkle removal in the outer orbital area.Objective: Using selective nerve blocking technology to cases of patients with lower eyelid skin sagging for orbit lateral crow ’s-feet removal surgery,in order to observe the rationality of the selective nerve block technique,effectiveness,operability,security and long-term effect.Materials and methods: A total of 15 cases with high selective nerve block removal in our hospital were selected.To surgery,preoperative and postoperative cases research,in the orbitofrontal area using selective nerve block processing performance crow’s feet,the temporal branch of the area outside and the orbicularis oculi muscle to controls,zygomatic branch of subprime selectively blocking nerve;Specific examination index for: patients with preoperative use camera to photograph temporalcrow’s feet,including side,a positive,left oblique side,right side,the quiet condition and the condition of the smile,respectively,pen to mark crow’s feet.The patient was photographed at the same level after the operation.All patients were followed up for 12 months to observe the duration of the operation,postoperative complications,short-term and long-term wrinkle effects,and patient satisfaction.At the same time,the degree of wrinkles in the outer orbital area of the patient was evaluated every three months after the operation,and the effect was observed.Results: Nerve block postoperative effect analysis: preoperative patients recovering well within six months,also with good recovery after 12 months,patients with nerve any is zero,and local depression in patients with the number zero.Statistical analysis of postoperative complications: there were no similar symptoms in patients with nerve injury,skin necrosis,partial depression and bilateral asymmetric projects,and the overall condition was good.The patients with hematoma appeared on 3 sides,a total of 2 patients,after the effective disinfection treatment,the patient’s symptoms disappeared,P=0.108,the difference was not statistically significant.At the same time,there were 7 patients with mild skin infection,5 patients in total.After disinfection treatment,the patient’s condition was significantly improved,P=0.677,and the difference was not statistically significant.Postoperative fish tail score analysis: in the 0subregion,the number of patients in the postoperative period reached 18,P=0.560,the difference was not statistically significant.In the 1 subregion,the number of of patients was 9,P=0.488,the difference was not statistically significant.In the 2 subregion,the study indicated that the number of patients in the 12 months after surgery was less,only3,P=0.566,and the difference was not statistically significant.In the 3 subregion,the number of patients was 0.Patient satisfaction analysis: the majority of patients showed a satisfactory attitude and the prognosis of the operation was good.66.67% of the patients showed a very satisfactory attitude,P=0.045,and the difference was statistically significant.13.33% of patients showed a satisfactory attitude,P=0.905,and the difference was not statistically significant.Twenty percent of the patients showed a satisfactory attitude,and the difference was not statistically significant.Conclusions: The high selective nerve block was selected to remove the crow’s feet,and the overall wrinkle effect was good.The patients had less bleeding after operation and the complications.All patients were followed up for 1 year with good wrinkling effect and no recurrence.The whole process is simple and effective,and the patient’s satisfaction is high,which is worthy of further recommendation in clinical practice. |
