下颌角肥大整形术临床解剖学研究
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摘要
目的 探讨咬肌、翼内肌形态在下颌角肥大形成过程中的作用；
下颌角角度、骨质厚度、下颌支高度、宽度，下颌角间宽、下颌角外翻
角度之间的相关关系；确定下颌角肥大截骨术的安全范围；对下颌角肥
大的截骨方式进行改进；对下颌角肥大整形术口内口外入路利用解剖学
进行比较；为下颌角肥大整形术提供临床解剖学基础。
材料和方法
1、对20例湿性成人离体下颌骨进行定点测量，测量下颌角间宽，
分左右侧测量下颌角角度、下颌支高、下颌角间宽、下颌角外翻角度，
并对其间的关系进行相关统计分析。对下颌孔（管）到下颌支后缘、下颌
体下缘、下颌角点的最小距离进行测量。
2、利用CT测量下颌角间宽、下颌角角度、咬肌及翼内肌厚度、
宽度，并探讨以上各因素之间的相关关系；并对临床表现明显的下面部
过宽者（肥大组）与正常人（正常组）各5例分两组对以上指标及咬肌
与翼内肌横截面积之比进行分组t检验。
3、对4例新鲜和8例固定头颅标本正中矢状切开（24例）逐层解
剖，定点测量及观察。
结果
1、下颌角角度、下颌支高度、宽度、下颌角外翻角度、下颌角厚
度数据左右侧无明显差异；以左侧为例下颌角角度、下颌支高度、宽度、
下颌角外翻角度、下颔角厚度、下颌角间宽数值为（X±S）119±6.83
”、67．刀士4．20mm、35．30士2．27 mm、18．70土 10．57”、5．77士 1．23 mm、
104．sl士 5．16 mm：下颌角间宽与下颌角外翻角度呈显著相关
（，0．875，poo刀00）；下颌支宽与下颌角角度呈显著负相关
（F－0石N尸—0．004）；下 颌孔距 下 颌 支后 缘 门．74 士
2．07（10．00·18．64）mm；B下颌缘28．02土4．85（9．38－37．46）mm：8下颔
角点19．83土3．54（14．0029．12）mm。下颌角截骨的安全范围是距下颌支
后缘 10mm，距下颌体下缘 gmm，距下颁角点 14mm的形区域内。
2、咬肌厚度与下颌角间宽、下颌角角度呈显著相关关系（poo刀00、
0刀of）。翼内肌厚度与下颌角间宽、下颌角角度无相关关系（P＝0．15、
0石8人肥大、正常两组下颌角角度、下颔角间宽、咬肌厚度存在显著
差异卜0．000、0．001、0．002），翼内肌厚度无显著性差异（P＝0，449）。咬
肌与翼内肌横截面积之比存在显著性差异（P—0刀of）。
3、腮腺咬肌筋膜表面，咬肌在颧弓附着点前端至下颌角方向，面
横动脉、腮腺导管、面神经上颊支、下颊支与下颌角的距离（mm）分
别是 72土 3、62上 2、54 t 2、16土 2。咬肌大体分两层，主要营养血管
在浅层，手术可以去除深层的咬肌而避免重要血管神经损伤。
结论
正常下颅角有一定的外翻角度，是决定下领角间宽的主要原因：咬
肌的相对翼内肌过度发育是形成下颌角肥大的最主要因素。下颔角肥大
整形术应充分考虑这一因素，术中去除部分内层咬肌。口内入路下颌角
肥大整形术较口外入路安全、科学。下颌角肥大截骨术应分别针对下颌
角外翻、下颔角度过小及下颌支过高设计截骨方案。
Purpose The purpose of this study was to determine the reasons of
the prominence of mandibular angle and the relationship between the
gonion degree \the height and breadth of the mandibular ramus \ bigonial
breadth and the eversion degree of gonion;and provide a morphological and
anatomic basis for correcting the prominence of mandibular angle.
Methods
1.20 adult fresh skulls was performed. The bigonial breadth \the
degree of the gonion angle and the height and breadth of the mandible
ramus \thinkness of the gonion\ the dietance between mandibular foramen
and the posterior\inferior edge of mandibule and gonion were obtained .The
descriptives data were analysised by software SPSS 10.0.
2. In axial computed tomography, it is possible to measure the
thickness\breadth of the masseter and the medial ptergoid in the transection
and the mandibular angle,the bigonial breadth in the anter-poster
X-Ray .The date were initial analysed using a simple correlation and
indpendent samples T-test.
3. The observation and measurement of the relationahip between the
gonion and the artery \the branches of the facial nerve\the partotid
duct;the morphology and artery of the masseter muscle were done oii 12
cadaver heads(24 lateral)
Result
1 .The descriptives data of the mandibular angle \the height and breadth
of the ramus \ bigonial breadth and the eversion degree of gonion\the
thickness of gonion was 119?.830 、 67.71?.20mm、 35.30?.27 mm
104.51 ?.16mm、 18.70?10.57、 5.77?1.23 mm; The bigonial breadth
was significantly related with the degree of the gonial eversion angle
(r=0.875,P=0.000)and the height of mandibular ramus
(r=0.741,P=0.000);The height mandibular ramus was significantly related
with both the bigonial breadth and the gonial eversion angle;the ramus
breadth was significantly negitive related with the cent of gonion
(r=-0.6 1 4,P=0.004).
2.The bigonial breadth and gonial eversion angle was significantly
related with the thickness of masseter muscle(P=0.000),otherwise the
thickness of the medial ptergoid was on the contary(P=0.65\0.15).There was
significant differences between the group of prominent and the normal in
the gonial angle (P=0.000)\ the bigonial breadth (P=0.001) and thickness of
masseter muscle(P=0.002).But there was no difference in the thickness of
the medial pterygoid muscle(P=0.449).
3. On the line between the gonion and the attachment of masserter
muscle at the point of anterior-zygomatic arch ,the distence(mm)between
the transversa facil artery parotid duct .. facial nerve zygomatic
branches\buccal branches and the gonion was 72、 62、2、 54 ?2、16
?2mm.The masseter muscle was inserted into the deep and superficial
fibres.The central nutritious artery laid in the super-fibers.Tlie deeper fibers
could be moved during operation to avoid damnify of the main artery and
nerve.
Conclusion The thickness of the master muscle was a important
factor that affected the lower facial morphology.The hyperplasia of
masserter muscle caused the mandibular angle enlarged. The operation of
correcting enlarged mandibular angle by an ititraoral approach was a
security and feasible method. When ostectomy for reducing the withed of
the lower face was to do ,the changes above mentioned should be
considered respectively.
下颌角角度、骨质厚度、下颌支高度、宽度，下颌角间宽、下颌角外翻
角度之间的相关关系；确定下颌角肥大截骨术的安全范围；对下颌角肥
大的截骨方式进行改进；对下颌角肥大整形术口内口外入路利用解剖学
进行比较；为下颌角肥大整形术提供临床解剖学基础。
材料和方法
1、对20例湿性成人离体下颌骨进行定点测量，测量下颌角间宽，
分左右侧测量下颌角角度、下颌支高、下颌角间宽、下颌角外翻角度，
并对其间的关系进行相关统计分析。对下颌孔（管）到下颌支后缘、下颌
体下缘、下颌角点的最小距离进行测量。
2、利用CT测量下颌角间宽、下颌角角度、咬肌及翼内肌厚度、
宽度，并探讨以上各因素之间的相关关系；并对临床表现明显的下面部
过宽者（肥大组）与正常人（正常组）各5例分两组对以上指标及咬肌
与翼内肌横截面积之比进行分组t检验。
3、对4例新鲜和8例固定头颅标本正中矢状切开（24例）逐层解
剖，定点测量及观察。
结果
1、下颌角角度、下颌支高度、宽度、下颌角外翻角度、下颌角厚
度数据左右侧无明显差异；以左侧为例下颌角角度、下颌支高度、宽度、
下颌角外翻角度、下颔角厚度、下颌角间宽数值为（X±S）119±6.83
”、67．刀士4．20mm、35．30士2．27 mm、18．70土 10．57”、5．77士 1．23 mm、
104．sl士 5．16 mm：下颌角间宽与下颌角外翻角度呈显著相关
（，0．875，poo刀00）；下颌支宽与下颌角角度呈显著负相关
（F－0石N尸—0．004）；下 颌孔距 下 颌 支后 缘 门．74 士
2．07（10．00·18．64）mm；B下颌缘28．02土4．85（9．38－37．46）mm：8下颔
角点19．83土3．54（14．0029．12）mm。下颌角截骨的安全范围是距下颌支
后缘 10mm，距下颌体下缘 gmm，距下颁角点 14mm的形区域内。
2、咬肌厚度与下颌角间宽、下颌角角度呈显著相关关系（poo刀00、
0刀of）。翼内肌厚度与下颌角间宽、下颌角角度无相关关系（P＝0．15、
0石8人肥大、正常两组下颌角角度、下颔角间宽、咬肌厚度存在显著
差异卜0．000、0．001、0．002），翼内肌厚度无显著性差异（P＝0，449）。咬
肌与翼内肌横截面积之比存在显著性差异（P—0刀of）。
3、腮腺咬肌筋膜表面，咬肌在颧弓附着点前端至下颌角方向，面
横动脉、腮腺导管、面神经上颊支、下颊支与下颌角的距离（mm）分
别是 72土 3、62上 2、54 t 2、16土 2。咬肌大体分两层，主要营养血管
在浅层，手术可以去除深层的咬肌而避免重要血管神经损伤。
结论
正常下颅角有一定的外翻角度，是决定下领角间宽的主要原因：咬
肌的相对翼内肌过度发育是形成下颌角肥大的最主要因素。下颔角肥大
整形术应充分考虑这一因素，术中去除部分内层咬肌。口内入路下颌角
肥大整形术较口外入路安全、科学。下颌角肥大截骨术应分别针对下颌
角外翻、下颔角度过小及下颌支过高设计截骨方案。
Purpose The purpose of this study was to determine the reasons of
the prominence of mandibular angle and the relationship between the
gonion degree \the height and breadth of the mandibular ramus \ bigonial
breadth and the eversion degree of gonion;and provide a morphological and
anatomic basis for correcting the prominence of mandibular angle.
Methods
1.20 adult fresh skulls was performed. The bigonial breadth \the
degree of the gonion angle and the height and breadth of the mandible
ramus \thinkness of the gonion\ the dietance between mandibular foramen
and the posterior\inferior edge of mandibule and gonion were obtained .The
descriptives data were analysised by software SPSS 10.0.
2. In axial computed tomography, it is possible to measure the
thickness\breadth of the masseter and the medial ptergoid in the transection
and the mandibular angle,the bigonial breadth in the anter-poster
X-Ray .The date were initial analysed using a simple correlation and
indpendent samples T-test.
3. The observation and measurement of the relationahip between the
gonion and the artery \the branches of the facial nerve\the partotid
duct;the morphology and artery of the masseter muscle were done oii 12
cadaver heads(24 lateral)
Result
1 .The descriptives data of the mandibular angle \the height and breadth
of the ramus \ bigonial breadth and the eversion degree of gonion\the
thickness of gonion was 119?.830 、 67.71?.20mm、 35.30?.27 mm
104.51 ?.16mm、 18.70?10.57、 5.77?1.23 mm; The bigonial breadth
was significantly related with the degree of the gonial eversion angle
(r=0.875,P=0.000)and the height of mandibular ramus
(r=0.741,P=0.000);The height mandibular ramus was significantly related
with both the bigonial breadth and the gonial eversion angle;the ramus
breadth was significantly negitive related with the cent of gonion
(r=-0.6 1 4,P=0.004).
2.The bigonial breadth and gonial eversion angle was significantly
related with the thickness of masseter muscle(P=0.000),otherwise the
thickness of the medial ptergoid was on the contary(P=0.65\0.15).There was
significant differences between the group of prominent and the normal in
the gonial angle (P=0.000)\ the bigonial breadth (P=0.001) and thickness of
masseter muscle(P=0.002).But there was no difference in the thickness of
the medial pterygoid muscle(P=0.449).
3. On the line between the gonion and the attachment of masserter
muscle at the point of anterior-zygomatic arch ,the distence(mm)between
the transversa facil artery parotid duct .. facial nerve zygomatic
branches\buccal branches and the gonion was 72、 62、2、 54 ?2、16
?2mm.The masseter muscle was inserted into the deep and superficial
fibres.The central nutritious artery laid in the super-fibers.Tlie deeper fibers
could be moved during operation to avoid damnify of the main artery and
nerve.
Conclusion The thickness of the master muscle was a important
factor that affected the lower facial morphology.The hyperplasia of
masserter muscle caused the mandibular angle enlarged. The operation of
correcting enlarged mandibular angle by an ititraoral approach was a
security and feasible method. When ostectomy for reducing the withed of
the lower face was to do ,the changes above mentioned should be
considered respectively.
引文
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