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试述颞区软组织的层次及各层特点。

问答题
2022-06-29 17:53
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正确答案

颞区软组织由浅入深分为皮肤、浅筋膜、颞筋膜、颞肌和颅骨外膜5层。
(1)皮肤:颞区的皮肤移动性较大,手术时无论选择纵行或横行切口,均易缝合,愈合后的瘢痕亦不明显。
(2)浅筋膜:所含脂肪组织较少。血管和神经可分为耳前和耳后两组。1)耳前组:有颞浅动、静脉和耳颞神经,三者伴行,出腮腺上缘,越颧弓到达颞区。颞浅动脉为颈外动脉的两终支之一,其搏动可在耳屏前方触及,该动脉在颧上方约2~3cm处分为前、后两支。颞浅静脉汇入下颌后静脉。耳颞神经是三叉神经第三支下颌神经的分支,可在耳轮脚前方进行局部阻滞麻醉。2)耳后组:有耳后动、静脉和枕小神经,分布于颞区后部。耳后动脉起自颈外动脉,耳后静脉汇入颈外静脉,枕小神经来自第2、3颈神经,属颈丛的分支。
(3)颞筋膜:上方附着于上颞线,向下分为深、浅两层,浅层附着于颧弓的外面,深层附着于颧弓的内面。两层之间夹有脂肪组织,颞中动脉(发自上颌动脉)及颞中静脉由此经过。
(4)颞肌:呈扇形,起自颞窝和颞筋膜深面,前部肌纤维向下,后部肌纤维向前,逐渐集中,经颧弓深面,止于下颌骨的冠突。颞肌深部有颞深血管和神经,颞深动脉来自上颌动脉,颞深神经来自下颌神经,支配颞肌。
(5)颅骨外膜:较薄,紧贴于颞骨表面,因而此区很少发生骨膜下血肿。骨膜与颞肌之间,含有大量脂肪组织,称颞筋膜下疏松结缔组织,并经颧弓深面与颞下间隙相通,再向前则与面的颊脂体相连续。因此,颞筋膜下疏松结缔组织中有出血或炎症时,可向下蔓延至面部,形成面深部的血肿或脓肿,而面部炎症,如牙源性感染也可蔓延到颞筋膜下疏松结缔组织中。


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