Microsurgical Anatomy Of Frontotemporal Orbitozygomatic

Objective Microsurgical anatomy of frontotemporal orbitozygomatic is to get anatomical basis of frontotemporal orbitozygomatic.Methods Five cadaveric heads perfused by red siliconehe in arteries and fixed by 10% formalin were dissected layer by layer by frontotemporal orbitozygomatic approach under microscope. This anatomy described in detail the design of the skin incision, the stepwise dissection of skin, bone flap, taking pictures and measuring the tissue.Results 1、Temporal soft tissue can be divided into skin, subcutaneous fat, superficial temporal fascia, fascia connective tissue, the shallow layer of the deep temporal fascia, the middle fat pad, the deep layer of deep temporal fascia, the deep fat pad, the temporal muscle and membrane of the skull.2、The frontotemporal branch of facial nerve divided into anterior, middle and posterior branch. Anterior and middle branch of the three branches cross the 1/3 point of back zygomatic arch,about lcm before superficial temporal artery and 2.3cm before antilobium. Frontotemporal branchs of facial nerve main walk on surface of superficial temporal fascia in the upper area of temporal and walk between shallow layer and deep layer of deep temporal fascia in the lower area of temporal.3、Supraorbital nerve and supraorbital artery pass by supraorbital hole(or supraorbital notch) orbital by orbital, dominate and nutrition ipsilateral forehead skin, the visible supraorbital notch in 4 cases, supraorbital hole in 6 cases, the distance of the average distance between the supraorbital hole and broomahya is 25.55±2.67 (21.90～29.11) mm.4、Zygomatic arch is located between shallow layer and deep layer of deep temporal fascia the middle fat pad. The length of zygomatic arch is 28.00±3.97 (23.20～34.99) mm, anterior width is 22.20±2.14 (19.10-24.22) mm, posterior width is 8.01±1.69 (5.44-10.34) mm, upper width is 7.20±1.36 (5.52-9.90) mm, lower width is 16.46±1.30 (15.08～18.79) mm.5、Anterior communicating artery complex measurement results: diameter of left anterior cerebral artery A1 segment is 2.93±0.82 (1.89-3.84) mm; the right diameter is 2.23±0.58 (1.41～2.88) mm.6、Posterior communicating artery is the channel of communication between internal carotid artery system and vertebral basilar artery system. The average length of the posterior communicating artery is 11.92±2.34 (9.98～15.82) mm.7、There are many triangular lateral wall of the cavernous sinus and measurement result:the Oculomotor triangle, inner edge is15.20±2.76 (10.12～18.96) mm, lateral edge is 13.85±2.36 (9.12～17.10) mm, bottom edge is15.05±3.32 (7.01～18.00) mm; Dolenc triangle, inner edge is 9.93±1.54 (7.46～11.80) mm, lateral edge is 10.49±1.42 (8.89-12.42) mm, bottom edge is9.30±1.84 (6.20～11.45) mm; Parkinson triangle, inner edge is 18.13±5.03 (10.01～24.10) mm, lateral edge is 18.82±5.29(12.20～25.52) mm, bottom edge is 6.58±1.68 (4.40～9.26) mm; paramedial triangle, inner edge is 13.03±2.54 (8.90～17.49) mm, lateral edge is12.30±2.57 (7.99～16.49) mm, bottom edge is4.78±1.93 (2.61～7.42) mm.Conclusion 1、Frontotemporal orbitozygomatic surgery approach is applicable to the anterior and middle cranial fossa, saddle area, orbital apical petrous bone slope area, spinosum and basilar artery bifurcation lesions, other skull base surgery approach hard to fully expose.2、Frontotemporal orbitozygomatic surgery approach by increasing the removal of bone flap, can reduce brain tissue traction, provide wider space for surgery and surgical perspective and reduce damages to nerves and blood vessels.3、The anterior communicating artery complex has complex anatomy and abundant blood vessels, and the anterior communicating artery is a good site for internal carotid artery aneurysm.4、The anatomical structure of the cavernous sinus can be almost better exposed through the cavernous triangle.