目的研究下面部颈阔肌解剖形态,为注射A型肉毒毒素治疗下面部松弛提供解剖学依据。探讨A型肉毒毒素注射治疗下面部松弛的安全注射位点及其疗效。方法①解剖面颈部肌肉正常的成人头颈部尸体标本15例30侧。暴露下面部颈阔肌,测量颈阔肌在面部的延伸角度、走行方向及覆盖范围,应用SPSS 22.0进行统计学分析。②2015年8月至2017年10月门诊收治55例下面部松弛患者,采用A型肉毒毒素对下颌缘处颈阔肌进行定点注射,注射前、后对患者进行标准化摄影,采用Photoshop CC测量治疗前、后下面部提升的距离及角度,应用SPSS 22.0进行统计学分析。结果①颈阔肌根据面中部的走行方向可分为直型(36.7%)、直曲型(50.0%)及横型(13.3%)3类,100%覆盖下颌角。3种类型颈阔肌后肌束最高点在面中部的分布差异有统计学意义(P<0.05),说明颈阔肌的分布变异性很大。而颈阔肌肌束纤薄稳定,分布表浅。②设计位点进行注射,注射前、后照片的测量数据经统计分析,差异均有统计学意义(P<0.05)。结论①下面部颈阔肌表浅且薄,形态分布变异度高,选择下面部注射位点时,颈阔肌注射位点紧靠下颌缘处。注射时应尽量表浅。②应用A型肉毒毒素注射改善下面部轮廓形态,治疗效果肯定。

Objective To study the anatomical morphology of the platysma muscle of the lower face,so as to provide anatomical basis for the treatment of facial laxity by injection of botulinum toxin type A. To explore the safe injection site of botulinum toxin type A in the treatment of facial relaxation, and to explore the effect of botulinum toxin type A. Methods ① Extensively dissect and analysis of 30 hemifaces in 15 cadavers . Exposed the platysma muscle of the lower face, and measured the width of the platysma muscle, the extension angle in face, and coverage of the face. Then use SPSS 22.0 software to statistical analysis.②Analysis clinical data of the treatment of facial laxity patients using botulinum toxin type A from August 2015 to October, 2017. Inject botulinum toxin type A to the platysma muscle of the lower face. Standardized photograph patients before and after injection. Use Photoshop CC to measure the facial ascension and the mandibular margin ascending angle before and after treatment. Use SPSS 22.0 software to statistical analysis the measured data before and after treatment. Results ① According to the direction of the platysma muscle, the direction of posterior muscle bundle can be divided into straight, straight-curved and curved three categories, accounting for 36.7%,50.0% and 13.3% respectively, and in all cases, it covered the mandibular angle. The distribution of the high peak of the posterior muscle beam in the platysma muscle was statistically significant,indicating that the structure and distribution of the platysma muscle varied greatly, whereas the broad of muscle is stable and the distribution table was shallow.② Injected botulinum toxin type A in designed site of platysma muscle, and used the " ring diameter rule" to measure the data of the lower part before and after injection. Then compared data from two groups and check whether the difference between the two groups was statistically significant. It is the indicator that the treatment was effective. Conclusions ①The platysma muscle is thin and the thickness of the muscle is thin, and the morphological distribution varied greatly, so the platysma muscle injection site is pressed against the lower jaw. You should try to be shallow during injection.②The treatment of the following contour morphology was improved by the botulinum toxin type A injection and the therapeutic effect was positive.