The courses and distributions of the lingual nerve in the ventral … · 2019-06-28 · The courses and distributions of the lingual nerve in the ventral tongue region; Anatomical

The courses and distributions of the lingual nerve in the ventral tongue region; Anatomical consideration for frenectomy

Yong-Je Woo, D.D.S.

Department of Dentistry

The Graduate School, Yonsei University

The courses and distributions of the lingual nerve in the ventral tongue region; Anatomical consideration for frenectomy

Directed by Professor Hee-Jin Kim, D.D.S., Ph.D.

The Master's Thesissubmitted to the Department of Dentistry,the Graduate School of Yonsei University

in partial fulfillment of the requirements for the degree of

Master of Dentistry

Yong-Je Woo, D .D.S.

December 2008

This certifies that the Master's Thesisof Yong-Je Woo is approved.

---------------------------------------------------------------- Thesis Supervisor : Prof. Hee-Jin Kim

---------------------------------------------------------------- Thesis Committee Member : Prof. Kyung-Seok Hu

---------------------------------------------------------------- Thesis Committee Member : Prof. Ki-Seok Koh

The Graduate School Yonsei University

December 2008

ACKNOWLEDGEMENTS

본 논문이 완성되기 까지 부족한 저를 항상 격려해주시고 사랑과 관심으

로 이끌어주신 김희진 교수님께 깊은 감사를 드립니다. 또한 많은 격려와

지도 편달을 해주신 고기석 교수님께도 감사를 드립니다.

또한 본 연구내내 많은 도움을 아끼지 않으신 허경석 교수님과 치과대학

구강생물학교실 해부학교실원들께도 감사의 인사를 드립니다.

주위에서 저를 항상 응원해 주시고 보살펴주신 부모님과 장인, 장모님께

감사드리며 마지막으로 사랑하는 나의 아내 윤정, 예쁜딸 예원, 그리고 어

제 극적으로 태어난 둘째 아들에게 진정으로 사랑과 고마움의 마음을 전합

니다.

모든 분들께 진심으로 감사드립니다.

2008년 12월 저자 씀

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TABLE OF CONTENTS

LIST OF FIGURES ‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥ ⅱ

LIST OF TABLES ‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥ ⅲ

ABSTRACT ‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥ iv

Ⅰ. INTRODUCTION ‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥ 1

Ⅱ. MATERIALS AND METHODS ‥‥‥‥‥‥‥‥‥‥‥‥ 4

1. Materials ‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥ 4

2. Methods ‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥ 4

Ⅲ. RESULTS ‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥ 7

Ⅳ. DISCUSSION ‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥ 15

Ⅴ. CONCLUSION ‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥ 18

REFERENCES‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥ 19

ABSTRACT (In KOREAN) ‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥ 24

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LIST OF FIGURES

Figure 1. Classification of the course of the lingual nerve (LN)

into five patterns. ‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥ 5

Figure 2. Five patterns of the proceeding course of the lingual

nerve (LN). ‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥ 8

Figure 3. The twigs (TM) directly innervating to the vental of the

the tongue. ‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥ 12

Figure 4. The innervation of the LN to the tongue which was

visualized by modified Sihler's nerve staining.‥‥‥‥‥‥ 14

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LIST OF TABLES

Table 1. The innervation of the LN to the tongue which was

visualized by modified Sihler's nerve staining‥‥‥‥‥‥ 11

Table 2. Asymmetry of the anatomical patterns of the lingual

nerve between right and left side‥‥‥‥‥‥‥‥‥‥‥ 13

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Abstract

Thecoursesanddistributionsofthelingualnerveintheventraltongueregion;Anatomical

considerationforfrenectomyYYYooonnnggg---JJJeeeWWWooooooDDD...DDD...SSS...

DepartmentofDentistryTheGraduateSchool,YonseiUniversity

(DirectedbyProfessorHee-JinKim D.D.S.,Ph.D.)

Theaim ofthisstudywastoelucidatetheintra-andsub-lingualcourseofthelingualnerve(LN)attheventraltongueregionandtoserveastheclinicalguidance for safe surgicalprocedures such as frenectomy.We evaluatedsixteenspecimensbymeansofgrossobservationafterdetaileddissections,andsix specimensvisualizedby Sihler'sstaining.Allspecimenswereharvestedfrom theembalmedKoreancadavers.WeclassifiedtheproceedingpatternsoftheLN into5typesandconfirmedthedistributionoftheLN onthetonguetip.TheclassificationoftheLN wasmadewithreferencetothelineinwhichthestyloglossus(SG)andgenioglossusmuscle(GG)interlaced.BasedonthecourseofLN andtheexistenceofthetinytwigdirectlyinnervatingtothesublingualmucosa (TM),the LN was classified into straight,curved andverticalpatternwithorwithouttheTM.WithouttheTM,Shownwerethestraightpatternin9.4%,curvedpatternin46.9% andverticalpatternin18.8%.NothavingtheTM,thestraightpatternandcurvedpatternwaspresentin6.3% andin18.8%,repectively.Theresultsfrom theSihler'sstaininganalysisdemonstratedthattheregionofthetonguetipwasinnervatedbytheLN.The

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presentstudyproposedthatsurgicalmanipulationsattheventraltongueregionmay damagetheLN and resultin numbnessthetonguetip and providedusefulanatomicalreferenceforthevarioussurgicalproceduresattheventraltongueregion.���������������������������������������������������������������������������

Key words : lingual nerve, tongue tip, lingual frenulum, frenectomy,frenuloplasty,Sihler'sstaining

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Thecoursesanddistributionsofthelingualnerveintheventraltongueregion;Anatomical

considerationforfrenectomy

YYYooonnnggg---JJJeeeWWWooooooDDD...DDD...SSS...

DepartmentofDentistry,TheGraduateSchool,YonseiUniversity

(DirectedbyProfessorHee-JinKim D.D.S.,Ph.D.)

ⅠⅠⅠ...IIINNNTTTRRROOODDDUUUCCCTTTIIIOOONNN

The lingualnerve (LN)is originated from the posteriortrunk ofthemandibularenerveandcarriesgeneralsensationfrom theanteriortwo-thirdsofthetongue,thelingualmucosaontheflooroftheoralcavityandlingualgingivaassociatedwiththelowerteeth(HeasmanandBeynon,1986).Afterpassing through the infratemporal fossa and proceeding between themandibularramusandthemedialpterygoid,theLN entersintothetongueonthelateralsurfaceofthehyoglossusmuscle(HG)(Kim etal.,2004).NervetwigsoftheLN reachthetipofthetonguesupplyingafferentnervefiberstotheventralregionofthetongue(Standring,2005;Saigusaetal.,2006).

Injury tothelingualnerveoften occursduring extraction ofthethird

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molar,localanesthesia,orthognathic surgery,preprosthetic surgery,tumorexcision,orfacemaskventilation(McGeachie,2002;Graff-RadfordandEvans,2003;Kim etal.,2004;Brimacombe etal.,2005;Smith and Lung,2006;Tolstunov,2007).Hence,theanatomicalstudiesoftheLN mainlyhavebeenfocused on courses atthe regions ofthe mouth floorand the retromolartrigonewhicharesusceptibletoinjuryduringthesemanipulations(Lauretanoetal.,1997;McGeachie,2002;Graff-Radford and Evans,2003;Kim etal.,2004).However,itisnecessaryforperformingsafetysurgicalproceduressuchas frenectomy and partialglossectomy for the ankyloglossia (tongue-tie),macroglossia or tongue cancer to recognize anatomy of the sub- andintra-lingualcourseandpositionoftheLN attheventralregionofthetonguecomprisingthelingualfrenulum.(Tantawi,1969;Allisonetal.,1971;Winstockand Warnakulasuriya,1986;Herren etal.,1989;Wright,1995;Garciaetal.2002;LalakeaandMessner,2003;Fiorottietal.,2004;Gallegos-Hernandezetal.,2004;Queiroz,2004;Halland Renfrew,2005;Hellerand Gabbay,2005;Ostapiuk,2006;Wallaceand Clarke,2006;Segaletal.,2007;Wang etal.,2008).There are some descriptions ofthe lingualinnervations using byclassicalmethodssuch asgrossanatomicaldissection in cadavericstudies,neuraltracingtechniquesandelectrophysiology(El-Malek,1938;Lawn,1966;Yamamoto,1975;Loew,1980).However,few detailedneuroanatomicaldepictionhasnotbeendemonstratedfortheLN attheventraltongueregion,regardingthesesurgicalinterventions.Furthermore,itisdifficulttodissecttheLN intheirintra-lingualdistributionswithoutmarkedmodificationofthecourseofthenervebranches(Zuretal.,2004;Toureetal.,2005).WhereasSihler’snerve staining makes whole specimens translucent while counterstainingnerves,andhenceadetailedview ofthenervebranchesandtheirendscanbeexamined withoutthe modifications ofthe courses ofthe nerve branches(Sandersetal.,1993;MuandSanders,1996;MuandSanders,1998;Muand

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Sanders,1999).In this study, investigations were performed elucidating sub- and

intra-lingualtopographyoftheLN attheventraltongueregiontoserveasareferenceofvarioussurgicalinterventionsbymeansofthegrossanatomicalobservationandSihler'snervestaining.

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ⅡⅡⅡ...MMMAAATTTEEERRRIIIAAALLLSSS &&& MMMEEETTTHHHOOODDDSSS

1.MaterialsTwenty-twospecimensoftonguewereusedinpresentstudy(12males,10

females;average69.0ageyears)andtheywereharvestedfrom theembalmedKoreancadavers.GrossanatomicaldissectionsweremadeontheLN in16specimens.NervestainingwasperformedonsixspecimensinaccordancewithmodifiedSihler'sstainingmethod.

2.MethodsA.ProceedingpatternsofthelingualnerveThesublingualmucosawasdelicatelystrippedoffintheventraltongue

region and connective tissue was removed by a detailed dissection foridentifying thetopography oftheLN,HG,SG and SS.Thereferenceline(S-G line)was established where the SG and the SS interlaced and thereferencepoint(T point)wassetonthepointwheretheS-G lineoftheeachsidemet.Theclassificationwasmadeaccording tothecourseofthemostmedialbranchoftheLN (mLN)attheventraltongueregionandthepresenceofthenervetwigsoftheLN directlyinnervatingtothelingualmucosa(TM).Therightand leftsides ofthespecimen wereseparately regarded as anindependentobservationobject.Oncompletionofthedissection,thetopographyofthemLN wasclassifiedintofivetypesasfollows(Fig.1).TypeⅠa:mLN proceedingstraightalongtheS-Lline,nothavingtheTM.TypeⅠb:mLN proceedingstraightalongtheS-Lline,baringtheTM.TypeⅡa:mLN proceedingcurvedlywithadistancefrom theS-Lline,not

havingtheTM.TypeⅡb:mLN proceedingwithacurvedkeepingadistancefrom theS-L

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line,baringtheTM.TypeⅢ:mLN proceeding anteriorly ontheSG,andascending vertically

nearthemidline,nothavingtheTM.

Fig.1.Classification ofthecourseofthelingualnerve(LN)into fivepatterns.A,TypeⅠa;B,TypeⅠb;C,TypeⅡa;D,TypeⅡb;E,TypeⅢ.

B.PreparationofSihler'sstaining forelucidating theinnervationsatthetonguetip

Modified Sihler’s nerve staining technique was performed for the

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observationofthenervedistributionattheventraltongueregion(Fig.4).10%unneutralizedformalinwasinjectedthroughbloodvesselsforfixationofthemuscles(fixation).Fixed muscleswerewashed using irrigation water,anddepositedin3% aqueouspotassium hydroxidesolutionwithadditionof0.2mlof 3% hydrogen peroxide solution for 4 weeks (maceration anddepigmentation).Onepartglacialaceticacid,onepartglycerin,andsixpartsof 1% aqueous chloral hydrate constituted the Sihler solution I.Aftermaceration,muscles were transferred into Sihlersolution I(decalcification).Sihler’ssolutionIIwascomposedofonepartEhrlichhematoxylin,onepartglycerin,andsixparts1% aqueouschloralhydrate.DecalcifiedspecimenswerestainedbyimmersionandplacedinSihler’ssolutionIIinforthreeorfourweeks(Staining).After staining,musclesweretreatedwithSihler’ssolutionItode-stainmuscularfibersforoneortwohours(Destaining).Thedestainedspecimenswerewashedinrunningtapwaterfor90minutesanddepositedin0.05% lithium carbonate solution for 1 hour (Neutralization). After theneutralization,thespecimenswastreatedwithdailyincreasingconcentrationsofglycerin(40%,60%,80%,and100%)(Clearing).

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ⅢⅢⅢ...RRREEESSSUUULLLTTTSSS

1.LingualnervecoursesattheventraltongueA.OverallcoursesTheLN coursesof32sidesattheventraltongueregionweredetectedin

the16specimens.MostoftheLN branchestraveledalongtheS-G line.ThemLN ofrightandleftsideapproachedeachotherneartheT point(tonguetip)andthenenteredbetweentheSG andSS.However,therewasnocaseofthe mLN reaching orextending beyond the midline priorto inserting themuscle.ThemLN werecategorizedintothe5typesaccordingtothecourseswithreferencetotheS-G lineandthepresenceoftheTM (Fig.2)(Table1).15.6% (5cases)ofthetotalwasobservedasthestraighttypewhile9.4% (3cases)lackedtheTM (TypeIa)(Fig.2a),and6.3% (2cases)hadaTM(TypeIb)(Fig.2b).Thecurvedtype(65.6%,15cases)wasthemostcommonanddividedintoTypeIIa(withouttheTM)(Fig.2c)andTypeIIb(withtheTM)(Fig.2d),whichconstituted46.9% (15cases)and18.8% (6cases)oftheoverallfindingsrespectively.TheverticaltypewithouttheTM (TypeIII)(Fig.2e)wasfoundin18.8% (6cases).TherewasnocaseoftheverticaltypewiththeTM.In25.0% ofthecases,therewastheTM,whiledisregarding thecoursesofthemLN.TheTM wasproceeding medially andreachedtothemucosaofmiddleofthetonguetip(Fig.3).

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- 9 -

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Fig.2.Fivepatternsoftheproceedingcourseofthelingualnerve(LN).A,TypeIa,straighttypewithoutthemucosaltwigs(TM);B,TypeIb,straightwiththeTM;C,TypeIIa,curvedtypewithouttheTM;D,TypeIIb,curvedtypewiththeTM;E,TypeIII,verticaltypewithouttheTM.Arrow pointsthe TM. All specimen presented is right side. SG, styloglossus; GG,genioglossus;HG,hyoglossus;GH,geniohyoid;SLgl.,Sublingualgland;LN,lingualnerve;TM,twigsdirectly innervting to theventralmucosa ofthetongue.

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Table1.Frequencyofeachtypeoflingualnerveproceedingcourses

Coursesofthelingualnerveattheventral tongue

region

Coursesofthelingualnerveattheventraltongueregion

Straight(15.7%)

Curved(65.6%)

Vertical(18.8%)

Absence(75.0%)TypeⅠa TypeⅡb TypeⅢa

9.4% 46.9% 18.9%

Presence(25.0%)TypeⅠb TypeⅡb

6.3% 18.8%

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Fig.3.Thetwigs(TM)directlyinnervatingtotheventalmucosaofthetongue.ThespecimenbelongedtotheTypeIIbispresentedasaventalview.TheTM wasproceeding medially and reaching themidlineofthelingualfrenulum.SG,styloglossus;GG,genioglossus;LN,lingualnerve;TM,twigsdirectlyinnervtingtotheventralmucosaofthetongue.

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B.AsymmetryofthelingualnervecourseoneachsidesThedifferenceinthecoursesofthemLN betweenrightandleftsidewere

shownin9tongues(56.3%).ThecasewithTM wasfoundin6casesofthe16specimens(37.5%),and4ofthese6specimenshadTM ononlyoneside(66.7%).The asymmetry ofthe presence ofthe TM were shown in 6specimens(37.5%)(Table2).

Table 2.Asymmetry ofthe anatomicalpatterns ofthe lingualnervebetweenrightandleftside

2.DistributionoflingualnervecoursesonthetonguetipThenervedistributionwasvisualizedbySihler’snervestaininganditwas

shownthatthemainbranchofthemLN wasinsertedtotheSS andthenthey were traveling medially (Fig 4).The main branch ofthemLN wasterminated by reaching the tongue tip,and the branches of each sideconstitutedthenervenetworkatthemiddleofthetonguetip.Therewasno

ObserveditemsPatternsofeachside

MeasurementUnits(100%) Same Difference

Courseofthelingualnerve

Observed32cases(from 16tongues) 43.8% 56.3%

Presenceofthemucosaltwigs(TM)

Observed32cases(from 16tongues) 62.5% 37.5%

DistributionoftheTM Detected6tongues33.3%

(Presentineachside)

66.7%(Presentinonlyoneside)

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interconnectionoftheLN branchesofeachsidepriortoreachingthetonguetip.However,insomecases,thecommunicating twigswerepresentatthetongue tip region.Some additionaltwigs were branched from the mainbranchesandtravelledmorelaterallythanthemainbranches.Theseadditionaltwigsalsoreachedthetonguetipregionandweredistributedinthatregion.

Fig.4.TheinnervationoftheLN tothetonguewhichwasvisualizedbymodifiedSihler'snervestaining.TheLN ofrightandleftsideisapproachingeachotherandthereisananastomosisoftheLN ofeachside(arrow).Thetwigs(TM)directlyinnervatingtothemucosaisproceedinglaterallyandalsoreachthetonguetip(*).ThebranchesoftheLN ofeachsideformedthenerveplexusatthetonguetip(**).LN,lingualnerve;TM,mucosaltwigsdirectlyinnervtingtotheventralmucosaofthetongue.

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ⅣⅣⅣ...DDDIIISSSCCCUUUSSSSSSIIIOOONNN

The prevalence ofankyloglossia (tongue-tie)was reported from 4.2 to10.7% in the Unites States and United Kingdom (Segal et al.,2007)respectively.Frenectomy is a recommended procedure for patients withankiloglossiaandduetoitsinvasiveness,in-depthanatomicalknowledgeofthesub- and intra- lingualcourse is required.Generally,lingualnerve injurycausing numbness,paresthesia,and dysgeusiaofthetongueusually occursduringinvasivedentalinterventionssuchastheextractionofthethirdmolar(Graff-RadfordandEvans,2003;Brimacombeetal.,2005;Tolstunov,2007)andthus,have made many researchers study the anatomy ofthe LN in theretromolarareacomprisingthelingualmucosaatthemolarregion(Lauretanoetal.,1997;Behniaetal.,2000;McGeachie,2002;Graff-RadfordandEvans,2003;Kim etal.,2004,Erdogmusetal.,2008).Forthispurpose,itseemsindispensabletohaveathoroughknowledgeofthetopographyofthesub-andintra-lingualcourseattheventralregionofthetongueforperformingsafetysurgicalinterventionsuchasafrenectomy.Duetotheintermeshingofthetonguemuscles,itisimpossibletoobserve

theintra-lingualcourseoftheLN bydissection(Toureetal.,2005).Therefore,we used modified Silher’s nerve staining which enabled the nerve to bevisualizedwithoutmarkedmodificationoftheposition.ThemodifiedSihler’snervestainingwasusedfortheresearchoftheinnovationofthelarynxandcaninetongueuptodate(Sandersetal.,1993;WuandSanders,1996;WuandSanders,1998;WuandSanders,1999;Toureetal.,2005).Toureetal.(2005)andZubetal.(2004)reportedthedistributionoftheintralingualcourseoftheLN byusingmodifiedSihler’snervestaining,howevertheydidnotprovidetheclinicalcriteriaforsurgicaltreatment.Toureetal.(2005)reportedthatthe

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LN piercedintothetongue,anddividedintolateral,intermediateandmedialbranches after receiving an anastomosis from the anterior branch ofthehypoglossalnerve,andthiswasinaccordancewiththefindingsfrom Zubetal.(2004).Inthepresentstudy,wefoundthatatthetonguetipregion,theLNbranches ofrightand leftside were closely approaching each other,andeventually distributed to the middle of the tongue tip.There was ananastomosisoftheLN ofeachsideatthemiddleofthetonguetipandwiththeuseofSilher’sstaining,TM wasdetectedinalsoreachingthetonguetip(Fig.2).Basedonthesefindings,itmaybepostulatedthatthenumbnessofthetonguetipmayresultfrom injuriesinflictedontheintra-lingualtwigsandTM oftheLN andthepossibilityexiststhatthenerveinjurymaybeoccurredbyanincisionextendingtothetonguetip.Since,thenervetwigsoftheLN attheventraltongueregion did not

exceedthemidlineatthefrenulum region,itmaybesafetomaketheincisiononthemidlineintheventralmucosa.Furthermore,wewereabletostripoffthemucosathatpossessedtheLN.Toreducethelikelihoodofinjuriesduringsurgicalprocedures,theclinicianmayaftermakingaverticalincisionontheventralmucosaofthetongueusethisknowledgeofLN distributioncourseandtakeprecautionstoavoidinflictinganytypeofsurgicaltraumaorinjury.However,thecaseswiththeTM in37.5% whiledisregardingthecoursesoftheLN,andtheTypeIIIwasfoundastheLN proceededverticallyin18.8%and,thetransverseincisionorZ-frenuloplastywascapableofdamagingthenervetwigsinthecaseofverticalcourse(HellerandGabbay,2005).Segaletal.(2007)mentioned thatthe frenectomy was a safe intervention fortheankyloglossia.Inourstudy,themostcommonpatternoftheLN coursewasthecurved type(65.6%)which in casesoffrenectomiescan beperformedwithoutcausing seriousnervedamage.Alsothestraighttype(15.6%)wasevaluatedasthesafestpatterninthefrenuctomy.Thissupportstheconclusion

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bySegaletal.(2007).However,theTM waspresentinstraightandcurvedtypewhichconstituted25.1%.Althoughtheincidenceofnumbnessinducedbynerveinjuryduringthefrenectomywasnotclear,theexistenceofTM maysuggest that a nerve injury may result from careless and inadequatemanipulations during the frenectomy,such as the severe impingementbysurgicalforceps,untidyincisionattheupperareaoffrenulum nearthetonguetip.From the information obtained from the asymmetry ofthe LN course

(56.3%)andthepresenceoftheTM (37.5%),itmaybepostulatedthattheconfirmationoftheLN topographyononesidewouldnotguaranteethatsamewaspresentinanatomyoftheLN ontheotherside.Moreover,fourofthesixtongues,inwhichwedetectedTM,hadTM ononlyoneside.Sincethetongueinviablepatientsisdynamicandconstantlymoving,itis

difficulttoestablish thelandmark formeasurementofthetonguestructuresuch as the LN course,the proceeding patterns ofthe LN and mucosaldistributionwhichweprovidedinthisstudymayserveasaninvaluableguidetoperform surgicalinterventionssuchasfrenectomyorfrenuloplastysafely.

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ⅤⅤⅤ . CONCLUSION

Theconclusionsofthisstudyareasfollows.1. Itmaybepostulatedthatthenumbnessofthetonguetipmayresult

from injuriesinflictedontheintra-lingualtwigsandTM oftheLN andthepossibility exists thatthe nerve injury may be occurred by an incisionextendingtothetonguetip.2.To reduce the likelihood ofinjuries during surgicalprocedures,the

clinicianmayaftermaking averticalincisionontheventralmucosaofthetongueusethisknowledgeofLN distributioncourseandtakeprecautionstoavoidinflictinganytypeofsurgicaltraumaorinjury.3.TheexistenceofTM maysuggestthatanerveinjurymayresultfrom

careless and inadequate manipulations during the frenectomy,such as thesevereimpingementbysurgicalforceps,untidyincisionattheupperareaoffrenulum nearthetonguetip.

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Abstract (in korean)

혀 배쪽에서의 혀신경 주행과 분포 ; 혀주름띠 절제술에서의해부학적 고려

<지도교수 김 희 진>

연세대학교 대학원 치의학과

우 용 제

이 연구의 목적은 혀신경의 혀 배쪽에서 혀 속 및 혀 바깥 주행을 밝혀 혀 주름띠절제술과 같은 외과적 술직의 임상적 자료를 제공하기 위함이다.혀신경의 주행과분포를 관찰하기 위하여 한국인 혀 반쪽 16쪽을 미세해부 하였고 6쪽을 실러(Sihler)염색 처리하였다.이를 위해 혀신경을 그 주행에 따라 5개로 분류하였고,혀끝에서의 분포를 확인하였다.혀신경 주행의 분류를 위해 붓혀근과 턱끝혀근이 만나는 선을 기준점으로 설정하였다.또한 혀밑 부위의 점막으로 바로 분포하는 작은가지 (점막가지)의 유무를 혀신경 주행 및 분포 분류에 고려하였다.점막가지가 없는 경우 9.4%에서 곧은 양상,46.9%에서 휘어져 들어가는 양상 그리고 18.8%에서수직으로 들어가는 양상을 보였다.점막가지가 있는 경우 6.3%에서 곧은 양상,18.8%에서 휘어져 들어가는 양상을 보였다.실러 염색을 통해 혀신경의 혀 끝에 분포하는 것을 확인할 수 있었다.이 연구를 통해 혀 배쪽 부위에서의 수술적 조작에의해 혀끝마비와 같은 부작용을 줄 수 있음을 확인하였으며,이 부위의 다양한 외과적 술식을 위한 해부학적 근거를 제공하였다.

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핵심되는 말 :혀신경,혀끝,혀주름띠,혀주름띠 절제술,혀주름띠 성형술,실러 염색