【晨读】神经电刺激治疗慢性头面部疼痛：综述（二）
英语晨读 ·
山东省立医院疼痛科英语晨读已经坚持10余年的时间了，每天交班前15分钟都会精选一篇英文文献进行阅读和翻译。一是可以保持工作后的英语阅读习惯，二是可以学习前沿的疼痛相关知识。我们会将晨读内容与大家分享，助力疼痛学习。
本次文献选自Antony AB, Mazzola AJ, Dhaliwal GS, et al. Neurostimulation for the Treatment of Chronic Head and Facial Pain: A Literature Review[J]. Pain Physician, 2019, 22(5):447-477. 本次学习由陈阳住院医师主讲。
Facial Anatomy/Innervation
Headaches and facial pain can be difficult to di-agnose and treat often because of the confluence of complex anatomic structures and sensory systems. The trigeminal cranial nerve (CN V) and its ophthalmic (CN V1), maxillary (CN V2), and mandibular (CN V3) divisions provide sensory innervation to the face via their cuta-neous terminal branches. These branches relay sensory input and converge at the Gasserian ganglion (also known as trigeminal or semilunar ganglion) located in Meckel’s cave . Cutaneous branches of each such as the supraorbital, infraorbital, and mental nerves can be targeted for various therapeutic interventions .
面部解剖/神经支配
由于复杂的解剖结构和感觉系统交织在一起，头面部疼痛往往难以诊断和治疗。三叉神经（CN V）及其分支眼神经（CN V1）、上颌神经（CN V2）和下颌神经（CN V3）通过皮肤末端分支支配面部感觉。这些分支传递感觉信号，并汇聚在位于Meckel腔中的Gasserian神经节（也称为三叉神经节或半月神经节）。眶上、眶下和颏神经等皮肤分支均可作为各种治疗性干预的靶点。
Trigeminal Nerve
The trigeminal nerve carries much of the general sensory information from the head, and also innervates the muscles that move the lower jaw. At the level of the middle cranial fossa, the sensory root forms the trigeminal ganglion that holds the cell bodies of these sensory neurons. Of note, the motor root lies below and separates proximal to this point. From the Gas-serian ganglion arise the aforementioned 3 divisions of sensory nerves: the ophthalmic nerve, the maxillary nerve, and the mandibular nerve .
三叉神经
三叉神经传导从头部发出的一般感觉信息，并支配移动下颌的肌肉。在颅中窝水平，感觉根形成三叉神经节，容纳这些感觉神经元的细胞体。值得注意的是，运动根位于下方并在该点附近分开。从Gasserian神经节中分出上述3条感觉神经：眼神经、上颌神经和下颌神经。
Ophthalmic Nerve
The ophthalmic division enters the orbit through the superior orbital fissure. It carries sensation from the cephalic part of the anterior face covering the skin from the nose, upper eyelids, upper bridge of nose, scalp, and forehead, as well as sensation from the cornea, mucosa of nasal cavity, and frontal paranasal sinuses.
This nerve has various divisions .The supraorbital and the supratrochlear nerves leave the orbit superiorly and are responsible for transmitting sensation from the eyelid, forehead, and scalp. The supraorbital nerve passes through the fron-talis muscle and continues superiorly providing cover-age over the anterior scalp to the vertex of the head. Similarly, the supratrochlear nerve passes through the frontalis and continues across the anterior forehead supplying the center of the forehead . Both these peripheral nerves have been targeted for pain relief as they are easily accessible at a location of maximal nociception where they superficially traverse under the subcutaneous tissue at the forehead .
眼神经
眼神经通过眶上裂进入眼眶。它传导包括鼻子、上眼睑、上鼻梁、头皮和前额的前头面部传来的感觉以及角膜、鼻腔粘膜和额鼻旁窦的感觉。该神经有多条分支。
眶上神经和滑车上神经从眶上分出，并负责传递眼睑、前额和头皮的感觉。眶上神经穿过额肌，并继续向上覆盖头皮至头顶。同样，滑车上神经穿过额肌并继续穿过前额，直至前额的中心。这两个外周神经在额头的皮下组织下横越，可以轻松触及，故而都可作为缓解疼痛的靶点。
Maxillary Nerve
The maxillary nerve exits the cranial cavity through the foramen rotundum and enters the pterygopalatine fossa. It supplies the skin including the upper lip, lower eyelid, upper teeth and gums, mucosa of the nose, max-illary and ethmoid sinuses, and palate .The infraorbital nerve is a peripheral branch that exits the maxilla through the infraorbital foramen and provides sensation to the lower eyelid, cheek, side of the nose, and upper lip. Similarly, the zygomatico-temporal branch exits the zygomatic bone to supply sensation over the anterior temple located above the zygomatic arch .
上颌神经
上颌神经通过圆孔离开颅腔，进入翼颚窝。它支配包括上唇、下眼睑、上齿和牙龈、鼻粘膜、上颌窦和筛窦以及上颚的皮肤感觉。
眶下神经是通过眶下孔出上颌的外周分支，支配下眼睑、脸颊、鼻翼和上唇的感觉。同样，颧颞神经出颧骨，支配颧弓上方的前太阳穴上的感觉。