두힘살근 앞힘살의 형태변이와 두힘살근 뒤힘살과 붓목뿔근 사이의 위치 관계
Anatomic Variation of the Anterior Belly of Digastric Muscle and Positional Relationship between the Posterior Belly of Digastric and Stylohyoid Muscle
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본 연구는 한국인 두힘살근 앞힘살의 형태학적 분석과 더불어 두힘살근 뒤힘살과 근접하며 동일한 신경분포를 갖는 붓목뿔근(stylohyoid muscle)과 두힘살근 뒤힘살 사이의 해부학적 위치 관계를 확인하고자 하였다. 본 연구의 재료로는 한국 성인시신 34구(남: 21, 여: 13, 평균나이: 65 (24~89세))를 사용하였다. 34구의 시신 중8예에서 두힘살근 앞힘살과 턱목뿔근의 덧힘살 (accessory belly)을 확인하였다. 덧힘살은 아래턱솔기(mandibular raphe)의 표면을 교차하지 않는 유형(unilateral type)과 교차하는 유형(crossover type)으로 분류하였으며, 각각 3예와 5예에서 나타났다. 두힘살근 뒤힘살과 붓목뿔근 사이의 국소적인 위치 관계를 관찰한 결과, 관찰한 49쪽 중 32쪽(65%)에서 붓목뿔근의 힘살이 안쪽과 가쪽으로 나뉘어 두힘살근 뒤힘살의 힘줄을 감싸면서 목뿔뼈로 닿았으며, 이를 붓목뿔근힘살이 두힘살근 뒤힘살 힘줄의 가쪽으로 더 두꺼운 경우(21쪽)와 안쪽이 가쪽 부분보다 더 두꺼운 경우로 세분하였다 (11쪽). 관찰한 49쪽 중 17쪽(35%)에서 붓목뿔근이 두힘살근 뒤힘살보다 안쪽으로 지났으며, 붓목뿔근의힘살이 두힘살근 뒤힘살의 가쪽으로 주행하는 경우는 관찰되지 않았다. 두힘살근 앞힘살 부위에 존재하는 덧힘살의 형태는 매우 다양하게 나타났으며, 턱끝밑부위의 이러한 불규칙적인 형태는 비심미적인 목의 외형을 형성할 뿐 아니라 임상에서의 진단과 수술 과정에 어려움을 줄 수 있다. 대부분의 자료에서는 붓목뿔근 힘줄의 끝부분을 두힘살근의 중간힘줄이 관통하는 것으로 묘사하고 있으나, 연구 결과붓목뿔근이 두힘살근 뒤힘살의 안쪽으로 지나는 경우가 35%를 차지하였다. 본 연구는 두힘살근 부위의 해부학적구조 관계에 대한 보다 정확한 이해와 더불어 턱끝밑부위(submental region)와 위목부위(upper neck region)의 수술을 포함한 치료 시 적용 가능한 지침을 제시할 수 있을 것으로 기대한다.
Abstract
The digastric muscle is located in the suprahyoid region which consists of anterior belly, intermediate tendon and posterior belly. This muscle is an important landmark when performing an operation of submental and upper neck region. Previous researches have reported about variations of the anterior and posterior belly of digastric muscle. However,there are few studies about the general morphology of the digastric muscle and the relationship with surrounding muscles. The purpose of this study was to analyze the morphology of the anterior belly of digastric muscle and confirm the topographic relationship between the digastric muscle and the stylohyoid muscle of Korean. Thirty-four cadavers (21 males, 13 females; mean age 65 years; range 24~89 years) were used in this study. The skin, subcutaneous tissues, superficial fascia and platysma were removed and a detailed dissection was performed, with extreme care being taken not to damage underlying the muscles of submental and upper neck region. After the dissections,all specimens were sketched and photographed. In 8 specimens, we observed the accessory bellies of the anterior belly of digastric muscle. We classified the accessory bellies into the crossover type (five specimens, 14.7%) that cross the mandibular raphe and unilateral type (three specimens, 8.82%). The findings resulting from observation of the anatomical relationship between the posterior belly of digastric and stylohyoid muscles, the posterior belly of digastric muscle perforated the stylohyoid muscle in 32 cases (65%) out of 49sides. This case was subdivided into the belly of the stylohyoid muscle lean to the lateral (twenty-one specimens,42.9%) or medial side (eleven specimens, 22.4%) of the posterior belly of digastric muscle. In 17 specimens (35%), the stylohyoid muscle existed on the medial side of the posterior belly of digastric muscle.
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