口内纵行小切口硅胶假体隆颏术

目的：探讨应用口内纵行小切口硅胶假体隆颏术和减少手术并发症的方法.方法：根据颏部解剖特点借鉴隆鼻术的手术技巧，采用口内单一纵行小切口颏骨膜下隆颏术，矫治轻、中度小颏畸形126例.结果：本组126例，随防78例，6个月至8年.外形满意，无一例假体裸露.结论：应用口内纵行小切口硅胶假体隆颏术具有切口隐蔽，损伤小、并发症少、简便易行等特点，适合轻、中度小颏畸形的矫正。     

经口内切口假体植入矫治下颌后缩畸形的研究

目的 评估经口内切口假体植入骨膜下隆颏术的效果。方法 用局部解剖方法研究尸体颏区形态结构,进行隆颏术43例结果全部病例外形改善满意,无一例出现并发症。结论 经口内切口假体植入骨膜下治疗下颌后缩畸形效果良好,是一种安全而有效的方法。     

口内单侧侧方切口在隆颏术中的应用

目的:介绍一种适合使用假体隆颏的口内切口,以方便植入腔分离和假体植入,减少并发症,提高手术效果。方法:采用口内单侧侧方切口,即切口选择在右下2～3牙龈(左手操作者可将切口选择在左侧),距唇龈沟0.2～0.3cm处,长约0.5～1cm。采用局部麻醉。结果:自2003年11月至今,作者采用该切口行假体植入隆颏术18例,获得满意效果,未出现并发症。结论:采用口内单侧侧方切口行隆颏术,具有方便植入腔分离、假体植入、有利于减少并发症发生等优点。     

颞深筋膜浅层假体置入颞部填充术的经验

目的 探讨在颢深筋膜浅面分离,硅胶假体置入的颞部填充术的临床效果及安全性.方法 单纯的颞部填充术采用局部肿胀麻醉,经颞部发际内小切口达帽状腱膜下,紧贴颞深筋膜表面行置入腔隙分离,接近眶外侧缘和颧弓上缘时谨慎钝性分离,将修剪好的硅胶假体经切口置入,准确定位固定,切口缝合后局部加压包扎.结果 应用于47例(94侧)的颞部填充术患者,术后效果满意,并发症少.无一例发生永久性面神经颞支损伤.结论 采用硅胶假体作为填充材料,置入颞深筋膜的浅面腔隙,手术操作简便,效果确切,安全可靠,不易出现面神经颞支损伤,值得推广使用.     

口内双侧纵形小切口U形剥离法治疗小颏畸形

目的 探讨口内双侧纵形小切口U形剥离法隆颏术矫正小颏畸形的临床效果.方法 自2011年1月至2012年9月,应用口内双侧纵形小切口U形剥离法隆颏术治疗小颏畸形36例,均采用口内双侧纵形小切口入路,骨膜下U形分离腔隙,血管钳引导置入硅胶假体.结果 对所有患者随访3～15个月,术后恢复良好,无切口裂开、假体移位、假体位置不对称等并发症发生,颏部外形满意.结论 口内双侧纵形小切口U形剥离法隆颏术切口隐蔽,下唇肌肉无明显破坏,假体易于放入,双侧对称性良好,术后固定要求不高,该方法易于掌握,安全有效.     

口内双侧横行小切口隆颏术

目的:探求一种通过口内双侧横行小切口使假体置入更加方便准确、减轻术中损伤及术后并发症的隆颏手术新方法。方法:根据颏部解剖结构特点,采用口内双侧粘膜上横行小切口,切口定位于双侧尖牙下方距唇龈沟5mm处,长约8mm。横行切开粘膜及粘膜下组织,分别从两侧粘膜切口纵行向下钝性分离肌层至骨膜,用剥离子在骨膜下剥离拟置入假体腔隙,假体置入后肌层及粘膜分层缝合。结果:笔者采用该切口进行硅胶假体置入隆颏术共3例,切口均Ⅰ期愈合,未出现明显术后并发症。随访1～6个月,均获得满意效果。结论:采用经口内双侧横行小切口进行硅胶假体隆颏术对矫正McCarthyⅠ型轻度小颏畸形可获得满意术后效果,且保留颏部肌肉完整性并避开颏神经,创伤小,有利于减少术后并发症等优点。     

硅胶假体隆颞术

1995～ 1998我们先后收治颞部凹陷 16例 ,31侧 ,经用硅胶假体充填治疗 ,效果满意。1　手术方法女性于手术前 3ｄ起 ,用 1∶5 0 0 0新洁尔灭溶液洗头 ,1ｄ 2次。男性剃光头。术前于坐位 ,用美蓝液描出颞凹陷区的范围 ,并剪纸样 ,依样将医用硅胶切塑成形 ,边缘成斜坡状 ,灭菌备用。在局部浸润麻醉下 ,经颞部发际内顺毛发方向切口 ,在颞深筋膜表面向前分离 1ｃｍ ,切开颞深筋膜 ,沿颞肌膜表面钝性分离至眶上外侧凹陷区 ,将备用的硅胶块置入剥离的腔隙内 ,以无明显隆突 ,假体边缘平整 ,双侧对称为满意。然后分层缝合切口 ,在假体后缘经皮肤作褥…     

经口内切口硅胶体隆颏术30例报告

颏短小畸形成形术主要有骨水平延长或加植骨颏成形术、硅胶体植入增大颏成形术以及其他一些方法。笔者所在医院自１９９５年２月至１９９８年２月对单纯颏部短小畸形的病例采用经口内横切口行硅胶体隆颏术共３０例，取得了较满意的效果，现报道如下。１临床资料本组３０例，男性６例，女性２４例，年龄１８岁～２７岁。均为先天性颏短小畸形，且无明显咬合错位畸形者。采用国产医用硅胶模型植入１９例，硅胶块术前自行设计雕塑者１１例。２手术方法手术前按患者颏部畸形轻重程度用美蓝标出所需充填范围，选择合适的硅胶体，如成品不适用，则…     

治疗小颏畸形的三种术式对比分析

目的 对比分析硅胶假体置入隆颏术、自体骨移植隆颏术和颏部水平截骨颏成形术的临床效果和常见并发症。方法 通过三维CT、头颅正侧位X线检查和第2次手术观察，分析三种治疗小颏畸形手术各自的优缺点并明确其适应证。结果 硅胶假体置入隆颏术后存在假体位置异常、颏部骨质吸收、假体周围骨膜反应、颏部矫正不足等缺点；自体骨移植隆颏术后存在较严重的远期移植骨质吸收和颏部形态改善不足问题；颏部水平截骨颏成形术矫正小颏畸形效果良好。结论 硅胶假体置入隆颏术适用于轻度的下面部矢状方向发育不良、不伴有前下面高不足、无面部不对称且颏唇沟较浅的患者。颏部水平截骨颏成形术适用于各种程度及类型的小颏畸形的矫治，尤其适用于颏部偏斜和面部不对称的调整。自体骨移植隆颏术长期效果不佳，应谨慎使用。     

硅胶假体植入矫治小颏畸形

经口内位于唇粘膜系带上缘作宽约２０ｍｍ的“Ｖ”形切口，按照预先标记的范围在骨膜上、肌肉下分离出底大口小的烧杯状腔隙。在雕刻成形的硅胶假体中心轴线上贯穿丝线，假体植入腔隙后上提丝线，对准门齿正中，观察确定假体位置是否正确，并将丝线缝合固定在正中线投影下的骨膜上，以防止假体偏移。分离之颏前肌与假体上缘的骨膜作包埋缝合。用该法治疗小颏畸形９８例（女９７例，男１例），随访４２例，满意率９７％。硅胶假体植入矫治小颏畸形是一种安全、有效、经济、简便的方法。     

自体脂肪移植在颞部凹陷填充中的应用

目的探讨自体脂肪移植在颞部凹陷填充中的应用。方法采用低压抽吸、低速离心、多点、多隧道、多层次、少量注射(Low-pressure liposuction,Low-speed centrifuge,Multi-points,Multi-tunnels,Multi-layers and Low-amounts injection,3L3M)的自体脂肪移植技术,对36例颞部凹陷患者行多区域脂肪移植。1颞区在皮下层、颞浅筋膜层、肌肉层行填充;2额区在额肌皮下层和额肌下行填充;3眶外侧区于皮下层行极少量的脂肪填充。结果 36例颞部凹陷患者经脂肪填充后外形均有明显改善。随访3~24个月,各填充区外形保持较好,移植脂肪吸收率较低,三方评价满意率分别为83.3%、88.9%及86.1%。结论采用3L3M的自体脂肪移植技术填充颞部凹陷,可以得到满意的效果。     

Silicone bleed associated with double-lumen breast prostheses

In an effort to reduce contact of tissue with silicone gel, it has become popular to use double-lumen prostheses in mammaplasty. We report a case of silicon incorporation by human tissue after insertion of a double-lumen implant.     

Silicone gel granuloma following compressive mammography

Silicone implant rupture is well recognized, particularly with the thin-walled implants inserted some years ago. On occasions a chronic granulomatous inflammation has been noted if silicone globules have infitrated the tissues. The rupture may occur apparently spontaneously or after trauma, including attempts at external closed capsulotomy. The case report presented in this article documents rupture and dissemination of silicone caused by compressive mammography. Recent practice suggests that in order to enhance the image produced by mammography, particularly in the presence of the masking of a silicone implant, extreme compression is the preferred technique but perhaps should be regarded with some caution in patients with breast implants.     

Silicon assays in women with and without silicone gel breast implants--a review.

During the past 5 years, as the failure properties of silicone gel breast implants have emerged, there has been considerable interest in measuring the levels of silicone and silicon in blood, serum, breast milk, and body tissues. Assays have been done in control patients without implant exposure, and in patients with silicone gel implants in an attempt to predict implant failure. Nuclear magnetic resonance measurements of silicone compounds have not been helpful because of their low sensitivity of detection. However, all compounds containing the element silicon, which includes silicone, have been measured accurately. Modern techniques, such as electrothermal atomic absorption spectrometry, direct-current plasma emission spectrometry, and inductively coupled plasma emission spectroscopy have allowed precise measurement of silicon in body fluids and tissues. Using these techniques, recent studies have demonstrated consistent levels of silicon in the blood and plasma of control women without exposure to implants. In one study, plasma silicon was shown to be 140 +/- 10 ng per milliliter. In four other studies, serum silicon levels in control patients were the following: mean, 130 +/- 70 ng per milliliter; mean, 170 +/- 100 ng per milliliter; median, 100 ng per milliliter (range, 30-209 ng per milliliter); and 10 to 250 ng per milliliter. Three independent studies have shown that women with silicone gel implants have higher blood and serum silicon levels than control subjects, but their values were still within the range of control subjects. One study has shown that the mean silicon level in breast milk was not significantly different between 15 implant patients and 34 control patients. The measurement of silicon in control breast tissue has shown consistent results in three different studies, with most tests varying from <0.2 to 2.2 microg per gram dry weight. Three studies have shown that capsules from women with silicone gel breast implants had markedly elevated silicon levels compared with control breast tissue. Median silicon levels varied from 9,980 to 14,390 microg per gram dry weight. There was no significant difference in capsule silicon level between intact and ruptured implants or associated with implant duration in situ or year of implantation. Four studies have shown that capsules from saline implants had elevated levels of silicon compared with control tissue, but their silicon levels were much lower than those of gel implants. The median levels of silicon in the capsules of these studies were as follows: 7.7, 71.5, 198, and 1,100 microg per gram dry weight. Based on current knowledge, because of the large variability among patients, the use of silicon measurements in blood, serum, breast milk, or implant capsule tissue has no clinical role for the effective monitoring of implant leakage in women with silicone gel breast implants.     

内镜下额颞部除皱术的改进

目的 探讨将内镜技术应用于除皱术中以来,通过技术的改良,以获得创伤小,避免神经、血管损伤,彻底止血,固定确实的效果.方法 颞部采用两个间断的小切口,避开颞浅血管的分支,在内镜辅助下于颞浅筋膜下进行剥离及止血、悬吊固定.额部在发际后做3个横行切口,在内镜辅助下操作,将额部剥离后的皮瓣向上悬吊固定于切口下方颅骨外板上.结果 采用内镜额颞部除皱58例,术后肿胀程度轻,无明显瘀青,术后1周均能恢复社交活动.术后1年随访有56例(96.55%)明显改善;2年随访35例中有33例(94.29%)明显改善.未出现面神经损伤病例.结论 通过内镜辅助下除皱术可充分认识到术中明视下操作,能减少术中血管、神经的误伤,便于分离、止血、缝合及悬提固定,通过技术改良能达到创伤更小,康复更快,效果更满意的目的,因此扩大了手术适应人群.     

内镜下额颞部除皱术的改进

目的探讨将内镜技术应用于除皱术中以来,通过技术的改良,以获得创伤小,避免神经、血管损伤,彻底止血,固定确实的效果。方法颞部采用两个间断的小切口,避开颞浅血管的分支,在内镜辅助下于颞浅筋膜下进行剥离及止血、悬吊固定。额部在发际后做3个横行切口,在内镜辅助下操作,将额部剥离后的皮瓣向上悬吊固定于切口下方颅骨外板上。结果采用内镜额颞部除皱58例,术后肿胀程度轻,无明显瘀青,术后1周均能恢复社交活动。术后1年随访有56例（96．55％）明显改善;2年随访35例中有33例（94．29％）明显改善。未出现面神经损伤病例。结论通过内镜辅助下除皱术可充分认识到术中明视下操作,能减少术中血管、神经的误伤,便于分离、止血、缝合及悬提固定,通过技术改良能达到创伤更小,康复更快,效果更满意的目的,因此扩大了手术适应人群。     

Primary breast lymphoma in a patient with silicone breast implants: a case report and review of the literature.

Primary breast lymphoma is a rare disease. Estimated incidence is 72 to 910 cases per year. We report a patient who developed anaplastic large cell lymphoma in her breast adjacent to a silicone breast implant 14 years after elective breast augmentation. Metastatic work up revealed no other focus of disease. She was treated with systemic chemotherapy. Review of the literature revealed five cases of primary breast lymphoma associated with a breast implant. Patients presented with either a mass or a periprosthetic fluid collection an average of eight years after either silicone gel-filled or saline-filled breast implant placement. Diagnosis was obtained with either biopsy or aspiration. All patients had the same histological subtype, anaplastic large cell lymphoma. It is unlikely that any cause-effect relationship exists between breast implants and primary breast lymphoma since chance alone could easily account for the low incidence of primary breast lymphoma in patients with breast implants. However, a fluid collection around a breast implant may be a unique presentation for this population of patients. Clinicians should include malignancy in the differential diagnosis of periprosthetic fluid collections and periprosthetic masses. Useful diagnostic tests may include MRI, aspiration with cytology, and percutaneous or open biopsy.     

Rupture of an expander prosthesis mimics axillary cancer recurrence.

Regional silicone gel migration from a ruptured breast implant has been reported at different locations including the upper extremity, chest wall muscles, axilla and back. We report a patient who presented with an axillary mass that mimicked a regional recurrence 5 years after breast cancer reconstruction with a latissimus dorsi musculocutaneous flap and silicon gel expander-prosthesis. Surgical exploration revealed that the mass contained silicone gel around the port of the breast expander that had ruptured. The mass was confluent with an intracapsular silicone leak through a tract along the tube of the expander port.     

Silicone gel breast implant rupture presenting as a fluctuant back mass after latissimus dorsi breast reconstruction

The authors describe a patient who presented with acute onset of a lower back fluctuant mass 12 years after breast reconstruction with a latissimus dorsi musculocutaneous flap and silicone gel implant. Aspiration and subsequent surgical exploration revealed this mass to be free-flowing silicone gel within a cavity that was confluent with the breast implant capsule through an axillary tunnel. Excision of the back cavity, explantation with subtotal capsulectomy, and implant replacement resolved the problem. Although distant migration of extracapsular silicone gel from the breast to the axilla, arm, abdomen, and groin has been described, the authors think this represents the first reported case of distant migration of silicone gel to the lower back.