第一、二鳃弓综合征颜面不对称的整形外科矫治

目的探讨第一、二鳃弓综合征面部不对称畸形的整形外科矫治方法。方法根据第一、二鳃弓综合征患者临床及X线所示面部双侧不对称情况,采用健侧下颌骨外板去除、颧骨截骨降低;患侧下颌体、颧骨应用健侧下颌骨外板贴附植骨或高密度多孔聚乙烯(Medpor)假体置入等术式,配合颏部水平截骨颏成形术,以缩小面部双侧宽度的差异,矫治颜面不对称畸形。结果共矫治23例,经6个月至3年的术后随访观察,双侧面部宽度差异明显缩小,正面观面部不对称明显改善。结论第一、二鳃弓综合征面部骨骼发育畸形是三维方向的,双侧面骨宽度的差异,是造成正面观面部不对称的重要因素,根据受术者的具体情况,采用以上术式的组合,扩充患侧或同时缩窄健侧骨骼,进行面部骨性支架重建,可以取得良好的矫治效果。

Orthopedic treatment of facial asymmetry in first and second branchial arch syndrome

Objective To explore the methods in treatment of facial asymmetry in the first and second branchial arch syndrome. Method According to the appearance of the face and X-ray, several operations were used to reduce the width disparity of the bilateral sides and to rectify the asymmetry of the face. The operations included mandibular outer cortex osteotomy, malar reduction at the normal side, autogenous mandibular outer cortex onlay grafting, medpor implantation to mandible and malar at the affected side, and genioplasty. Results 23 cases were treated with the above-mentioned methods. After 6 months to 3 years follow-up, the width difference between the bilateral sides was diminished and the asymmetry of the face was greatly improved. Conclusions The facial bone deformities of the first and second branchial arch syndrome are three-dimensional, and the disparity in the bilateral width of the face is an important factor that results in facial asymmetry. According to patient's situation, the above methods can be used to augment the affected side or reduce the normal side simultaneously for reconstruction of the facial skeleton. The results of the treatment are satisfactory.