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。

Comparison study of three methods for the treatment of microgenia

OBJECTIVE: To analyze the clinical results and complications of three methods for microgenia, including chin augmentation with silicone implant, bone autograft, and genioplasty. METHODS: The advantages and disadvantages of the three methods for microgenia were assessed through 3-D CT reconstruction, X-ray and intraoperative observation during the second operation. The indications for each technique were also studied. RESULTS: The frequently observed problems for chin augmentation with silicone implants were implant malposition, underlying bone absorption, periosteal reaction and undercorrection. Chin augmentation with bone autograft had a great long-term bone graft absorption which led to undercorrection. Genioplasty showed a satisfactory cosmetic result with no serious complication. CONCLUSIONS: Chin augmentation with silicone implant is suitable for mild microgenia with a shallow mentolabial groove, but without facial vertical insufficient and facial asymmetry. Genioplasty can be used in all kinds of microgenia in any severity, especially those with deviated chin and facial asymmetry. Chin augmentation with bone autograft can't achieve good long-term result and should be applied prudently.