经口内切口行下颌角及骨外板截除的面下部轮廓整形术

目的探讨经口内切口行下颌角及骨外板截骨术对面下部轮廓的治疗效果。方法在鼻气管插管全身麻醉下,对68例因下颌角肥大致方形脸的患者行口内切口定位,并肿胀麻醉,充分显露下颌截骨区,直视下用来复锯行下颌角和部分下颌骨升支、水平支外板斜行截除术,颏孔周围以小圆柱磨头磨平,放置负压引流并关闭黏骨膜切口。结果所有患者术中一次性截除的骨片完整,术中及术后无大出血、血肿、感染和神经损伤等并发症发生。术后随访效果满意,切口均I期愈合。结论经口内切口行下颌角及骨外板斜行截骨的手术操作方法简单、安全,手术时间短且效果良好,适合大部分情况的下颌角肥大的治疗,值得临床推广。     

内窥镜辅助下口内入路下颌角截骨术29例体会

目的探讨内窥镜辅助下口内入路下颌角截骨改脸形的手术方法。方法内窥镜辅助下,经口内入路,先用小圆钻钻孔,之后用来复锯截除下颌骨外板、摆动锯长斜形或弧形截骨。结果本组共29例患者,术后随访3个月以上,效果满意26例,不满意3例。术后伤口均Ⅰ期愈合,开口度、口型及咀嚼功能均正常,无血管损伤、下齿槽神经损伤、下颌骨意外骨折等严重并发症发生。结论内窥镜辅助下口内切口下颌角截骨重塑面部轮廓手术是安全有效的手术方法。     

口内入路应用直角钻打孔法截骨和摆动锯截骨矫治下颌角肥大的比较研究

目的:探索一种简单有效而且风险小的下颌角肥大矫治术.方法:对76例下颌角肥大患者随机分为两组,均采用口内入路.A组37例,全部应用传统的摆动锯进行下颌角截骨术;B组39例,全部应用直角钻打孔法截骨,即在下颌角的预设截骨线上打一排全层穿通的小孔,然后用骨凿凿下要切除的下颌骨.结果:B组患者术中及术后出血明显少于A组,B组术中未有1例损伤知名血管,而A组有3例分别损伤了面动脉和下颌后静脉,术后B组较A组患者肿胀轻,恢复快.随访6个月～1年,两组患者下颌角间距明显变小,外形满意,两组患者满意率没有明显差别.结论:直角钻打孔法截骨和摆动锯截骨矫治下颌角肥大都能达到满意效果,但前者比后者更安全、并发症更少、风险更小.     

口内入路三角块截骨并外板去除和咬肌修薄矫正严重方脸畸形

目的：应用三角块截骨、外板去除和咬肌修薄联合颏部截骨治疗严重方脸畸形.方法：应用口内入路，改良的下颌骨矢状劈开去除外板、摆动锯去除下颌角和咬肌修薄矫正下颌角咬肌肥大，颏部截骨前下移动，取下的下颌骨块充填固定矫正颏部短小.结果：应用该方法治疗严重方脸畸形7例，效果良好，脸型改善明显.结论：三角块截骨、外板去除和咬肌修薄联合颏部整形对矫正严重方脸畸形具有良好的效果。     

下颌角缩小术三个关键点的分析

目的在下面部骨性轮廓改形的手术中,寻找下颌骨最佳截骨部位以获得更好的手术效果。方法对382例女性受术者,经口内入路,在气管插管全身麻醉下,利用电动往复锯片的弹性,原位调整锯片切入骨质的角度,一次性整体截除下颌骨升支下部、下颌角、下颌骨外板、下颌骨体下缘及部分颏骨,将残端磨削平滑圆润,线条流畅。结果早期为追求下颌角最大程度地截骨缩小下面部,致出现俗称“马脸”变形、第2下颌角,8例均是由于早期手术对下颌骨体及下缘、下颏处理不到位。术后随访101例,医患双方对效果非常满意61例,满意22例,基本满意11例,不满意5例,差2例。结论下面部骨性缩小的3个关键点足下颌角后份、下颌骨体中份和颏骨前份。     

下颌角截骨术与下颌角外板矢状劈开术联合矫治低角型下颌角肥大

目的：下颌角肥大有多种式术可选,对于低角型下颌角肥大,往往一种式术很难达到满意的矫治效果,本文选择了一组低角型下颌角肥大患者,来研究下颌角截骨术与下颌角外板矢状劈开术联合应用治疗低角型下颌角肥大的治疗效果。方法：选择本科室2005年8月～2005年11月间治疗的24例低角型下颌角肥大患者,完善术前检查与分析。在全麻下应用下颌角截骨术与下颌角外板矢状劈开术进行联合矫治。术后观察治疗效果,并在8周后对所有患者进行随访,调查患者满意度。结果：所有24例患者矫治后Ⅰ期愈合,所有患者下颌角角度增大,两下颌角间宽度明显减小,达到了下颌角的正常美学标准。8周后随访,所有患者均对治疗效果表示满意。结论：下颌角截骨术与下颌角外板矢状劈开术联合应用,可有效地矫治低角型下颌角肥大,使患者下颌角达到一个理想的美学标准。     

下颌角截除并下颌骨外板切除一次成形面下份缩小术

目的:探讨下颌角截除与下颌骨外板切除术一次成形的可行性。方法:全身麻醉,口内进路,在下颌骨外板切除时,附加特定的设计,在切除外板的同时,选择性的将下颌角部分切除。结果:大多就医者出院时拍照与术前已有较大改观,效果满意。结论:下颌角截除与下颌骨外板切除术一次成形可以简化手术创伤,在下颌缩小设计方面具有可控性。     

口内进路下颌角及咬肌肥大矫正术

为了避免面部留有切口疤痕,寻找出一种简单方便的回内进路手术方式。方法：口内进路、用skruber摆动锯截除肥大的下颌角,来复锯经日内补充截除骨断面下部骨突起及部分骨下绿,再用长柄骨磨头进一步磨改。结果：12例患者面形改善明显。结论：下颌角及咬肌肥大采用正颌外科技术经单纯的日内进路不需作辅加切口即能达到良好的手术效果。     

下颌骨角全层截骨加下颌骨外板劈除行方形脸改型术

目的 寻求一种新的更有效的方形脸改型术式.方法 对68例(年龄21～40岁,女65例,男3例)方形脸求术者用高速涡轮气钻和骨凿实施了口内入路下颌角全层三角形截骨加下颌外板劈除术,咬肌肥大者同时行咬肌内层切除术,颊部丰满者则行部分颊脂垫摘除.结果 使用高速涡轮气钻和骨凿截除全层下颌角和劈除下颌外板极为容易.56例3～24个月术后随访,双下颌角间距明显缩小,脸型呈椭圆.无下颌不对称、下颌意外骨折.侧方轮廓自然.结论 下颌角全层截骨加下颌外板劈除不仅可有效缩小下颌正面宽度,而且还能改善下颌侧方轮廓,是方形脸改型的一种有效术式.     

下面部宽大综合整形

目的探讨简便、安全、有效的下面部宽大的综合修复方法。方法根据术前下颌角宽大的情况,在局部神经阻滞加局部浸润麻醉下,经口内入路分别采用下颌角磨削、角部弧形截骨和升支外板截骨,结合咬肌部分切除、颊脂垫部分切除和面颊部皮下脂肪抽吸等手术,整体全面重塑下面部轮廓。结果共102例,对71例进行4～24个月随访,其中60例满意,9例尚可,2例不满意,满意率为97％。结论针对下面部宽大的原因采用单一或联合手术,对下面部骨组织和软组织综合塑形,符合美容手术原则,对受术者全身影响小,并发症少,效果好。     

矢状劈除下颌骨体外板及部分下颌角面改形术

目的：探讨面下1/3过宽的手术矫治方法。方法：采用下颌骨体矢状劈骨、切除部分下颌角、去除部分深层咬肌的方法治疗该类患者。结果：7例患者,术后面下部宽度明显减少,比例协调,双侧对称,X线复查截骨线圆钝,愈合好。结论：该法有效地纠正了面下1/3过宽,并且术后下颌角外形自然,曲线柔和,整体面形轮廓协调柔美,医患双方均感满意。     

下颌骨分区截骨术重塑面下部轮廓

目的将下颌骨以美学观为准分为升支下区、下领角区、下颌体区、颏区。通过分区截骨术，矫正面下部前份、中份、后份宽大的不良形态。方法结合下颌骨外板矢状劈开和下颌骨角部和下颌骨下缘的全层截骨术和隆颏术，对下颌骨角部、体部和颏部进行分别截骨重塑，同时矫正面下部正面和侧面的欠美外形。结果于2003年5月至2005年8月，共开展此类手术23例，下颌角、升支下部、体部截骨18例，颏部截骨5例。隆颏术的方式有固体硅胶假体置入12例，膨化聚四氟乙烯假体置入3例，自体下颌骨外板移植5例。术后外形均得到明显改善，外观满意，未发生颏神经断裂并发症，3例口唇麻木于1～3个月后自然恢复。结论对下颌骨进行分区截骨可以更全面的矫正面下部过宽，重塑面下部的轮廓以美化面型。     

Lower face remodeling by mandibular angle ostectomy

The results of lower face remodeling using various mandibular angle reduction techniques in 212 patients with hypertrophy of mandibular angle are presented. Hypertrophy of the mandibular angle is the most common lower face deformity in Asian women. The deformity can usually be corrected with various types of mandibular angle reduction. The surgical techniques reported include intraoral mandibular angle ostectomy, intraoral ostectomy of the lateral cortex around the mandibular angle, reduction mandibuloplasty by retroauricular approach as well as intra/extraoral approach. The key point for a successful operation is selection of surgical methods and choosing a line for mandible ostectomy based on the different types of prominent mandibular angle. The intra/extraoral approach was the most commonly performed ostectomy in this study and had few complications.     

Classification and Treatment of Prominent Mandibular Angle

In Oriental culture, the contour of the mandibular angle is important for feminine facial shape because a woman who has a wide and square face is thought to have had an unhappy life. A prominent mandibular angle, which does not coincide with the natural look, produces a characteristic quadrangle, coarse, and muscular appearance. So Oriental women who have a prominent mandibular angle want to have an ovoid, reduced, and slender face by aesthetic mandibular angle resection. Many satisfactory corrections of a prominent mandibular angle by various operative techniques have been reported. But reasonable morphologic classification and treatment were not reported. So we classified prominent mandibular angles into four groups by morphology and operated on the patients according to their classification with different modalities: no square shape but only a reduced gonial angle in the profile view—class I, mild form; severe mandibular angle protrusion with lateral protrusion—class II, moderate form; a definite square-shaped angle (class II) with masseteric hypertrophy—class III, severe form; and combined prominent mandibular angle and chin deformity—class IV, complex form. We use angle ostectomy through the intraoral route alone or with an additional external stab incision for class I. An external stab incision to set up the reciprocating saw is sometimes helpful in class I cases because there is no lateral protrusion of the angle. For class II cases, we use conventional intraoral angle ostectomy only or angle splitting ostectomy with contouring. For class III cases, we use angle splitting ostectomy and contouring with partial masseteric myectomy. In class IV, we use angle ostectomy and additional genioplasty. During 7 years, we have performed 46 cases of mandibular angle resection. Of the mandibular angle resection cases, 19 were class I, 15 were class II, 9 were class III, and 3 were class IV. A total of 42 patients were satisfied with the postoperative results. For reasonable and satisfactory final results, classification according to the mandibular angle shape and suitable treatment according to the classification are essential.     

口内入路两种方法下颌角修整术矫正脸型的临床应用

目的:探讨经口内入路不同术式矫正下颌宽大的适应证及疗效。方法:对85例下颌宽大患者随机分为两组,均采用口内入路。A组43例,全部采用摆动锯进行下颌角截骨术。B组42例,全部采用磨骨法磨除下颌角。结果:磨骨组患者较截骨组肿胀轻,恢复快。磨骨组术中出血少于截骨组。随访6个月～1年,下颌骨正位片测量显示两组患者的下颌角间距和面下三分之一宽度均变小,两组满意率均较高。结论:截骨法和磨骨法均能达到矫正面型的满意效果,但2型(外翻型下颌角)采用磨骨法较好,1型(后下突出型下颌角)和3型(复合型)截骨法效果更好。     

Reconstruction of a maxillary defect using the remnant bone of mandibular angle ostectomy

The buttress is the cornerstone of the midface both functionally and aesthetically. Therefore, fracture of the buttress requires surgery. A patient wanted cosmetic surgery simultaneously with a reduction of facial bone fracture. To achieve this, we reconstructed the defect of the maxillary buttress using the remnant bone of the mandible angle ostectomy. A 27-year-old man presented with a left maxilla fracture and defect at the maxillary buttress. Since the patient was considering cosmetic surgery to alter his square face, we planned a mandibular angle ostectomy and used the remnant bone as an onlay bone graft for maxillary reconstruction. There was no complication and the patient was satisfied with both the functional and aesthetical look of the reconstructive surgery. We reconstructed the defect of the maxillary buttress successfully using the remnant bone of the mandible angle ostectomy. Although this technique cannot be applied to every patient, reconstruction of facial bone defects with the remnant bone of the mandibular angle ostectomy may be a potential option in some cases.     

下颌骨外板截除术矫治下颌角肥大的可行性研究

目的 探讨下颌骨外板截除术矫治下颌角肥大的可行性.方法 中国实验用小香猪8头,建立截除下颌骨体部外板的动物模型;自下颌骨颏孔后0.5 cm至角前切迹,截除单侧面积3.0 cm×1.5cm下颌骨体部外板,对侧不手术作为自身对照;术后24周,处死动物,进行下颌骨大体形态观察,分别测量颏孔后1、2、3、4、5 cm处下颌骨内、外板及全层厚度,同时行下颌骨局部生物力学的测定.结果 下颌骨外板截除术后,局部骨骼大体形态无明显变形;术侧下颌骨体部内板变厚,外板变薄,总的厚度变薄(P＜0.05).术侧下颌骨生物力学指标:最大载荷(1397.74±889.17)N,刚度(7994.69±5137.7)N,强度(754.74±370.90)N/cm2与对照侧相比,差异均无统计学意义(P＞0.05).结论 动物实验结果提示,下颌骨外板截除术矫治下颌角肥大手术可行.     

单纯下颌骨磨削法矫治下颌角肥大

目的 探讨下颌角肥大骨磨削法治疗的临床效果。方法 在局部肿胀麻醉下，采用口内切口入路，常规分离显露下颌骨，在预定需要矫正的下颌骨区域，使用特殊器械磨削下颌骨体外侧皮质骨、下颌骨下缘及下颌角骨质，同时对部分肥大的咬肌进行处理，矫治下颌角肥大。结果 对58例下颌角肥大患者均行下颌骨磨削法矫治，除1例术中损伤下齿槽血管引起出血外，无其他并发症发生。术后随访6～18个月，全部病例取得良好的矫治效果。结论 下颌骨磨削法矫治下颌角肥大是一种并发症少、安全有效的好方法。与截骨矫治下颌角肥大的方法相比，该术式保留了下颌骨的内板。维持了颌颈区的立体感。