眉弓轮廓的三维CT初步测量及分析

目的　初步了解中国人眉弓的正常形态 ,为眉弓轮廓的美容改型提供依据。方法　采用计算机辅助三维CT重建技术 ,对 4 0例正常人眉弓形态结构做立体的定量测定与分析。结果　男性在额宽、额高、颅长、眶上嵴突、眶高、上下眶缘之差及耳前鼻根距均明显大于女性 (P <0 .0 5 ) ,而青年组在前额高、颅长、眶上嵴突、前额角也明显小于老年组 (P <0 .0 5 )。结论　眉弓轮廓存在性别差异 ,并有随年龄增大而前突的趋势。     

超声骨刀行眉弓轮廓过突矫治术

我们于2010年应用超声骨刀(ultrasonic osteotomy)对1例眉弓轮廓过突美容就医者进行了前额截骨术,收到理想效果,同时与另1例采用常规电动来复锯前额截骨矫治的相同病例进行了比较,现将比较情况报告如下,并结合文献报道对超声骨刀的截骨原理、特点以及在前额轮廓畸形矫治中的应用进行初步探讨.     

高密度多孔聚乙烯修复颅骨缺损远期断裂一例

病例　患者男 ,2 1岁。 1996年 10月因车祸致左额眶缺损、左眼失明 7个月入院。专科检查 :左前额及眉局部创口已愈合 ,瘢痕已软化 ,左眼无光感 ,前额部与相连眉弓全层骨缺损 6ｃｍ× 8ｃｍ ,缺损区有明显的脑组织搏动征象。手术方法及结果　在全麻插管下 ,经双侧头皮冠状切口径路 ,翻转头皮瓣 ,暴露骨缺损区 ,发现前额缺损 (约 6ｃｍ× 8ｃｍ)、眉弓缺损以及眶上壁缺损 ,眶内软组织与颅内硬脑膜紧密粘连。术中因担心损伤脑组织 ,仅松解眶上壁前 2 / 3,然后分别于额眉弓区及眶上壁选用 6ｃｍ× 8ｃｍ、3ｃｍ× 3ｃｍ两块高密度多孔聚乙烯 (Ｍ…     

眶壁爆裂性骨折经鼻内窥镜手术治疗

目的 探讨经鼻内窥镜整复眶壁爆裂性骨折的疗效。方法 60例眶壁骨折中，眶下壁骨折28例，眶内壁骨折20例，内下壁复合骨折12例，均采用经鼻内窥镜手术整复。结果 41例复视中38例显效，2例有效，1例无效。17例眼球内陷、复视中16显效，1例有效(眼球内陷矫正良好，复视未能消失)。2例仅眼球内陷术后双眼突出度对称(显效)。总有效率98．3％(59/60)。结论 经鼻内窥镜行眶壁骨折整复术，无面部伤口，视野清晰，对周围组织损伤轻，疗效好，恢复快。     

EC胶在颅底手术中的应用体会

1997年 6月～ 1999年 8月 ,在颅底手术中应用广州白云医用胶总公司生产的 5 0 8系列医用ＥＣ耳脑胶 (以下简称ＥＣ胶 ) 41例 ,效果较为满意 ,介绍如下。临床资料一、一般资料 :41例中 ,男 2 4例 ,女 17例 ,年龄 16～ 65岁。其中眶内肿瘤及颅眶沟通肿瘤 12例 ,手术过程中将锯开的眉弓用ＥＣ胶粘合复位 ;颅底肿瘤术中用以骨面渗血的止血及硬膜修补 19例 ;大面积开放性粉碎性前颅底骨折 3例 ,用以封闭额窦及修补缺损的硬膜 ;脑脊液鼻漏 1例 ,经保守治疗 1个月无效后手术 ,采用ＥＣ胶和肌筋膜修补漏口 ;垂体瘤及三叉神经纤维瘤各 1例 ,分别用以…     

眼型重塑——重睑成形手术的综合思考

眼睛除具有重要的视觉功能外，也是传情达意。表现人的精神面貌的重要“窗口”。一双完美的眼睛，是面容美的突出标志。眼睛除了自身睑裂的长度、高度，内外眦角，上下睑缘的弧线。内外眦连线与水平线夹角，平视时角膜露出率等均要符合美学标准外，眼周部位的形态也须符合美学标准，如侧面观眉弓的高度不能低于眼球的最高处，内眦窝（又称鼻眶窝）呈弧形曲线美，上睑窝不能过于凹陷或饱满。下睑区平展，眉眼间距不能过近，眉弓与颧突间在外眦部位应形成一凹陷等。     

鼻筛眶骨骨折后继发畸形的二期重建

目的 探讨鼻筛眶骨骨折继发畸形的修复方法。方法 手术采用头皮冠状切口入路或邻近瘢痕切口入路，充分显露额鼻眶区骨折部位，用小裂钻行眶内缘弧形截骨，将突起的骨折块截除并打磨平整，缩窄两眶内缘之间的宽度。根据需要用2～3条自体颅骨外板叠加塑成鼻支架，在鼻根部用微型钛板将支架固定于额骨鼻突。充分松解内眦韧带与邻近组织的瘢痕粘连，避免复位时存在张力，必要时于眶底处充分剥离松解眶骨骨膜并纵行切开减张，使内眦韧带尽量在无张力的情况下牵拉复位至泪囊窝后上方，用钢丝穿经鼻骨固定。采用自体颅骨外板或高密度多孔聚乙烯(Medpor)修复眶内壁及其它眶壁缺损，矫正眼球内陷畸形。结果 1996年12月～2001年12月，共治疗严重鼻筛眶骨骨折晚期继发畸形患者34例，其中同时合并眶颧骨折12例、额骨骨折4例、Le Fort Ⅲ型骨折l例及Le Fort Ⅱ型骨折l例。所有患者术后畸形均获明显改善。结论 鼻筛眶骨骨折后期继发畸形手术的重点在于应用自体骨重建鼻背骨性支架，重塑鼻背轮廓；双侧眶内缘骨折突起截骨缩窄，内眦韧带复位固定和内眦整形矫正创伤性内眦距增宽，恢复鼻根部高度与内眦间距的协调比例关系；同时眶壁植骨矫正眼球内陷畸形。     

鼻眶骨折的治疗体会

鼻眶骨折为面部常见外伤,及时正确处理可使伤者在功能及美容方面有良好的治疗效果。本文报道本院自1991年至1998年收治的11例鼻眶骨折病人的治疗体会。1临床资料1.1一般资料:11例中,男9例,女2例;年龄16～60岁。就诊时间1小时至12小时不等,平均3小时。骨折类型:开放性骨折8例,闭合性骨折3例。开放性骨折中,6例有单侧鼻骨和上颌骨骨折凹陷,合并有眶底骨折3例,均有不同程度的皮下淤血肿胀、眼痛及视力模糊症状,其中2例鼻根部塌陷,眶间距明显增宽,压痛明显;筛窦眶骨折3例(2例为开放性及1例闭合性)。所有病人有程度不同了解骨折范围。1.2治疗方法…     

一期手术治疗前额凹陷前颅底粉碎性骨折并脑脊液鼻漏

目的 介绍一期手术治疗前额凹陷前颅底粉碎性骨折并脑脊液鼻漏的体会。方法 对5例病人施行一期手术。预留前额部带蒂膜瓣，电灼额叶底创伤部位蛛网膜，使局部蛛网膜下腔闭合，修补硬膜裂伤，并用生物胶与骨膜瓣粘合；修复前颅底骨缺损，恢复期对额底硬膜的支撑和密闭性。结果 全组病人均治愈，前额部观满意，5例脑脊液鼻漏，术后有4例停止，1例减少，经保守治疗后，亦停止，随访3-6月，无复发，结论 闭合受损局部的蛛网膜下腔，修补硬膜裂伤；修复或重建前颅底骨缺损，是手术成功的关键。     

软组织激光全息扫描鼻眶窝的三维数字图像分析

目的　介绍三维扫描仪在非接触条件下采集面部软组织精确数据的方法 ,为临床整形提供标准的鼻眶窝三维测量数据。方法　应用三维激光扫描仪和Geomagic软件 ,采集 12例标准汉族人的颜面轮廓 ,并对鼻眶窝进行数据测量和分析。结果　通过三维激光扫描和逆向工程软件可以再现出面部形态有意义的任一角度的三维图像 ,且精确度达到 0 0 1mm ,实验初步确定了鼻眶窝最低点的三维定位 ,描述了鼻眶窝的三维形态特征。结论　此方法可以全面反映鼻眶窝与周围结构形态学上的相互关系 ,三维激光扫描是实现术前设计、手术模拟和术后效果评价的新途径     

Surgical approaches for the correction of metopic synostosis

Premature closure of the metopic suture results in a deformity ranging from a minor variation to a severe cosmetic deformity. The three principal abnormalities comprising metopic synostosis are trigonocephaly secondary to the restriction of growth of both frontal bones, deficient lateral supraorbital rims, and hypotelorism. Seventeen of 18 patients evaluated for metopic synostosis had surgical correction of their anomalies. For a minor degree of prominence at the metopic suture, a bicoronal flap followed by shaping at the suture with a shaping burr was sufficient and yielded favorable cosmetic results. A more extensive procedure for cosmetic resolution of trigonocephaly and hypotelorism was required for those patients with more pronounced deformities. In patients with moderate to severe metopic synostosis, the following procedures were important in achieving excellent cosmetic results: a bicoronal subgaleal flap down to the supraorbital rims with preservation of continuity of pericranium with an intact periorbita; bifrontal craniotomy with complete removal of the metopic suture; dural plication in midline to achieve an immediate aesthetically pleasing contour; removal or remodeling of the supraorbital rims and nasion with replacement of the remodeled frontal bone anteriorly in order to rebuild the orbital rim and release the supraorbital bar from the anterior cranial base; and securement of the bifrontal bones anteriorly and laterally, but not posteriorly, to allow further anterior and lateral displacement of the supralateral orbital margin.     

Dr. Paul Tessier and facial skeletal masculinization

The male facial skeleton is larger and more angular than that of the female. The male skull has bossing in the area of the frontal sinuses (there is bossing even without presence of the sinuses--5% of people do not have a frontal sinus) and a small flat spot in the mid forehead between the areas of bossing and usually slightly above them. Also there is bossing in the superior lateral orbital angle. The chin on an average basis is 17% vertically higher in the male and there is more fullness laterally. The angle of the mandible is larger inferioro-posteriorly and generally flares out more laterally. The oblique line is fuller in the male. To date 6 males who have wanted to have a more masculine face have been operated on forehead, chin, and mandible. All 6 have done well and without complications. Their acceptance of this surgery has been great.     

Intraorbital schwannoma arising from the supraorbital nerve

A 67-year-old man presented a three-month history of double vision and slight numbness at his right forehead. Neurological examination on admission demonstrated diplopia at lower gaze and mild hypesthesia at right frontal. MRI disclosed an extraconal cystic mass, centered over the superior rectus muscle, in the superior part of the right orbit. 3D-CT scan in bone window image showed an erosion of the right orbital roof. An operation was performed by a transcranial extradural anterior orbitotomy. It was noticed that the supraorbital nerve entered the cyst wall of the tumor. The mass was dissected from the surrounding intraorbital fat and was removed completely. Pathologically, diagnosis of schwannoma was made. Postoperatively, the diplopia diminished, although numbness at the right forehead remained. Orbital schwannomas constitute 1 to 4% of all orbital tumours. Identification of the nerve of origin of the tumours is difficult. Including this present case, only 11 cases of supraorbital nerve schwannoma, and only three cases of the tumour without neurofibromatosis, have been reported.     

Forehead anatomy: arterial variations and venous link of the midline forehead flap.

The largest prospective cadaver study done over a 3-year period to investigate the arterial variations of the forehead is presented. The primary goal was to find anatomical support for various forehead flaps previously designed. Thirty cadaver foreheads (60 hemi-foreheads) were dissected from deep to superficial to identify arterial variations. The arteries were filled with a latex solution prior to dissection. The results show that the supratrochlear and dorsal nasal arteries have a relatively constant origin. Vertical (VB), oblique (OB), medial (MB) and lateral branches (LB) of the supraorbital artery were identified. The frontal branch of the superficial temporal artery (FBSTA) was found to continue in the direction of the scalp at the lateral orbital rim vertical line and gave off a transverse branch, the transverse frontal artery (TFA), to supply the forehead. The oblique branch of the supraorbital artery (OBSOA) most often anastomosed with either the transverse frontal artery or the frontal branch of the superficial temporal artery at the lateral orbital rim vertical line. A central artery (CA) was consistently found originating from the dorsal nasal artery usually 5mm from its origin. The central artery had a constant anastomosis with the opposite central artery in the inferior transverse third of the forehead. The central artery was not easily identifiable in the superior third of the forehead. The angular artery (AA) was found to have a variable termination. The angular artery could communicate with the supratrochlear artery (STrA) at the supraorbital rim (SOR) or it could continue up into the forehead medial to the STrA. This artery was called the paracentral artery (PCA). The central artery, paracentral artery and supratrochlear artery have an important relationship with the most prominent central vein that is relevant to flap construction. The significance of the central artery and vein favours the median forehead flap as anatomically superior and the prominent central vein is a constant landmark on which to select the side of the pedicle. Clear landmarks for defining the pedicle base for the median forehead flap are provided.     

双额扩展截骨术治疗幼儿颅缝早闭症

目的 解决幼小患儿颅缝早闭症所致的颅腔狭窄，慢性颅内压增高和头颅外形异常，方法 取头皮冠状切口入路，双侧额颅，顶颅，包括眶上缘，颞骨部开颅，额眶带形成，固定于眶上壁，并前移，前倾30－40度，以扩大前颅凹，额骨板成形，并固定于额眶带之上，形成良好的额鼻外形；颅骨分块截开，拼接骨板，行骨块重组和固定，保持颅顶部合适的间隙。结果 12例6月至3岁儿童，手术后颅腔增大，外形良好，无严重并发症，随访无复发。结论 双额扩展截骨术是治疗幼儿颅缝早闭症上佳之选，     

额颞皮瓣内动脉吻合情况的解剖学研究

目的：明确额颞皮瓣供养血管－颞浅动脉额支与眶上动脉的吻合情况，为临床实践提供可靠的解剖学资料。方法：用红色乳胶灌注17具成人尸头，解剖观察额颞浅动脉额支及眶上动脉的分支及其相互关系，结果：显示颞浅动脉额支的终末支平均为3．4支，其中，22／34侧的颞浅动脉额支以一终末支与眶上动脉分支直接吻合，8／34例以一交通支与眶上动脉分支相连，4／34侧两者之间则无明显的吻合或交通。结论：颞浅动脉与眶上动脉之间的吻合方式主要是颞浅动脉的终末支与眶上动脉分支直接吻合，或以一交通支相连。     

Trans-Sinusal Frontal Approach for Olfactory Groove Meningiomas

The authors report on their experience with the trans-sinusal frontal approach in removing olfactory groove meningiomas. Six tumors were operated on by the trans-sinusal frontal approach, using a bicoronal incision; two tumors developed on one side, and there were four bilateral olfactosellar tumors. Osteotomy of the anterior wall of the frontal sinus was performed with an oscillating saw without any burr hole. The posterior wall of the sinus was resected and the tumor was attacked through a real subfrontal route along the plane of the anterior skull base. Ethmoidal blood supply was controlled at the initial stages of the operation, allowing avascular tumor debulking. Olfactory nerves, invaded by the tumor, were removed along with the tumor. Tumor extensions toward the sella and the optic canals were removed without brain retraction, opening of the Sylvian fissure, or dissection of the carotid arteries. All patients made a good neurologic recovery; intellectual impairment disappeared within 1 month, and visual acuity normalized within 2 weeks. Olfactory nets were preserved on the contralateral side in unilateral tumors. The trans-sinusal frontal approach is technically easy and safe to achieve. Osteotomy and replacement of the anterior wall of the frontal sinus are rapidly performed. When the frontal sinus is small, imageguided surgery allows precise deliniation of its limits and the free bone flap, including the calvarial outer layer, tangentially cut from one supraorbital canal to the other. The cosmetic result is perfect, as the normal contour of the forehead is maintained without any scar or visible burr hole. The trans-sinusal frontal approach gives access to the orbital roofs and to the central anterior skull base from the crista galli to the tuberculum sellae and the anterior clinoid processes. The trans-sinusal frontal approach represents an alternative to conventional craniotomies for tumors developed in the central anterior skull base, especially for olfactory groove meningiomas, whatever their size.     

Aesthetic incision in the subcutaneous forehead lift

The forehead plays a relevant role, perhaps the most important role, in what we shall call the topographical area of the orbital rims, since it flaccidity causes the eyebrows to droop, thus dragging down the upper eyelid and producing skin redundancy. Most published works on the subject of the forehead lift describe the classic coronal incision, with subgalea dissection involving an individualized design for each patient, according to the density of the hair. However, when the forehead has hair growing high on the head, the coronal incision becomes an anterior incision, following the first hairline. However, this has the same problems as the coronal incision, namely, anesthetizing the posterior part of the scar and, in some cases, depression of the scar on the edge of the flap caused by the retraction of the galea and the inadequate elimination of forehead furrows. Over the past two years, the author has used a nonlinear anterior incision with subcutaneous dissection in many select cases.     

Orbital rim and malar advancement for unilateral coronal synostosis in the older pediatric age group

The authors describe a technique for lateral orbital rim and malar advancement in patients in the older pediatric age group. The technique makes use of a strip craniotomy containing the supraorbital margin, greater sphenoid wing, and temporal bone, with en bloc inclusion of the lateral orbital rim, zygoma, and malar prominence. The method allows a contoured yet stable construction secured in a tongue-in-groove fashion with plate-and-screw fixation. It creates a symmetrical reconstruction of both frontal and lateral orbital aspects in the untreated or inadequately treated older plagiocephalic child with orbital dystopia. The accompanying malar recession is likewise corrected.     

改良额肌腱膜瓣悬吊术治疗上睑下垂

改良额肌腱膜瓣悬吊术治疗上睑下垂23例,不做眉下切口,减少额肌浅、深两面分离范围,省略了形成额肌瓣所需的一切附加切口和锐性分离。只须在额肌腱与眼轮匝肌和眶隔间作钝性分离形成一个额肌腱膜游离缘,牵拉向下与睑板上缘作固定缝合即可。避免了损伤眶上与神经血管束和术后血肿之虑。临床应用效果满意。