颜面部凹陷畸形的整复治疗

引起颜面部凹陷畸形的原因很多,可分为骨性凹陷和软组织凹陷畸形.笔者1986年6月至200 0年6月间采用陈旧性骨折复位内固定,自体骨移植,自体骨移植+人工骨填充术,膨体聚四氟乙烯(ePTFE)植入及自体脂肪颗粒注射移植等方法整复颜面部骨性凹陷畸形和软组织凹陷畸形共58例,收到较好效果,报道如下.     

膨体聚四氟乙烯植入整复腮腺术后凹陷畸形

目的：探讨应用膨体聚四氟乙烯（ePTFE）植入腮腺切除术后凹陷畸形和预防味觉性出汗综合征（Frey综合征）的可行性.方法：11例因肿瘤行腮腺浅叶或深浅叶切除的男女患者立即在术区植入ePTFE补片并追踪观察其整复术区凹陷畸形的美容效果和防止术区Ffey综合征效果.结果：11例患者的手术切口均Ⅰ期愈合.经24～79个月随访，所有患者腮腺术区均无明显凹陷畸形，无一例发生Frey综合征.结论：ePTFE植入整复腮腺切除后凹陷畸形的美容效果良好，防止术区出现Frey综合征的效果良好。     

颜面部凹陷畸形的整复治疗

引起颜面部凹陷畸形的原因很多 ,可分为骨性凹陷和软组织凹陷畸形。笔者 1986年 6月至 2 0 0 0年 6月间采用陈旧性骨折复位内固定 ,自体骨移植 ,自体骨移植 人工骨填充术 ,膨体聚四氟乙烯 (ｅＰＴＦＥ)植入及自体脂肪颗粒注射移植等方法整复颜面部骨性凹陷畸形和软组织凹陷畸形共 5 8例 ,收到较好效果 ,报道如下。1　临床资料　1.1　一般资料　本组 5 8例中 ,男 2 6例 ,女 32例。年龄 11～4 3岁。本组骨性凹陷畸形 2 3例 ,其中上颌骨、颧骨多发性陈旧性骨折凹陷畸形 4例 ,外伤性前额、颞部及眶周凹陷畸形 9例 ,外伤性鼻骨骨折鞍鼻畸形 2例 …     

颜面凹陷畸形的临床分型及整复

目的为规范各类颜面凹陷畸形的临床治疗提供参考性建议。方法根据凹陷部位支撑组织的异常或被覆组织的异常情况。临床上将凹陷畸形分为三型：Ⅰ型为骨性凹陷畸形，包括先天性发育不良。后天性局部骨组织缺损、错位或塌陷；Ⅱ型为软组织凹陷畸形。包括局部软组织萎缩、缺损或黏连；Ⅲ型为复合性凹陷畸形。骨与软组织同时存在萎缩、缺损或较严重的塌陷。并依照此分型分别采用游离皮瓣、肌皮瓣或带蒂肌皮瓣填充法。局部组织瓣填充法。带蒂组织瓣加医用材料混合填充法，游离脂肪颗粒填充法。HA人工骨填充法。硅胶假体填充法。有机玻璃填充法，奥美定填充法。复杂凹陷畸形的综合治疗整复方法。为216例患者修复颜面凹陷畸形。结果随访216例患者6个月至5年，未发现严重并发症，外观效果满意。结论此颜面凹陷畸形的临床分型简单、合理。便于临床对颜面凹陷畸形的整复。具有一定的实用价值。     

膨体聚四氟乙烯在单侧唇裂术后继发鼻畸形整复术中的应用

目的：探讨膨体聚四氟乙烯材料在单侧唇裂术后继发鼻畸形中的利用及效果分析。方法：取鼻正中蝶形切口加双侧鼻翼缘切口应用膨体聚四氟乙烯加强型补片辅助下矫正鼻尖歪斜、鼻翼塌陷、低鼻畸形;依据Ⅰ期手术所遗留的上唇瘢痕切口行鼻基底和患侧鼻翼基底部填充术。结果：应用膨体聚四氟乙烯加强型补片为66例患者行单侧唇裂术后继发鼻畸形整复术。术后随访6个月～6年,满意者61例,占92.4%,不满意5例,占7.6%,5例患者术后出现伤口感染,将ePTFE假体取出。结论：膨体聚四氟乙烯为单侧唇裂术后继发鼻畸形整复术中治疗鼻尖鼻翼等畸形和面中部塌陷提供了较为理想的软组织替代材料,术后效果满意。     

胸三角皮瓣修复半侧颜面萎缩的临床研究

目的：治疗半侧颜面萎缩与面颊部凹陷畸形。方法：采用加长的远端去表皮的胸三角皮瓣充填治疗半侧面颜面萎缩与面颊部凹陷１６例。结果：１６例均取得理想的治疗效果,除供区有延迟愈合外,皮瓣无感染坏死现象,外形均获明显改善。结论：这种方法对治疗半侧颜面萎缩与面颊部凹陷畸形的较好的治疗效果,值得推广应用。     

胸三角真皮脂肪瓣修复颜面部萎缩与凹陷畸形

目的：探讨应用胸三角真皮脂肪瓣治疗颜面部萎缩与凹陷畸形的美学效果。方法：采用加长的远端去表皮的胸三角真皮脂肪瓣充填治疗颜面部萎缩与凹陷畸形12例。结果：12例均取得了理想的形态修复效果，创面均Ⅰ期愈合，除供区有2例延迟愈合外，皮瓣均无感染坏死现象，充填外形均获明显改善。结论：这种方法对治疗颜面部萎缩与凹陷畸形均有较好的治疗效果，值得推广应用。     

颜面凹陷畸形的临床分型及整复

目的为规范各类颜面凹陷畸形的临床治疗提供参考性建议.方法根据凹陷部位支撑组织的异常或被覆组织的异常情况,临床上将凹陷畸形分为三型Ⅰ型为骨性凹陷畸形,包括先天性发育不良,后天性局部骨组织缺损、错位或塌陷;Ⅱ型为软组织凹陷畸形,包括局部软组织萎缩、缺损或黏连;Ⅲ型为复合性凹陷畸形,骨与软组织同时存在萎缩、缺损或较严重的塌陷.并依照此分型分别采用游离皮瓣、肌皮瓣或带蒂肌皮瓣填充法,局部组织瓣填充法,带蒂组织瓣加医用材料混合填充法,游离脂肪颗粒填充法,HA人工骨填充法,硅胶假体填充法,有机玻璃填充法,奥美定填充法,复杂凹陷畸形的综合治疗整复方法,为216例患者修复颜面凹陷畸形.结果随访216例患者6个月至5年,未发现严重并发症,外观效果满意.结论此颜面凹陷畸形的临床分型简单、合理,便于临床对颜面凹陷畸形的整复,具有一定的实用价值.     

ePTFE假体置入法隆颏术治疗中重度小颏畸形29例

目的 探讨ePTFE假体隆颏术治疗中重度小颏畸形的可行性和临床效果.方法 在唇龈沟唇侧、左右3号牙之间,避开舌系带作倒U形切口,置入ePTFE隆颏假体行隆颏术.结果 本组29例中重度小颏畸形患者,术后切口均Ⅰ期愈合,无感染,无切口裂开.所有患者随访0.5～3年,效果满意.结论 ePTFE假体隆颏术安全,简单,是治疗中重度小颏畸形的有效方法.     

聚丙烯酰胺水凝胶在唇部整复中的应用——附23例报告

目的 应用聚丙烯酰胺水凝胶（PAHG）整复唇红、唇部凹陷、唇珠缺损、薄唇,探索唇部整复新方法。方法 23例不同程度唇部缺损、凹陷畸形,根据缺损大小,个性化地选用PAHG-C型注射植入口轮匝肌下,充分塑形。结果 其中22例效果满意,1例出现硬结,抽出后2个月再次植入,随访3个月至1年无不良反应,唇部外形良好,手感柔软,神经感觉正常。结论 PAHG具有良好的生物相容性。对组织刺激小,质软,接近正常组织,操作简单,是整复唇部组织微小缺损,凹陷畸形良好的软组织填充剂。     

The choice of incisions and myoplasties in face lifts

The choice of the site of incision in facial and forehead face lifts is very important, as, apart from minimising the scars, it determines the absence of alteration in the hairline. This is particularly important in occipital and frontal regions but also in the "sideburns". After defining the incision, the surgeon must decide which platysma muscles must be used to correct frontal, horizontal or vertical wrinkles, crows feet or cervical folds. The author presents his experience and technical developments in these two fields.     

歪鼻矫正术99例报告

本文探讨歪鼻矫正手术的最佳手术方法、切口及术后处理。歪鼻矫正手术方法：取两侧鼻前庭内软骨间切口,剥离鼻骨外侧骨膜及鼻腔侧粘骨膜,凿除宽侧鼻背部骨质使左右鼻背宽度对称,凿断鼻骨间缝和窄侧鼻背上颌骨鼻突,抬平塌陷部位同时压下隆起部位,使左右对称。伴有鹰鼻或中隔弯曲者可同时矫正。手术矫正９９ 例歪鼻,一次性完全矫正者９３ 例,再次手术矫正者６ 例。此法手术,矫正彻底,疗效可靠。     

现代面中除皱术的面神经解剖学研究

目的 明确ＳＭＡＳ与面神经的关系。方法 对１２具（２４例）成人尸头行大体解剖观察。结果 ＳＭＡＳ分布于面中部,向前逐渐变薄,于口角水平外侧水小范围的“洞区”。面神经出腮腺后,并非在ＳＭＡＳ深面。而是在咬肌筋膜深面走行。面神经额支在颧弓以下０．５ｃｍ区域穿出深筋膜,跨过颧弓。在颊脂肪垫区,大部分神经分支走行在垫内,小部分分支形成面神经丛,分布于其表面。在颧大肌表面上１／３恒定有一颧支跨过,支配眼轮匝     

Evaluation of valved saphenous vein homograft as right ventricle-pulmonary artery conduit in modified stage I Norwood operation

Potential drawbacks from right ventricle-pulmonary artery (RV-PA) conduit in modified Norwood procedure may be regurgitation through the conduit and incision at the systemic ventricle. In order to address the question if valved RV-PA conduit can provide hemodynamic advantages, we retrospectively reviewed the data of patients who underwent modified stage I Norwood operation with either a non-valved ePTFE RV-PA conduit (ePTFE) or a valved saphenous vein homograft (SVG). Four patients in each group, both the ePTFE and SVG, were involved in the study and 2 patients in each group eventually died. Conduit regurgitation was seen mild to moderate-to-severe in all patients with ePTFE and mild in one patient with SVG. This regurgitation progressed over the next several months in the ePTFE group. Tricuspid regurgitation became worse in the ePTFE group, whereas it was improved in 2 patients within the SVG group. RV ejection fraction was reduced from 70+/-4% to 55+/-12% in the ePTFE group, whereas it was improved from 62+/-10% to 70+/-2% in the SVG group postoperatively (P<0.05). We conclude that conduit regurgitation may cause RV systolic dysfunction and prolong a functional recovery after modified stage I Norwood procedure. Saphenous vein homograft may be a choice as RV-PA conduit in this procedure.     

膨体聚四氟乙烯鼻整形287例体会

目的介绍采用膨体聚四氟乙烯(ePTFE)行鼻整形术的临床体会。方法于鼻小柱处行“V-Y”入路,收拢穹窿,妥善处理鼻翼软骨,将修剪好的ePTFE假体置入鼻背部,同时重塑鼻尖和鼻孔的形态。结果本组287例患者,随访其中的233例患者1~8年,除2例患者因感染将假体取出,5例患者行再次补充修整外,其余患者均获得较满意的效果。结论ePTFE作为鼻整形材料,术后不透光、较稳固,鼻外形的弧度接近自然,是比较理想的鼻整形材料。     

膨体聚四氟乙烯在隆鼻术中的应用

目的　介绍膨体聚四氟乙烯用于隆鼻术中的手术技巧和体会。方法　将膨体聚四氟乙烯加强型补片根据求美者的鼻形切割、缝制成“L”型鼻假体。置入层次为鼻背筋膜下。结果　 144例患者经 1～ 4周的随访 ,除 2例早期因拆线后鼻小柱旁切口裂开而再次缝合外 ,其余均取得满意效果。结论　膨体聚四氟乙烯为较理想的隆鼻材料替代品 ,尤其适合硅橡胶隆鼻术后鼻尖部张力过大导致鼻尖皮肤变薄的患者     

Endoscopically assisted harvesting of the superficial temporal artery: technical note

OBJECTIVE: We developed an endoscopic method for harvesting the superficial temporal artery (STA) through a small incision away from the artery. This method was used to harvest the frontal branch of the STA through an incision made along the parietal branch. METHODS: A 7-cm linear incision is made along the parietal branch of the STA. After the parietal branch has been exposed, the frontal branch is accessed through the incision with the use of an optical retractor and a 4-mm endoscope. The frontal branch is harvested subcutaneously, under endoscopic observation. Both branches of the STA are anastomosed to the middle cerebral artery via a small craniotomy made through the incision. This method was used for six patients who presented with ischemic symptoms attributable to hypoperfusion in the middle cerebral artery area. RESULTS: The frontal branch of the STA, measuring 6 to 8 cm, was harvested subcutaneously. The procedure required 30 to 60 minutes. The patency of the artery was verified with postoperative angiography. Hair loss or scalp necrosis was not noted for any patient. CONCLUSION: Our experience demonstrates that the STA can be harvested through a small incision distant from the artery. Postoperative scalp necrosis and hair loss can be avoided. This less-invasive method expands the use of the STA in revascularization surgery beyond the limitations imposed by its anatomic course.     

Expanded polytetrafluoroethylene membrane for prevention of adhesions in patients undergoing external decompression and subsequent cranioplasty

Cranioplasty performed after external decompression for brain swelling may be difficult because of the development of adhesions between the temporal muscle and the dura. Membranes composed of expanded polytetrafluoroethylene (ePTFE) were inserted at external decompression to prevent such adhesions. The ePTFE membranes were placed suturelessly between the temporal muscle and the dura, covering the proximal portion of the temporal muscle at the sphenoidal ridge and the dural suture line. In addition, part of the membrane was placed directly below the skin incision to allow easy visualization at subsequent cranioplasty in 10 patients. Cranioplasty was performed 38 to 126 days (mean 63.9 days) after external decompression. No adhesions were observed, either between the ePTFE membranes and the dura, or between the membranes and the temporal muscle. No temporal muscle and dural injuries occurred during cranioplasty, and no patient showed signs of infection. Mean operating time was 71.0 minutes and mean blood loss was 75.2 ml. Sutureless insertion of ePTFE membranes at external decompression increases the ease and safety of subsequent cranioplasty, decreases operating time and blood loss, and avoids injury to the temporal muscle and dura.     

鼻整形术中应用膨体聚四氟乙烯治疗鼻尖低平

目的探讨膨体聚四氟乙烯（expanded pytetraflu-oroethylene，ePTFE）在隆鼻术中治疗鼻尖过低、鼻孔显露的手术方法，以减少传统手术方法的并发症。方法取鼻正中蝶形切口加双侧鼻翼缘切口行ePTFE加强型补片隆鼻术及治疗鼻尖低平。结果应用ePTFE加强型补片为536例患者隆鼻术及治疗鼻尖低平术。术后随访3个月至6年，满意者533例，占99．4％，不满意3例，占0．6％，3例患者术后出现伤口感染，取出ePTFE假体，并于3个月后重新行ePTFE假体隆鼻术，效果满意。结论应用ePTFE在隆鼻术中治疗鼻尖过低、鼻孔显露，可以明显减少传统手术方法的并发症，术后效果理想。     

颧骨颧弓缩小及下颌角截骨术27例临床体会

目的:通过手术改善部分方脸畸形患者面部外观,观察手术效果,探讨有效的手术方式。方法:对27例要求行面部轮廓整形的患者施行口内联合耳前切口颧骨颧弓缩小术及下颌角截骨术,纠正患者的下颌角肥大及颧骨颧弓的肥大。结果:所有患者术后随访3月,均恢复良好,术后面部轮廓改善满意。其中5例术后出现下唇麻木,术后3月左右自行恢复。结论:颧骨颧弓缩小及下颌角截骨术对方脸患者面部轮廓改善效果良好,同时面部神经血管丰富,术者应熟悉解剖,不断积累手术经验及操作技巧才能达到满意的手术效果。