头皮冠状切口治疗颧骨颧弓骨折

目的:研究头皮冠状切口治疗各类颧骨颧弓骨折的实用性及美学意义。方法:采用头皮冠状切口,充分暴露颧额缝、颧骨体及颧弓,复位颧骨颧弓后以微型钛板固定,口腔内辅助切口固定颧颌缝。所有患者经10个月～1年随访,对其疗效进行分析。结果:37例颧骨颧弓骨折患者全部治愈,术后面部外形满意,开口度恢复正常,无一例发生面神经损伤。结论:采用头皮冠状切口治疗颧骨颧弓骨折,骨折复位充分,面部不留瘢痕,损伤面神经机会极少,但要注意皮瓣翻开的层次。     

头皮冠状切口治疗多发性颧骨及颧弓骨折16例报告

自1997年1月～2002年1月，我科共收治多发性颧骨及颧弓骨折病人16例。均采用头皮冠状切口入路颧骨、颧弓复位小钛板内固定术，效果满意。现总结报告如下。     

经口小微切口颧骨颧弓降低术56例临床观察

目的探讨经口内小微切口颧骨颧弓降低的手术方法。方法对2013-06—2015-07间收治的56例面部整形求美者,采用口内第1、2上磨牙对应的前庭沟处2.0 cm切口,剥离颧弓后间隙,盲视下行颧骨颧弓截骨术。结果本组56例受术者中仅2例术后出现术区肿胀,经切开引流后痊愈。其余54例受术者未发生感染、血肿等并发症。术后随访3~12个月,效果满意。结论经口小微切口盲视下行颧骨颧弓降低术,安全、快捷、损伤小、颧骨颧弓降低明显、并发症少,患者的满意率达94.6%。     

微创下颧骨颧弓缩小术的临床应用

目的:探讨微创下颧骨颧弓缩小术的临床应用效果及操作要点.方法:对41例颧骨颧弓复合体肥大的患者采用微创下颧骨颧弓缩小术,术中应用MEDIKAN微动力面部改形手术系统,在微创下将颧骨根部及颧弓后侧截断,使游离的颧骨颧弓内移,术后面颊部弹力套外固定一月.结果:本组41例,术后2天-12个月,得以随访者37例,有3例患者因术中颧骨骨膜下剥离范围较多,术后肿胀恢复较慢,但术后6个月恢复自然,其余患者术后效果均良好,患者自觉满意.结论:微创下颧骨颧弓缩小术,手术在微创下进行,组织损伤小,术后恢复快,手术效果明显,值得临床推广.     

颧骨颧弓缩小术回顾

颧骨颧弓缩小术,早期仅为磨削、凿除突出的颧骨体等简单的方法,Onizuka等[1]采用口内入路行颧骨体磨骨以降低颧部的突度,但是局部颧突的降低,无法改善由于颧弓突出引起的面宽,反而使得面部更显得扁平;Whitaker等[2]提出经     

经头皮半冠状切口治疗颧骨复合体骨折的临床研究

颧骨位于面中部侧方的突出位置，易受外力打击而致伤，是面部骨折的好发部位之一。颧骨自身坚硬，骨折线常常发生在与周围骨连接的薄弱区域以及颧弓部，形成以颧骨为中心的邻近多骨骨折，称之为颧骨复合体骨折。本院近年来采用头皮冠状切口，选择性辅助局部切口入路。应用坚固内固定技术对27例颧骨复合体骨折患者进行手术治疗，疗效满意。现报道如下。     

冠状切口颧骨截骨缩小成形术的几点改进

东亚人的审美标准以尖圆形的面型为最美,因此有许多高颧骨面型者提出颧骨颧弓缩小成形术的要求,其术式主要有全冠状切口、口内切口、口内-耳前小切口、颞部发际内切口等,其中口内入路的采用最为广泛。Onizuka等发表了经口内-耳前小切口进行颧骨截骨手术的论文,但这种手术可导致面中部软组织松垂和鼻唇沟加深等面容老化表现,使医者和受术者感到不满。     

颧弓缩小在面部“苹果弧”轮廓美学再造及年轻化中的应用

美丽有双重概念,一是年轻;二是轮廓和外形美丽.千百年来,多少学者为此做了大量的实践和探索.现笔者仅就面部轮廓的美学再造作一探讨.面部轮廓的美化是美丽的第一要素，如何标识和塑造面部轮廓美，有多种理论见诸于文献[1-10]。     

颧骨颧弓缩小截骨术的手术径路比较

目的：颧骨颧弓肥大多见于东亚人，通过颧骨颧弓缩小截骨术手术径路的比较，选择更简捷有效的截骨术。方法：比较经冠状切口或经口内或经口内加耳前切口暴露颧骨的颧突、颧弓部缩小术。截骨位于颧骨根部、颧弓远端，使高耸的颧骨内陷、下移，并固定。结果：通过经冠状切口截骨的45例，口内切口切、磨骨的12例，口内切口“L”形截骨的21例，口内加耳前切口的“L”形截骨的58例分类比较，结果显示：口内切口创伤小、切口隐蔽，明显优于冠状切口入路，而口内加耳前切口则使截骨术更为简捷有效。对大于45岁的患者，冠状切口可同时进行颧骨颧弓缩小和去皱术。结论：经口内加耳前切口的颧骨颧弓缩小截骨术，可作为首选方法之一。     

面部骨膜下除皱术

骨膜下除皱术是根据面部老化的病理特点，即骨骼脱钙、体积变小、面部软组织松弛下垂、皮肤弹性下降等进行设计的。目前，许多人手术范围局限于分离颧弓前１／３，限制了面中部软组织的有效提升。作者通过改进颧弓部入路，完全游离颧弓，面中部软组织及表情肌充分上提，使面部年轻化，８例病人均达到满意的效果，无面神经的损伤及其它手术并发症。     

内窥镜骨膜下除皱术的应用

目的　传统除皱术在达到除皱效果的同时难以避免产生一些不良反应 ,如较长的头皮瘢痕、麻木、脱发、出血多、恢复期长等。为避免上述不良反应 ,我们在除皱术中应用了内窥镜技术独到具有的优点。方法　额部在骨膜下分离 ,颞部在颞深筋膜层分离 ,贯通额颞部形成视腔 ,在内窥镜直视下切除皱眉肌、降眉肌以及额肌 ,同时切开眶缘骨膜 ,通过纠正肌肉间的不平衡而达到手术目的和效果。结果　 1996～1997年间开展的内窥镜骨膜下除皱术 ,共 10例 ,年龄 2 8～ 43岁 ,平均年龄 3 3岁。各例术后效果均较满意 ,手术能纠正眉下垂、眼角下垂 ,减少颞部皱纹及眉间皱纹。结论　内窥镜手术具有切口小、出血少、损伤轻等优点。在掌握指征的前提下 ,内窥镜骨膜下除皱能达到满意的效果。随着内窥镜技术与器械的不断完善 ,其术式会被较多的受术者接受。     

后置切口式颞部除皱术

目的：探讨一种单一切口、能减轻手术后瘢痕性脱发和鬓角不对称的颞部除皱方法。方法：将手术切口设计在颅后中线上，从帽状腱膜深层钝性分离，进入颞区在颞浅筋膜深分离至眶外侧，充分上提颞部组织后切除多余头皮组织，最后分层缝合。结果：经手术后1～12月的观察，患者的眉、外眦上提效果明显，减少瘢痕性秃发和鬓角不对称并发症出现。结论：后置切口式颞部除皱术是一种有效的颞部除皱方式。     

后置切口式颞部除铍术

目的:探讨一种单一切口、能减轻手术后瘢痕性脱发和鬓角不对称的颞部除皱方法.方法:将手术切口设计在颅后中线上,从帽状腱膜深层钝性分离,进入颞区在颞浅筋膜深分离至眶外侧,充分上提颞部组织后切除多余头皮组织,最后分层缝合.结果:经手术后1～12月的观察,患者的眉、外眦上提效果明显,减少瘢痕性秃发和鬓角不对称并发症出现.结论:后置切口式颞部除皱术是一种有效的颞部除皱方式.     

The subperiosteal rhytidectomy: the third-generation face-lift.

The subperiosteal frontal rhytidectomy described by Tessier was the departure point for a new approach for facial rejuvenation. Psillakis described the subperiosteal face-lift "as an improved concept for correction of the aging face." However, this technique has a high incidence of frontal nerve injury and because of the limitations in the subperiosteal dissection, the facial soft tissues cannot be lifted reliably to the desired position. Other authors have repeated the Psillakis experience with the same frustrations and complication rate. In this report, I describe the evolution of the subperiosteal face-lift and the significant modifications that I have introduced, making this procedure safer and improving results in the degree of facial rejuvenation. My approach of subperiosteal rhytidectomy has been used in 34 patients with a minimal complication rate. This technique also addresses the rejuvenation of the central portion of the face and the restoration of tension of the facial mimetic musculature not obtained by current brow/face-lift procedures.     

The pretragal incision in rhytidectomy

Although an endotragal incision is used in rhytidectomy to avoid a visible pretragal scar, patients may not understand that the superior and inferior portions of the preauricular scar cannot be hidden inside the ear. The endotragal incision is also more likely to distort normal external ear anatomy. The author explains his preference for the pretragal incision and presents his face lift technique. (Aesthetic Surg J 2001;21:564-568.)     

Modified temple incision for facial rhytidectomy

A modified temple incision is discussed. The incision has been used on 286 patients. The incision starts cephalad in the temple hair, continues caudally parallel to the ear axis along the caudal border of the sideburn, turns cephalad close to the helix, and then continues along the anterior border of the ear. The advantages of the incision are numerous. First, it virtually eliminates any possibility for injury to the temporal branches of the facial nerve and preserves the temporal vessels. Second, the temple and sideburn skin flap is not elevated so the chance of hair loss is minimal. Third, the incision significantly increases the distribution length of the excised area; this minimizes any possibility of "dog ear" formation. Midface and upperface rhytidectomies are more effective because the skin is pulled a shorter distance. The drawbacks of the incision are the possibility of a visible scar in the most caudal portion of the sideburns and added surgical time because of the need for meticulous incision repair.     

下睑缘和口内联合切口面中部提升术

目的:探讨经下睑缘和口内联合切口骨膜下面中部提升手术方法的临床疗效和解剖基础。方法:采用下睑袋切除术的手术切口,在眼轮匝肌下层次常规完成下睑松弛皮肤切除术后,于眶缘下2￣3mm切开骨膜,通过口内切口在梨状孔下缘水平切开骨膜,共同完成颧骨和上颌骨的骨膜下分离,外侧的分离止于颧大肌起点的内侧,内侧为鼻骨与上颌骨转折处。切开剥离范围内、外侧骨膜,将颊部脂肪垫的前叶及其下的骨膜,颧部的皮下脂肪垫向上外固定,然后将骨膜与眶缘的骨膜向上外方重叠缝合,缝合下睑切口。结果:采用本方法临床治疗下睑皮肤松弛和面中部老化患者13例,并发症轻,可同时达到下睑和面中部满意的美容效果。结论:本方法切口隐蔽,并发症少,可作为面中部年轻化手术的推荐使用方法。     

The retroauricular coronal incision.

The coronal incision has been modified so that if it needs to be extended to improve exposure, the extension will be behind the ear and therefore less noticeable. The incision has been used in 25 adults and 30 children with no complications. Its cosmetic appearance is superior to the preauricular coronal incision, and it is preferred especially by young people in whom the scar tends to widen with time.     

Small incision subperiosteal and trans-blepharoplasty forehead and browlift.

The purpose of the study is to evaluate the safety and efficacy of non-endoscopic, small-incision subperiosteal forehead and browlift in patients undergoing associated upper eyelid blepharoplasty. This is a retrospective, non-comparative case series of 14 consecutive patients in 12 months. Eleven patients underwent bilateral and three unilateral surgery. Unilateral surgery was performed in patients with facial palsy and was augmented with cable suspension. The technique involves five small scalp incisions to create a single subperiosteal and deep temporal cavity. Superior arcus marginalis release and direct visualisation of the supraorbital nerve was achieved via a trans-blepharoplasty approach. All patients achieved a desirable browlift and contour. Follow up ranged from 2 to 40 weeks. Minor complications included transient diplopia (1), reduced upper eyelid sensation (1), and brief postoperative bleeding from one of the small incision sites (1). Small incision and trans-blepharoplasty forehead and browlift is a safe and effective method to achieve a cosmetically desirable browlift in patients that require associated upper eyelid blepharoplasty, using standard oculoplastic equipment without the need for an endoscope.