美容切口在腮腺手术中的运用

目的：尝试改良腮腺手术切口，以尽最大可能使切口瘢痕隐蔽。方法：对16例腮腺良性肿瘤患者（其中多形性腺瘤10例、腺淋巴瘤6例）采用耳前切口向下至耳垂后向后延伸至发际并沿发际边缘延伸的改良切口入路行腮腺区肿瘤及浅叶切除、面神经解剖术，术中尽量保留耳大神经，并随访1年观察术后切口隐蔽情况和手术预后。结果：所有患者均达到Ⅰ期愈合，无涎瘘和感染发生。术中术野暴露清晰，操作方便。术后2例患者出现暂时性面瘫，分别于1和2个月后恢复正常。其余患者未出现面神经损伤症状。16例患者中12例出现术后耳垂麻木，除耳大神经被切断者4例耳垂麻木症状无改善外其余8例均于术后3个月后恢复感觉。另外4例患者因手术切口为颞部和耳前切口未切至耳大神经区术后无耳垂麻木症状。患者对术后切口美观程度满意。术后随访1年无1例患者出现复发。结论：改良切口行腮腺区良性肿瘤及浅叶切除、面神经解剖术，术中术野暴露清晰，操作方便，不易损伤面神经，切口隐蔽，具有临床应用价值。     

美容切口在腮腺良性肿瘤手术中的应用

目的:探讨美容切口在腮腺良性肿瘤手术中的应效果。方法:68例患者随机分为两组,一组采用传统手术切口,另一组采用腮腺美容切口,两组手术方法均应用腮腺部分浅叶切除术、浅叶切除术和全叶切除术,随访观察该切口的美观程度以及临床疗效。结果:腮腺美容切口术后满意度显著高于传统组,手术时间、出血量、引流量、拔管时间、住院期、复发、暂时性面瘫、涎瘘和味觉出汗综合征的发生率比较,两组无统计学意义。结论:美容切口入路隐蔽,美容效果好,术后患者有较满意的面部外形,较传统手术切口有其优越性。     

改良手术治疗腮腺良性肿瘤

目的:比较两种手术方式在腮腺良性肿瘤治疗中的优缺点,以期寻找更适合治疗腮腺良性肿瘤的方法。方法:将30例腮腺良性肿瘤患者随机分为传统术式A组与改良术式B组,对两者的手术方式和术后的涎瘘、面瘫、面部畸形、Frey’s综合征(味觉出汗综合征)等进行比较。结果:术后涎瘘、面部畸形、Frey’s综合征A组高于B组;术后2周及3个月时,面瘫发生率A组高于B组,但1年后两组无显著性差异。结论:改良腮腺切除术治疗腮腺良性肿瘤在可减少术后并发症或后遗症的发生。     

耳后切口与传统S形切口行腮腺肿瘤切除的疗效对比研究

目的:评价经耳后切口及S形切口美容手术对腮腺肿瘤患者的疗效。方法:选择2016年2月-2018年2月笔者医院收治的40例腮腺肿瘤患者的临床资料进行研究,按照手术方法不同,将患者分成观察组(20例)和对照组(20例),对照组采用传统S形切口行肿瘤切除术,观察组采用经耳后切口行肿瘤切除术。比较两组患者手术时间、术中出血量等手术指标,比较术后并发症发生情况和面神经功能恢复情况,对患者外观进行主观评分并比较术后疗效。结果:两组患者手术时间、术中出血量等手术指标比较无明显差异,不具有统计学意义(P0.05),观察组患者切口长度明显优于对照组,两组比较差异有统计学意义(P0.05)。两组患者术后面瘫、耳垂麻木、Frey’s综合征等并发症发生情况和面神经功能恢复情况无明显差异,两组比较无统计学意义(P0.05),而观察组患者发生涎瘘和面部凹陷的情况明显优于对照组,有统计学意义(P0.05)。术后观察组患者治疗有效率为95.0%,对照组为90.0%,两组比较无统计学意义(P0.05)。观察组术后患者对外观满意评分明显优于对照组,比较有统计学意义(P0.05)。结论:经耳后切口和S形切口手术对腮腺肿瘤患者治疗效果满意,经耳后切口美容手术能显著改善患者术后外观,可达到较好的美容效果。     

耳屏周小切口在腮腺良性肿瘤切除中的应用

【摘要】目的评估耳屏周小切口在腮腺良性肿瘤切除术中应用的临床价值。方法30例腮腺良性肿瘤患者,应用耳屏周小切口行浅叶部分切除、保留面神经和耳大神经的腮腺良性肿瘤切除术。术后随访3～24个月,观察耳屏周小切口的美观度及临床疗效。结果所有患者均临床Ⅰ期愈合,术后腮腺功能良好,无涎瘘发生。随访,患者双侧外形对称,无凹陷等畸形,手术切口隐蔽,患者对耳周切口美学效果满意。本研究中出现术后暂时性面瘫患者2例,皮质激素并配合神经营养药物综合治疗后3个月均恢复正常;出现术后耳垂麻木不适患者4例,手术后3～10个月均逐渐恢复。本研究中所有患者均未出现味觉出汗综合征,无肿瘤复发。结论耳屏周小切口隐蔽、瘢痕小、并发症低,术后美容效果理想。     

除皱美容切口在腮腺良性肿瘤手术中的应用

目的:探讨除皱美容切口在腮腺良性肿瘤手术中的临床疗效和美容效果。方法:腮腺良性肿瘤26例,采用美容切口、保留腮腺主导管的区域性切除,并对术后临床疗效和美容效果3~18个月的随访。结果:所有患者均达到I期愈合,无涎瘘和感染发生,术后切口隐蔽、瘢痕不明显,腮腺区外形良好,腮腺分泌功能基本正常。患者对面容和功能的恢复均较满意,肿瘤无复发。结论:应用除皱美容切口的腮腺良性肿瘤切除术既保证了手术的整体质量,又取得了较好的术后美学效果。     

腮腺良性肿瘤的美容功能性术式临床应用

目的：探讨通过改良术式提高腮腺良性肿瘤手术的美容效果和功能的恢复。方法：手术治疗腮腺良性肿瘤47例,术式中对切口位置、SMAS腮腺筋膜瓣和胸锁乳突肌瓣的应用、保留导管的腮腺区域性切除、面神经及耳大神经的保护、腮腺残端及创区的处理等方面作了相应改良。并对术后美容效果和功能的恢复进行3～18个月的随访检查。结果：术后颌面部切口隐蔽瘢痕不明显,腮腺区外形良好,无凹陷畸形,无涎瘘和Frey氏综合征,耳垂和耳廓背部皮肤感觉功能及腮腺分泌功能基本正常。患者对面容和功能的恢复均较满意,未见肿瘤复发。结论：改良的腮腺肿瘤术式提高了手术的整体质量,取得了较好的美学和功能效果。     

腮腺良性肿瘤手术的美容设计

目的：探讨如何通过改良术式达到腮腺良性肿瘤手术的美学效果。方法：改良术式手术治疗腮腺良性肿瘤75例。术式中对以下方面作了相应改良：切口设计、耳大神经的保护、腮腺区域性切除、胸锁乳突肌瓣的应用、腮腺残端的处理等。随访观察该切口的美观程度以及临床疗效。结果：所有患者均达临床一期愈合,无涎瘘发生。13例患者术后出现暂时面瘫,3个月后恢复。所有患者术后均出现不同程度的耳垂麻木,于术后2个月恢复。患者对该切口的美观程度比较满意。结论：改良的腮腺肿瘤术式提高了手术的整体质量,克服了部分经典腮腺手术带来的美观方面的缺陷。     

耳后隐蔽切口逆向解剖面神经在腮腺部分切除术中的临床应用

目的:探讨耳后隐蔽切口沿下颌缘支逆向解剖面神经在腮腺部分切除术中的临床疗效。方法:选取2015年1月-2018年1月收治的62例腮腺肿瘤患者进行观察,随机分为观察组和对照组,对照组采用传统“S”形手术方法,观察组采用耳后隐蔽切口沿下颌缘支逆向解剖面神经方法,术后对患者进行随访,比较两组术后面神经功能、手术并发症、切口瘢痕评分及患者对术后切口美容效果的满意度。结果:术后随访6~12个月,两组面神经功能分级情况比较,观察组面神经功能分级以Ⅰ~Ⅲ级为主,明显优于对照组,差异有统计学意义(P<0.05)。观察组涎瘘、Frey综合征、耳垂麻木以及口干等并发症发生率低于对照组,差异有统计学意义(P<0.05)。术后6个月和术后12个月观察组评分均明显低于对照组,差异有统计学意义(P<0.05)。术后12个月,观察组患者满意度大于对照组,差异有统计学意义(P<0.05)。结论:耳后隐蔽切口沿下颌缘支逆向解剖面神经的腮腺部分切除术面神经功能保护较好,并发症少,切口美容效果好,值得临床推广应用。     

V形隐蔽切口与局段S形切口SP手术治疗腮腺良性肿瘤的疗效及安全性

目的 探讨V形隐蔽切口与局段S形切口腮腺切除术（SP）手术治疗腮腺良性肿瘤的疗效及安全性。方法 回顾性分析浙江省宁波市北仑区人民医院在2017年6月至2022年6月收治的56例腮腺良性肿瘤的临床资料。根据手术的不同切口分为观察组和对照组两组，观察组28例采用V形隐蔽切口，对照组28例采用局段S形切口。比较两组患者手术指标，包括手术时间、切口长度、引流量、出血量及住院时间；随访3个月，比较两组患者并发症发生率，包括腮瘘、面瘫、耳垂区域麻木、面部凹陷等；采用温哥华瘢痕量表（VSS）表比较两组手术的美容效果及患者对手术满意度。结果 观察组术中出血量、切口长度、引流量、住院时间均低于对照组（P<0.05），两组手术时间比较无明显差异（P>0.05）；观察组于术后1天出现2例短暂性面瘫，1例腮瘘，2例短暂耳垂区域麻木，对照组出现4例短暂性面瘫，2例腮瘘，4例短暂耳垂区域麻木，经治疗3个月后复查时均恢复，观察组并发症总发生率低于对照组（P<0.05）；观察组VSS评分低于对照组，满意度高于对照组（P<0.05）。结论 V形隐蔽切口相较于局段S形切口治疗腮腺良性肿瘤疗效更显著...     

Rhytidectomy and Parotidectomy Combined in the Same Patient

Until now, aesthetic goals in parotid surgery have seldom been addressed because oncologic concerns have largely overshadowed aesthetic issues for patients with parotid masses. Fortunately, the majority of parotid masses are benign pleomorphic adenomas that rarely recur, leaving a large group of patients healthy after their parotid surgery, with some desiring aesthetic improvement in their facial appearance. Traditional parotidectomy incisions leave a visible scar on the neck as well as a visible hollow in the retromandibular region, which can extend onto the cheek. A rhytidectomy approach to the parotid gland allows for a more concealed, aesthetically appealing scar while maintaining good visibility and access to the parotid gland. By performing bilateral sub-SMAS (superficial musculoaponeurotic system) rhytidectomy after a parotidectomy, facial symmetry and balance is enhanced, and these aesthetic deformities can be minimized. The SMAS flap can help to fill the hollow and form a tissue barrier over the resected gland to prevent gustatory sweating. Finally, the incision scarring is minimized with a rhytidectomy-type approach. Two cases are reported in which patients underwent both rhytidectomy and parotidectomy. In the one case, the procedures were performed in the same surgical setting. In the other case, they were performed in a delayed fashion. These cases exemplify the possibility of addressing facial aesthetic goals of rejuvenation in a patient requiring parotid resection.     

保留耳前鬓角形态的面中上部多层次除皱术

目的 介绍一种切口隐蔽、安全、有效、持久的面中上部除皱术式。方法 额部采取冠状切口，颢部切口与鼻唇沟平行，耳前切口位于鬓角后缘。进行面中上部多层次剥离。结果 2002年以来应用该法治疗面中上部老化者46例，效果满意，未发生严重并发症。结论 该术式保留了耳前鬓角的自然形态，切口瘢痕隐蔽，避免了重要神经、血管的损伤，多层次剥离符合解剖学原理，面部年轻化效果持久。     

Approach to eyebrow ptosis through the modified technique of Castan?res

One of the first signs of facial ageing appears in the forehead, with the descent of the lateral part of the brow. This is a troubling condition for all patients and elevation of the lateral part of the brow becomes a more and more frequent demand. The authors present their experience in 350 consecutive cases of direct eyebrow lift (“butterfly wing” incision) alone or in combination with rhytidectomy and/or blepharoplasty. The majority of the patients were female (90%). The age ranged from 43 to 85 years. Eighty per cent of the cases were performed simultaneously with rhytidectomy and blepharoplasty, 16% were performed in association with blepharoplasty and eyebrow lift alone represented 4%. The most common complication was epidermal cyst (3.4%) and suture dehiscence (2%). The “butterfly wing” incision provides a useful alternative to correction of eyebrow ptosis. Indication for surgery is dependent more on the ageing signs than on the patient''s chronological age. The final results are consistently very gratifying to the patient and to the plastic surgeon alike.     

The subcutaneous forehead lift with an anterior hairline incision.

This review of patients after forehead rhytidectomy represents the longest published postoperative follow-up to date. Fifty patients who had undergone subcutaneous forehead rhytidectomy through an anterior hairline incision were assessed by chart review, detailed questionnaire, and physical examination. The mean follow-up was 7.5 years with a range of 1 to 17 years. Benefits of the technique described include maintenance of forehead size, a mechanically efficient lift, a direct attack on wrinkles, and a low incidence of hair loss. Patient assessment indicates that the benefits of the procedure are long lasting. The disadvantages include the added precision required in executing the incision, closure, and time-consuming dissection.     

改良腮腺良性肿瘤切除术的美学效果

目的：探讨改良功能性腮腺良性肿瘤切除术的临床效果和美学效果。方法：收集32例腮腺良性肿瘤病例,采用腮腺美容切口、保留耳大神经、腮腺区域性切除和SMAS筋膜填塞（或植入脱细胞真皮基质）等改良腮腺良性肿瘤切除术,随访6～24个月,通过问卷调查患者面部外形满意度、腮腺区味觉出汗症状和术区感觉恢复情况,临床检查和淀粉碘试验评价面部外形、面神经功能和Freys综合征。结果：术后切口均Ⅰ期甲级愈合,随访6～24个月,腮腺区外形良好,凹陷畸形不明显。28例面神经功能评价为House-Brackmann分级Ⅰ级,4例为II级;3例术侧耳垂麻木,术后3～8个月触觉、痛觉和温度觉逐渐恢复;1例出现Freys综合征;术后美容效果满意率100%。结论：应用改良腮腺良性肿瘤切除术尽可能保留了术后腮腺功能,有效减少了术后多种并发症的发生,获得了良好的美学效果。     

Frey's syndrome: prevention with conservative parotidectomy and superficial musculoaponeurotic system preservation.

Between 1980 and 1990, 35 patients underwent conservative parotidectomy combining a rhytidectomy incision and a superficial musculoaponeurotic system preservation technique to reduce the postoperative incidence of Frey's syndrome. All patients were evaluated by questionnaire for subjective symptoms of gustatory sweating and flushing as well as satisfaction with the aesthetic appearance of their cheek. Six percent of patients (2 of 35) complained of symptoms of Frey's syndrome. Ninety-four percent of patients (33 of 35) noticed minimal or no contour deformity of the surgical area. Twenty patients underwent Minor's starch iodine testing to identify objective evidence of aberrant nerve regeneration at the postoperative site. Fifteen percent of these patients (3 of 20) demonstrated a positive starch iodine test; however, one of these three patients was unaware of symptoms of Frey's syndrome. Symptoms of gustatory sweating are a reliable indicator of aberrant nerve regeneration. Conservative parotidectomy with superficial musculoaponeurotic system preservation for benign parotid disease produces a low incidence of Frey's syndrome and satisfactory cosmetic results.     

Minimal incision rhytidectomy (short scar face lift) with lateral SMASectomy: Evolution and application

Background: The evolution of the author's technique for minimal incision rhytidectomy is reviewed. Objective: The purpose of this article is to outline the indications, advantages, and disadvantages of this technique. Methods: A total of 749 cases covering more than 10 years of clinical experience are reviewed. A classification of patient types is proposed that includes indications and surgical programs appropriate for each patient category. Results: In properly selected patients, the technique is safe, reliable, and reproducible. Complication rates are similar to those of other standard techniques. Conclusions: Minimal incision rhytidectomy with lateral SMASectomy is a useful technique that the plastic surgeon can add to his or her armamentarium.     

保留耳前鬓角形态并预防脱发的颞颊部除皱术

目的:介绍一种保留耳前鬓角形态并且预防术后脱发的颞颊部除皱术式。方法:颞部切口位于发际缘后方5cm左右并与鼻唇沟平行,耳前切口位于鬓角后缘。颞部于颞浅筋膜深面剥离至发际缘,切开颞浅筋膜于其浅面剥离至眼轮匝肌浅面。耳前于表浅肌肉腱膜浅面剥离至咬肌前缘。垂直于颞部切口向外上方悬吊颞浅筋膜,垂直于鼻唇沟向外上方悬吊腮腺浅面的表浅肌肉腱膜。结果:2008年以来应用该法治疗颞颊部面部老化患者24例,效果满意,未发生严重并发症。结论:该术式保留了耳前鬓角的自然形态,术后切口瘢痕隐蔽,无明显脱发,避免了重要神经、血管的损伤。     

额颞部小切口埋线悬吊固定除皱术

目的 总结额颞部小切口除皱的临床效果，选择术后有效的固定方法。方法 采用专用器械经小切口分别在额顶部帽状腱膜下颞部浅筋膜层分离，并切断部分额肌、皱眉肌、降眉肌，用埋线法拉紧头皮，悬吊固定并加压包扎。结果 本组52例，其中48例效果满意，4例基本满意，本组并发头皮血肿2例，头皮点状脱皮3例。结论 额颞部小切口除皱疗效肯定，采用了埋线悬吊固定，可保证及巩固术后效果，因操作简便、手术时间短、出血少、恢复快，是值得推广的一种除皱方法。