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.     

口内单侧小切口隆颏术

临床上,常见下颌短小或后缩患者,轻、中度者可通过假体隆颏术进行改善[1].手术方法分为口内和口外入路[2],口外入路因外露瘢痕明显,临床上应用较少;口内入路因切口隐蔽,瘢痕不明显等优点,受到广泛应用.     

口内单侧小切口隆颏术

临床上,常见下颌短小或后缩患者,轻、中度者可通过假体隆颏术进行改善。手术方法分为口内和口外入路,口外入路因外露瘢痕明显,临床上应用较少;口内入路因切口隐蔽,瘢痕不明显等优点,受到广泛应用。     

口内双侧横行小切口隆颏术

目的:探求一种通过口内双侧横行小切口使假体置入更加方便准确、减轻术中损伤及术后并发症的隆颏手术新方法。方法:根据颏部解剖结构特点,采用口内双侧粘膜上横行小切口,切口定位于双侧尖牙下方距唇龈沟5mm处,长约8mm。横行切开粘膜及粘膜下组织,分别从两侧粘膜切口纵行向下钝性分离肌层至骨膜,用剥离子在骨膜下剥离拟置入假体腔隙,假体置入后肌层及粘膜分层缝合。结果:笔者采用该切口进行硅胶假体置入隆颏术共3例,切口均Ⅰ期愈合,未出现明显术后并发症。随访1～6个月,均获得满意效果。结论:采用经口内双侧横行小切口进行硅胶假体隆颏术对矫正McCarthyⅠ型轻度小颏畸形可获得满意术后效果,且保留颏部肌肉完整性并避开颏神经,创伤小,有利于减少术后并发症等优点。     

隆颏术径路及并发症的比较

目的口内切口隆颏术是目前纠正小颏畸形的常用手术方法,而且切口较为隐蔽。通过对口内双侧纵切口和口内横切口这两种不同的手术进路来进行方法比较,从而选择更简捷有效的进路。方法口内双侧纵切口是在唇龈沟处3、4号牙各做两个小切口,左为1.0cm,右为0.5cm。横切口则是在唇龈沟做一长4cm的横行切口。以上方法均在骨膜下剥离腔隙,硅胶假体则放置在骨面上。结果口内双侧纵切口隆颏术为45例,对下唇肌肉破坏少,并发症少;横切口为32例,术后假体上抬移动比例高,易继发感染,唇粘膜易形成条索状疤痕。结论口内双侧纵切口隆颏术较口内横切口隆颏术更简捷有效,可作为首选手术径路。     

颏水平截骨联合置入假体治疗严重小颏畸形

目的介绍一种治疗严重小颏畸形,重塑颏部外形的有效方法.方法采用口内切口颏部水平截骨前移固定后,再联合利用在颏部置入合适假体的隆颏术,以进一步增加颏突度和颏长度,改善颏部形态.结果共治疗9例,术后患者颏部形态均得到明显改善,重塑的颏部外形符合美学标准,达到患者术前的预期要求.随访6个月至2年,效果稳定满意,无明显并发症出现.结论利用颏水平截骨联合置入假体的颏成形术治疗严重小颏畸形,使重塑的颏部形态达到了美学标准,面部轮廓比例协调,效果显著.     

隆颏术充填方法之改进

小颏畸形是临床上常见的一种先天性疾病。对He关系正常而主要畸形有颏部后缩者，临床上常采用充填隆颏术矫正。因方法简单，美容效果明显，已成为临床上较常见的美容手术之一。颏部充填材料目前多采用人工假体。     

高密度多孔聚乙烯假体在隆颏术中的应用

颏部发育不足，颏突过小，颏颈角不明显或消失，构成小颏畸形。自2003年1月至2006年3月，我们采用高密度多孔聚乙烯（Medpor）对小颏畸形者进行了隆颏术，获得了良好效果，现报告如下。[第一段]     

小颏畸形矫正术的临床体会

小颏畸形矫正术是一种常见的美容整形手术.由于患者面部轮廓及小颏畸形的程度不同,需要术者依据患者术前的颏部形态分析,选择合适的术式,以获得最佳的手术效果.常用的方法为硅胶假体置入术,但术后常有假体移位、切口感染、下唇感觉麻木等并发症[1].     

下颌角及咬肌肥大畸形的口内进路手术矫治

作者自１９８８年以来，采用口内进路手术矫治下颌角及咬肌肥大畸形患者１０例。本文讨论了手术方法、疗效、优点及注意事项。     

A型肉毒毒素治疗下眼睑轮匝肌肥厚

目的:观察局部注射A型肉毒毒素治疗下眼睑轮匝肌肥厚的临床效果.方法:采用A型肉毒毒素对27例单纯性眼轮匝肌肥厚患者进行局部注射治疗,每侧选择2个注射点,每注射点剂量为1～2单位,注射后半年内随访.结果:27例患者均取得满意效果,维持时间4～8个月.无并发症发生.结论:A型肉毒毒素是治疗单纯性下眼睑轮匝肌肥厚的安全有效方法.     

Resection of the buccal fat pad in the treatment of hypertrophy of the masseter muscle

Partial resection of the buccal fat pad added to the resection of the masseter muscle clearly improves the results in hypertrophy of these muscles.     

Resection of the buccal fat pad in the treatment of hypertrophy of the masseter muscle

Partial resection of the buccal fat pad added to the resection of the masseter muscle clearly improves the results in hypertrophy of these muscles.     

Extended effect after a single dose of type A botulinum toxin for asymmetric masseter muscle hypertrophy

Facial asymmetry can either be physiological or pathological and is a common cosmetic concern. A 35-year-old Indian male presented with broad appearing lower face and prominent left jaw since adolescence. Parotid enlargement and other local disorders were ruled out. Ultrasonographic thickness of right masseter muscle was 13 mm while that of left was 14.9 mm, in unclenched state. Type-A botulinum toxin (T-ABT) was injected, evenly at five points, in both muscles within the “safe zone”. Using a 29 gauge needle, 15 and 25 international units were delivered to right and left masseters, respectively. Six months post — injection, a reduction of 2.9 mm and 4.4 mm was observed along with a reduced external facial asymmetry. At 24 months, patient maintains a satisfactory facial contour with no significant early or late post-injection complications. Intra-massteric injection of T-ABT can be used effectively as a primary or adjunct procedure for holistic oculo-facial sculpting.KEY WORDS: Botulinum toxin, extended volume reduction, facial asymmetry, masseter hypertrophy     

钝针扇形连续注射法在肉毒毒素治疗咬肌肥大中的应用

目地：探索一种损伤小、不良反应少、效果稳定的新型肉毒毒素治疗咬肌肥大的注射方法。方法：对60例咬肌肥大的患者,双侧咬肌分别使用27G钝针扇形连续注射和30G锐针多点注射法治疗,对术后局部瘀青和肿胀情况,以及治疗效果进行评估。结果：术后3天复诊,钝针扇形连续注射后出现局部瘀青的2例,肿胀2例,锐针多点注射后出现局部瘀青11例,肿胀8例;术后4周复诊,60例咬肌肥大患者对肉毒毒素治疗均有效,无特殊不艮反应。治疗局部触诊,仍可触及一定量咬肌的,钝针扇形连续注射后有7例,锐针多点注射后出现12例。结论：钝针扇形注射法作为一种新型的肉毒毒素治疗咬肌肥大的方法,相比于锐针多点注射法,对局部皮肤损伤少,可明显降低术后瘀青肿胀的发生率,并获得更加稳定治疗效果,值得在临床工作中推广。     

Evaluation of asymmetric implants in breast augmentation surgery

Since more than 30 years, the quality of breast implants has continued to evolve in order to improve the aesthetic results of prosthetic augmentation. Shapes and materials of these implants have also evolved to obtain stronger and more reliable prostheses almost similar to the natural breast. Therefore it can be considered that the use of asymmetric implants is the last step in implant technology before using made to measure implants. Asymmetric implants allow obtaining different contours in harmony to the different breast shapes capable to reproduce faithfully, in all dimensions, the anatomy of the female breast, including the differences between each side which maximise the naturalness of the result. Such implants have an axis directed towards the exterior and lower part of the chest wall, are wider than high with a thinner part on their inner edge and a concave rear side moulding the curves of the chest wall. In our own experience, we placed between 2002 and 2004, asymmetric implants in 100 patients. Such implants were easy to place and no secondary rotation was observed. The control of secondary displacements even in case of prosthesis change seems to be linked to their concave rear side, roughness and asymmetry. When analysing retrospectively the medical records, no distinctive features were observed when compared to symmetric classic implants in easiness in the surgical procedure or in complications except a slightly higher rate of seroma formation. However asymmetric implants are less appropriate in case of major breast ptosis, patients being unsatisfied by the "too natural" breast shape. Moreover a high risk of secondary rotation seems to be real in such cases. In summary, for all these reasons, asymmetric implants, are gradually considered to be a first-rank choice for implants in breast augmentation cosmetic surgery.     

自体颗粒脂肪注射隆鼻术的应用

目的:探讨自体脂肪颗粒移植在隆鼻术中的临床应用。方法:针对23例单纯鼻根低平的就医者,注射自体脂肪颗粒进行隆鼻。结果:20例就医者1次充填即取得预期临床效果,3例就医者经过再次手术填充达到满意效果。结论:应用自体脂肪颗粒移植鼻根局部隆鼻能够达到良好、稳定的临床效果。