改良骨膜下综合剥离除皱术100例分析

目的　为了更有效地使面中部老化组织向上提紧复位。　方法　采用扩大的面部骨膜下剥离 ,或加用 SMAS下和皮下多层次综合剥离除皱术。尤其在颧弓部骨膜下进行剥离松解 ,掀起颧弓韧带的起点 ,以解除面中部老化组织上提复位的屏障。　结果　本组 10 0例术后显示恢复了面部各层组织年轻时的解剖关系 ,获得了年轻时鼻唇沟的形态和颌线轮廓 ,效果满意。未出现面神经额支受牵拉损伤的征象。　结论　本法适用于不同年龄 ,尤其是 40岁左右的除皱者     

颞深部眶颧骨膜下除皱及SMAS剪力除皱术

笔者报告１９９３￣１９９６年４６例面部除皱的经验，其中１２例颞深部眶颧骨膜下除皱（内含６例颧弓缩小整形），有或没有合并ＳＭＡＳ剪力除皱的，３４例进行两个层次的除皱及剪力ＳＭＡＳ除皱。颞深部眶骨膜上除皱术采用颅面外科手术进路，在颞窝前方，眶周，外眦韧带区，部分眶内，颧弓周围及上颌骨前、外侧方分离骨膜、将其与帽状腱膜，颞浅筋膜及上半面部的皮肤，头皮同时提紧，有的病例同时进行颧弓缩小整形，术后使上半面部     

面中部双层皮肤软组织提紧术

目的：为了改善面中部皮肤、软组织松驰，方法：通过分离面中部皮下组织和颧弓韧带组织，将颧部软组织向外上方复位并固定于颧骨骨膜上。结果：通过手术可有效地恢复中部松驰下垂的组织平化了鼻唇沟的深度。结论：应用面中部双层皮肤软组织是紧术，通过双层提紧固定，可以达到永久悬吊的作用。     

面中部双层皮肤软组织提紧术

目的　为了改善面中部皮肤、软组织松弛。方法　通过分离面中部皮下组织和颧弓韧带组织 ,将颧部软组织向外上方复位并固定于颧骨骨膜上。结果　通过手术可有效地恢复面中部松弛下垂的组织平化了鼻唇沟的深度。结论　应用面中部双层皮肤软组织提紧术 ,通过双层提紧固定 ,可以达到永久悬吊的作用。     

面中部双层皮肤软组织提紧术

目的为了改善面中部皮肤、软组织松弛.方法通过分离面中部皮下组织和颧弓韧带组织,将颧部软组织向外上方复位并固定于颧骨骨膜上.结果通过手术可有效地恢复面中部松弛下垂的组织平化了鼻唇沟的深度.结论应用面中部双层皮肤软组织提紧术,通过双层提紧固定,可以达到永久悬吊的作用.     

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。     

颞深部眶颧骨膜下除皱及SMAS剪力除皱术

笔者报告１９９３～１９９６年４６例面部除皱的经验，其中１２例颞深部眶颧骨膜下除皱（内含６例颧弓缩小整形），有或没有合并ＳＭＡＳ剪力除皱，３４例进行两个层次的除皱及剪力ＳＭＡＳ除皱。颞深部眶颧骨膜下除皱术采用颅面外科手术进路，在颞窝前方，眶周，外眦韧带区，部分眶内，颧弓周围及上颌骨前、外侧方分离骨膜，将其与帽状腱膜，颞浅筋膜及上半面部的皮肤、头皮同时提紧。有的病例同时进行颧弓缩小整形，术后使上半面部皮肤提紧，并使眼轮匝肌及其周围组织提紧，眉弓及眼角上悬，上、下眼睑松弛矫正，眼鼻沟，鼻唇沟变浅。特别对中年以上的上２／３面部除皱有效。ＳＭＡＳ剪力除皱是下半面部除皱。将皮肤及ＳＭＡＳ两平面进行提紧，耳前制成Ｓ状ＳＭＡＳ瓣，在其中央剪成两半，向上及向耳后方提紧，使颊、下颌、颈部松弛组织提紧，鼻唇沟变浅。颏下区松坠的脂肪作抽吸或切除。     

多层综合除皱术

应用多层综合的除皱方法使老化的面部年轻化。方法 进行多层次解剖分离，使老化移位的组织复位。包括皮肤及骨膜层的提紧，ＳＭＡＳ的悬吊，颧弓韧带的重建，颧骨的修薄。结果 自１９９３年以来，完成手术２８例，效果满意。结论面部老化是不同组织，不同解剖结构变化的综合体现。     

经颞部骨膜下剥离面中部提紧术

目的探讨一种经颞部矫正面中部老化征象的简单而有效的方法。方法经颞部头皮切口在颞浅筋膜和颞深筋膜间剥离,下达颧弓,内达眶外侧缘。在颧弓上约2cm,平行颧弓切开颞深筋膜浅层约3cm,在颞深筋膜浅层下剥离至颧弓上缘进入骨膜下剥离。松解面中部。将已充分活动的面中部全层组织上提,缝合固定于颞深筋膜表面。结果自2000年以来,临床应用21例,术后效果满意,外观自然,无并发症发生。结论本方法具有手术时间短,剥离层次深,耳前无切口,术后恢复快,效果自然,维持时间长的优点。选择合适的病例,能获得满意的效果。     

经颞部骨膜下剥离面中部提紧术

目的探讨一种经颞部矫正面中部老化征象的简单而有效的方法。方法经颞部头皮切口在颞浅筋膜和颞深筋膜间剥离,下达颧弓,内达眶外侧缘。在颧弓上约2cm,平行颧弓切开颞深筋膜浅层约3cm,在颞深筋膜浅层下剥离至颧弓上缘进入骨膜下剥离。松解面中部。将已充分活动的面中部全层组织上提,缝合固定于颞深筋膜表面。结果自2000年以来,临床应用21例,术后效果满意,外观自然,无并发症发生。结论本方法具有手术时间短,剥离层次深,耳前无切口,术后恢复快,效果自然,维持时间长的优点。选择合适的病例,能获得满意的效果。     

Reduction Malarplasty Using an L-Shaped Osteotomy Through Intraoral and Sideburns Incisions

The slender, oval-shaped face is considered to be attractive in East Asia. To obtain the ideal contour of the midface, reduction malarplasty has been popularized in oriental countries in recent years. This report describes a surgical technique for reduction of the zygomatic body and arch. After labiobuccal vestibular incisions are made, the anterior zygomatic body and lateral orbital rim are exposed by subperiosteal dissection. Thereafter, an L-shaped osteotomy is performed. Two parallel horizontal osteotomies are made in the anterior part of the zygomatic body, and the middle bone segment is removed. The zygomatic arch root is fractured through a small sideburn incision just anterior to the articular tubercle. Finally, the freed zygomatic complex is medially repositioned and fixed with one or two bicortex screws. Operations on 32 patients demonstrated that this technique may be a sound method for malar complex reduction, with the advantages of simple manipulation, stable fixation, and less risk of a drooping face.     

面神经额支的分布与面部上提术的关系

目的 明确面神经额支在颧部的软组织走行层次的分布。方法 对９人尸头（１８例）颜面行大体解剖观察。结果 面神经额支的分支数目为３￣７支，平均５支，无恒定的行径及体表投影。将颧弓均分成三段，统计跨过各段表面的额支分支数，发现额支交非仅限于颧弓的中后段，而是近全颧弓均有额支分支跨过，其分布密度以中１／３段最高，占总数的４４．４％（４０／９０）；前１／３段次之，中３８．８９％（３５／９０）；后１／３段又次     

Endobrow-midface lift

The introduction of endoscopes is responsible for the surge in many of the aesthetic facial plastic surgeries in the past decade. This relatively new technology is widely used in upper-third facial rejuvenation and created a natural evolution into the rejuvenation of the central midthird of the face. After careful patient selection and evaluation, several key maneuvers are accomplished to achieve forehead and midface rejuvenation: (1) a subperiosteal dissection of the scalp to the level of the superior and lateral orbital rims and zygomatic arch, (2) incision and release of orbital periosteum, (3) selective myectomies of the glabella muscles, (4) subperiosteal dissection of the midface (from infraorbital rim to the inferior aspect of the maxilla and laterally over the entire zygomatic arch to the gonial angle beneath the masseteric aponeurosis), and (5) suspension and reposition of the malar fat pad, suborbicularis oculi fat, and soft tissue overlying the angle of the mandible. Endobrow-midface lift is a safe and reliable method to rejuvenate the upper two thirds of the face with excellent results while minimizing the morbidities and complications associated with the traditional open procedures.     

Subperiosteal face-lift

The "facial mask" is composed of all of the tissues lying on top of the skeleton: periosteum, deep adipose tissue, superficial musculo-aponeurotic tissue and skin. The periosteum is the intermediate zone between the skeleton, responsible for the shape of the face, and the more superficial tissues which complete the shapes and, most importantly, represent the mobile part of the face and consequently the site of facial expression. The secret of an effective "mask-lift" depends on complete subperiosteal dissection of the malar bones, zygomatic arches and orbital margins. This dissection can be performed via a coronal approach, but it is easier to start the subperiosteal dissection via a short vestibular incision. Subperiosteal dissection via a coronal incision is not only useful to lift the facial mask; it is also useful for remodelling the orbital margins and to obtain bone grafts from the parietal area in order to reinforce the glabella, check bones and nasogenial folds.     

The anatomical basis for surgical preservation of temporal muscle

OBJECT: Mobilizing the temporal muscle is a common neurosurgical maneuver. Unfortunately, the cosmetic and functional complications that arise from postoperative muscular atrophy can be severe. Proper function of the muscle depends on proper innervation, vascularization, muscle tension, and the integrity of muscle fibers. In this study the authors describe the anatomy of the temporal muscle and report technical nuances that can be used to prevent its postoperative atrophy. METHODS: This study was designed to determine the susceptibility of the temporal muscle to injury during common surgical dissection. The authors studied the anatomy of the muscle and its vascularization and innervation in seven cadavers. A zygomatic osteotomy was performed followed by downward mobilization of the temporal muscle by using subperiosteal dissection, which preserved the muscle and allowed a study of its arterial and neural components. The temporal muscle is composed of a main portion and three muscle bundles. The muscle is innervated by the deep temporal nerves, which branch from the anterior division of the mandibular nerve. Blood is supplied through a rich anastomotic connection between the deep temporal arteries (anterior and posterior) on the medial side and the middle temporal artery (a branch of the superficial temporal artery [STA]) on the lateral side. CONCLUSIONS: Based on these anatomical findings, the authors recommend the following steps to preserve the temporal muscle: 1) preserve the STA; 2) prevent injury to the facial branches by using subfascial dissection; 3) use a zygomatic osteotomy to avoid compressing the muscle, arteries, and nerves, and for greater exposure when retracting the muscle; 4) dissect the muscle in subperiosteal retrograde fashion to preserve the deep vessels and nerves; 5) deinsert the muscle to the superior temporal line without cutting the fascia; and 6) reattach the muscle directly to the bone.     

面神经额支的分布与面部上提术的关系

目的明确面神经额支在颧弓及颞部的软组织走行层次和分布。方法对９具尸头（１８侧）颜面行大体解剖观察。结果面神经额支的分支数目为３～７支,平均５支,无恒定的行径及体表投影。将颧弓均分成三段,统计跨过各段表面的额支分支数,发现额支并非仅限于颧弓的中后段,而是近全颧弓均有额支分支跨过,其分布密度以中１／３段最高,占总数的４４４４％（４０／９０）;前１／３段次之,占３８８９％（３５／９０）;后１／３段又次之,占１６６７％（１５／９０）。额支分布于颧弓和颞部的浅筋膜层（即ＳＭＡＳ）的深面,其前段表面分支支配下外侧的眼轮匝肌,中段表面分支支配外侧的眼轮匝肌及少部分额肌,后段表面分支支配额肌和耳前肌。结论行骨膜下剥离面部上提术时,为减少面神经额支的损伤,应注意辨认颞部和颧弓部位的软组织层次,并非靠限制颧弓部位的解剖范围。     

Techniques for Preservation of the Frontotemporal Branch of Facial Nerve during Orbitozygomatic Approaches

Background During orbitozygomatic (OZ) approaches, the frontotemporal branch (FTB) of the facial nerve is exposed to injury if proper measures are not taken. This article describes in detail the nuances of the two most common techniques (interfascial and subfascial dissection). Design The FTB of the facial nerve was dissected and followed in its tissue planes on fresh-frozen cadaver heads. The interfascial and subfascial dissections were performed, and every step was photographed and examined. Results The interfascial dissection is safe to be started from the most anterior part of the superior temporal line and followed to the root of the zygoma. The dissection is continued on the deep temporalis fascia (DTF), and the interfascial fat pad is elevated. With the subfascial dissection, both the superficial temporalis fascia and the DTF are elevated. The interfascial dissection exposes the zygomatic arch directly, whereas the subfascial dissection requires an additional cut on the DTF to expose the zygomatic arch. Proper subperiosteal dissection on the zygomatic arch is another important step in FTB preservation. Conclusion Detailed understanding of the complex relationship of the tissue planes in the frontotemporal region is needed to perform OZ exposures safely.     

面神经额支的分布与面部上提术的关系

目的明确面神额支在颧弓及颢部的软组织走行层次和分布。方法对9具尸头(18侧)颜面行大体解剖观察。结果面神经额支的分支数目为3～7支,平均5支,无恒定的行径及体表投影。将颧弓均分成三段,统计跨过各段表面的额支分支数,发现额支并非仅限于颧弓的中后段,而是近全颧弓均有额支分支跨过,其分布密度以中1/3段最高,占总数的44.44%(40/90);前1/3段次之,占38.89%(35/90);后1/3段又次之,占16.67%(15/90)。额支分布于颧弓和颞部的浅筋膜层(即 SMAS)的深面,其前段表面分支支配下外侧的眼轮匝肌,中段表面分支支配外侧的眼轮匝肌及少部分额肌,后段表面分支支配额肌和耳前肌。结论行骨膜下剥离面部上提术时,为减少面神经额支的损伤,应注意辨认颞部和颧弓部位的软组织层次,并非靠限制颧弓部位的解剖范围。