下颌骨外板修复颅颌面畸形

目的 研究自体下颌骨外板移植在颅凳面骨骼畸形或缺损修复中的应用。方法 经口内切口显露下颌长支下份、下颌角、下颌体,根据所需骨量的大小及形状,采取一侧或双侧下颌外板,经裁塑形后配合坚强内固定技术用于颅颌面充填植骨或骨骼支架的重建。结果 自１９９３年４月至１９９９年１０月共采用下颌骨外板治疗颅颌面骨组织缺损或畸形５６例。其中颅颌面先天畸形１５例,创伤后畸形修复２１例,肿瘤切除后重建３例,美容整形１７例     

下颌骨外板修复颅颌面畸形

目的研究自体下颌骨外板移植在颅颌面骨骼畸形或缺损修复中的应用.方法经口内切口显露下颌升支下份、下颌角、下颌体,根据所需骨量的大小及形状,采取一侧或双侧下颌外板,经裁剪塑形后配合坚强内固定技术用于颅颌面充填植骨或骨骼支架的重建.结果自1993年4月至1999年10月共采用下颌骨外板治疗颅颌面骨组织缺损或畸形56例.其中颅颌面先天畸形15例,创伤后畸形修复21例,肿瘤切除后重建3 例,美容整形17例.随访6个月至3年,移植骨与邻近骨愈合良好,骨质无明显吸收,所有患者面部形态均得到明显改善.结论自体下颌骨外板主要是密质骨,移植后很少吸收,适合于面部骨骼的充填植骨,具有较高的机械强度,配合小夹板坚强内固定技术可很好的完成面部支架的重建,有效地矫正各种原因导致的颅颌面部骨骼畸形,采取方便,手术创伤小,于体表不遗留瘢痕,对生理功能干扰小,是理想的自体骨移植材料之一.     

下颌骨外板修复颅颌面畸形

目的研究自体下颌骨外板移植在颅颌面骨骼畸形或缺损修复中的应用。方法经口内切口显露下颌升支下份、下颌角、下颌体 ,根据所需骨量的大小及形状 ,采取一侧或双侧下颌外板 ,经裁剪塑形后配合坚强内固定技术用于颅颌面充填植骨或骨骼支架的重建。结果自 1993年 4月至 1999年 10月共采用下颌骨外板治疗颅颌面骨组织缺损或畸形 5 6例。其中颅颌面先天畸形 15例 ,创伤后畸形修复 2 1例 ,肿瘤切除后重建 3例 ,美容整形 17例。随访 6个月至 3年 ,移植骨与邻近骨愈合良好 ,骨质无明显吸收 ,所有患者面部形态均得到明显改善。结论自体下颌骨外板主要是密质骨 ,移植后很少吸收 ,适合于面部骨骼的充填植骨 ,具有较高的机械强度 ,配合小夹板坚强内固定技术可很好的完成面部支架的重建 ,有效地矫正各种原因导致的颅颌面部骨骼畸形 ,采取方便 ,手术创伤小 ,于体表不遗留瘢痕 ,对生理功能干扰小 ,是理想的自体骨移植材料之一。     

自体下颌骨外板游离移植技术在颅颌面外科中的应用进展

颅颌面外科是通过特殊的截骨和植骨方法将颅颌面骨分块移动,并按照整形美容原则重新组合固定,达到从根本上矫正畸形或美化容貌的新兴学科.骨移植是颅颌面外科中最重要的技术之一.目前,国内外常用于骨移植的供区主要有髂骨、肋骨、颅骨外板等;而关于下颌骨外板的应用最常见于通过将其截除以减小患者下面部的宽度.自体下颌骨外板作为一种骨游离移植供区,早在1970年,SN Kline就应用下颌骨颏部供骨治疗了1例下颌骨骨折延迟愈合的患者,并证实下颌骨外板取材方便、血供充分、并发症少,是良好的骨供区.     

自体颅骨外板、下颌骨外板整复颅颌面创伤后继发鼻畸形

目的　探讨自体颅骨外板、下颌骨外板移植在颅颌面创伤后继发鼻畸形矫正中的应用。方法　 1997～ 2 0 0 2年我们对 4 4例颅颌面创伤合并鼻畸形患者 ,运用颅颌面外科诊断和手术技术 ,为其恢复颅颌面骨性轮廓结构 ,同时运用自体颅骨外板或下颌骨外板移植重建鼻支架矫正鼻畸形。结果　所有病例伤口均一期愈合 ,治疗效果满意。经 6个月～ 2年随访观察 ,无感染、无鼻背皮肤红肿坏死、支架无外露及移位 ,骨吸收不明显 ,供区无并发症发生。结论　自体颅骨外板、下颌骨外板采取方便 ,切口隐蔽 ,并发症少 ,特别适用于外伤后严重鼻畸形的矫正 ,是一种理想的移植材料。     

严重复杂性颅颌面骨折后继发畸形的修复重建

目的 探讨严重复杂性颅颌面骨折后,继发畸形晚期重建的手术步骤及手术方法.方法 采用头皮冠状切口、下睑睫毛缘切口及口内龈颊沟切口入路,充分显露所有骨折部位.按照先上后下、再中间,由外向内的顺序进行各功能区域的修复.首先经颅内外联合入路修复额眶部畸形,然后进行眶颧部外侧面部支架的截骨重建,再行下颌骨截骨复位,最后行上颌骨Le Fort Ⅰ型截骨,颌间结扎后,通过下颌骨确定上颌骨的位置并用小夹板内固定.应用自体骨重建鼻背骨性支架,重塑鼻背轮廓;内眦韧带复位固定和内眦整形矫正创伤性内眦距增宽,恢复鼻根部高度与内眦间距的协调比例关系;同时眶壁植骨修复,缩小扩大的眶腔,矫正眼球内陷畸形.结果 共治疗复杂性颅颌面骨折后继发畸形12例.所有患者畸形均获明显改善,咬牙合功能恢复良好.结论 复杂性颅颌面骨折多涉及颅面骨三个或三个以上区域,骨折变化多样.熟知各区域的解剖功能特点、合理设计手术方案,方可最大程度地改善外形,恢复功能.     

严重复杂性颅颌面骨折后继发畸形的修复重建

目的探讨严重复杂性颅颌面骨折后,继发畸形晚期重建的手术步骤及手术方法.方法采用头皮冠状切口、下睑睫毛缘切口及口内龈颊沟切口入路,充分显露所有骨折部位.按照先上后下、再中间,由外向内的顺序进行各功能区域的修复.首先经颅内外联合入路修复额眶部畸形,然后进行眶颧部外侧面部支架的截骨重建,再行下颌骨截骨复位,最后行上颌骨Le Fort Ⅰ型截骨,颌间结扎后,通过下颌骨确定上颌骨的位置并用小夹板内固定.应用自体骨重建鼻背骨性支架,重塑鼻背轮廓;内眦韧带复位固定和内眦整形矫正创伤性内眦距增宽,恢复鼻根部高度与内眦间距的协调比例关系;同时眶壁植骨修复,缩小扩大的眶腔,矫正眼球内陷畸形.结果共治疗复杂性颅颌面骨折后继发畸形12例.所有患者畸形均获明显改善,咬牙合功能恢复良好.结论复杂性颅颌面骨折多涉及颅面骨三个或三个以上区域,骨折变化多样.熟知各区域的解剖功能特点、合理设计手术方案,方可最大程度地改善外形,恢复功能.     

自体骨、生物材料在颅颌面骨缺损修复中的应用研究

目的:运用自体骨与生物材料修复颅颌面骨缺损,观察临床效果并术后随访,以比较自体骨移植与生物材料植入的疗效。方法:将2006年以来笔者科室收治的各种颅颌面骨缺损129例患者分为A、B两组。A组:采用自体骨移植修复,共51例,其中带血管蒂的颅骨外板修复6例、颅骨外板修复37例、下颌骨外板修复8例;B组:采用生物材料植入修复,共78例,其中钛板(网)修复17例、Medpor修复46例、羟基磷灰石修复15例。术后随访6~72个月,通过摄相,头颅X线正、侧位片,面部轮廓测量,颌面部CT及三维重建,了解患者满意度,观察临床效果及有无后期并发症发生。结果:129例患者术后伤口均一期愈合,颅颌面轮廓得到了很大改善,同时具有很好的美容效果。自体骨修复患者中1例术后出现了血清肿,通过负压引流和加压包扎清除了血清肿后伤口一期愈合。术后随访1例Medpor修复额骨缺损患者切口边缘增生,1例Medpor修复患者固定的钛钉穿破皮肤,1例Medpor修复面中分患者修复体外露。其他患者术后随访,颅颌面骨轮廓外观正常,双侧对称,无再陷及表面凹凸不平、修复体移位、外露、假体取出等明显的并发症发生,患者对术后效果满意。结论:颅颌面骨缺损的修复首选自体骨,其中自体颅骨外板与下颌骨外板修复效果较好;当缺损面积大自体骨量不足时,考虑生物材料修复,其中Medpor、羟基磷灰石、钛板应用较多,临床效果满意。     

经眶外侧颅内外联合径路治疗颅眶骨纤维异常增殖症

目的 探讨颅眶骨纤维异常增殖症手术治疗的径路. 方法 对累及额骨、眼眶、蝶骨、颞骨的复杂颅面骨纤维异常增殖症患者,应用经眶外侧颅内外联合径路进行手术治疗,包括眶外侧及颞部开窗,病灶的部分或大部切除,视神经减压,颅眶骨外形重建等. 结果 自2005年以来,于临床治疗8例患者,术后随访9个月至3年,无明显并发症发生,复杂颅眶部畸形得以矫正,视力障碍有所改善.头颅CT示骨瓣愈合良好,未见病变复发. 结论 经眶外侧颅内外联合径路可作为治疗颅眶部骨纤维异常增殖症的首选方法.     

创伤性颅眶畸形的三维可视化诊断分析与手术整复

目的：依据颅眶创伤畸形诊断分类选择相应术式予以整复，并通过规范化治疗改善整复疗效。方法：81例创伤性颅眶畸形均经三维cT确诊为颅-眶-颧颌骨折和畸形。将其分为适合于选择手术术式的四类：①颅骨缺损；②眶壁爆裂骨折；③普通眶周骨折；④复杂眶周骨折。结果：①颅骨缺损12例（14．8％），采用自体肋骨或颅骨板移植获得良效；②眶壁爆裂骨折16例（19．7％），手术还纳眶内容、封闭疝孔、恢复眶腔容积和眼球位置；③普通眶周骨折21例（25．8％）：以骨缺损形态体积相同的骨组织修复，无骨质缺损者则截骨，使骨折段复位固定；④复杂眶周骨折32例（39．5％）：截断错位愈合的骨折线将眶-颧-颌复合体复位；眶粉碎者，应用CAD／CAM快速成型技术预制人工骨眶，手术效果良好。本组所有病例未出现植骨坏死、外露、畸形复发、眶内血肿等严重并发症。结论：颅骨缺损的整复仍以自体骨移植、钛网修复效果较好。眶爆裂骨折晚期畸形以植入自体骨或人工骨修复骨缺损、矫正复视、眼球复位为主。普通眶周骨折：采取截骨、植骨或生物材料植入修复的手术方案。复杂眶周骨折晚期畸形最有效的方法是截断错位愈合的骨折段，复位颅面骨结构形态。典型的Le Fort型骨折，宜采用Le FortⅠ～Ⅲ型截骨手术。     

Osteomas of the craniofacial region: A case series and review of literature

Objective:

To discuss the clinical presentation, diagnosis and management of osteomas involving the craniomaxillofacial region.

Materials and Methods:

This study was conducted from June 2004 to March 2012 at our institute. A total of 12 cases between the ages of 10 and 50 years were managed with surgical excision and reconstruction. The criteria used to diagnose osteoma included radiographic and clinical features and histological confirmation of the specimen. The total follow-up period ranged from 6 to 24 months.

Results:

Out of 12 osteomas, 10 were peripheral and 2 were centrally located. Mandible involvement was seen in six patients, four involved the orbit, one the frontal bone and one the frontal bone with the skull base. All patients undergoing excision and reconstruction had a favourable aesthetic and functional outcome. There were no recurrences and no post-operative complications.

Conclusion:

Osteomas affect all age groups with no sex predilection and are usually clinically asymptomatic till they become large in size. Surgical excision and appropriate reconstruction is the mainstay of management. Surgery is indicated when lesion is symptomatic or actively growing and the surgical approach for exposure of the lesion should be case specific.KEY WORDS: Craniofacial, osteoma, reconstruction     

Aesthetics and Function in Lip Reconstruction

Reconstruction of the lip following excision of malignant tumors is a frequent task of the plastic surgeon. Adequate oncological treatment must be followed by a satisfactory aesthetic and functional result. A simple and successful technique of lip reconstruction is revisited. It consists in using the remaining lip, which is released by way of a horizontal mucomyocutaneous flap(s) and stretched to fill the gap. Twenty-six consecutive cases of T2–T3 squamous cell carcinoma of the lip were treated using this technique, with excellent aesthetic and functional results.     

A new approach in axillary hidradenitis treatment: The scapular Island flap

The scapular island flap technique has been used in the treatment of seven cases of axillary hidradenitis suppurativa. This flap, providing a smooth skin surface with good elastic properties, easily covers the axilla and permits the cutaneous reconstruction of the involved axillary tissue excision with satisfying aesthetic, functional results and a rapid local cicatrization. The donor site was closed by primary suture.     

Nasal spreader grafts: a comparison of medpor to autologous tissue reconstruction

Reconstruction of the damaged nasal vault is challenging. Limited available autologous tissue has lead surgeons to pursue alloplastic alternatives. A retrospective review comparing 18 patients who underwent secondary rhinoplasty with internal nasal valve reconstruction with spreader graft (SG) implants using either autologous tissue or high-density porous polyethylene (Medpor) was performed. All underwent bilateral SG reconstruction of the internal nasal valve with Medpor (10 cases) or autologous cartilage (8 cases). Mean follow-up was 26 months for the autologous group and 29 months for the Medpor group. Functional performance and aesthetic results were identical. Complications were few: 1 case of unilateral infection in the Medpor group treated with partial excision, and 1 case of erythema at the auricular donor site for the autologous tissue group. For patients who have exhausted autologous tissue options or are unwilling to tolerate potential donor-site morbidity, the Medpor SG is an appropriate option that allows for excellent aesthetic and functional results that remains stable over time.     

扩张器在头额部的临床应用

目的　探讨头额部皮肤缺损修复术优于传统手术疗效的方法。方法　应用扩张器分Ⅱ或Ⅲ期 ,以旋转、推进、轴型或岛状皮瓣方式转移扩张皮瓣 ,修复 72例头额部的先天性或获得性皮肤缺损患者。结果　 72例患者中 ,除 1例皮瓣坏死约 3.0cm× 2 .5cm外 ,扩张皮瓣均全部成活 ,修复后形态自然 ,效果满意。结论　在充分做好术前设计、提高手术技巧和严防并发症发生的情况下 ,皮肤组织扩张术是头额部皮肤缺损修复的理想选择     

Radikale Skapulektomie mit Musculus-trapezius-Transfer bei Weichteilsarkom des Schultergürtels

In soft-tissue sarcoma, wide tumour excision (R0) has become the most important factor in local tumour control. Nowadays, radical scapulectomy with limb salvage is the treatment of choice for soft-tissue sarcomas of the shoulder girdle. We present the case of a 78-year-old man with extended low-grade fibrosarcoma of the left shoulder girdle. Despite his age, radical scapulectomy with intraoperative radiation and functional reconstruction of the shoulder girdle with a myocutaneous trapezius flap was performed. Good functional and aesthetic results could be obtained.     

The inner table calvarial bone graft harvest: a source of primary bone graft in the management of craniomaxillofacial skeletal injuries

Increased mechanization and pace of life have increased road traffic accidents and other grievous injuries in the past few years. These patients frequently have complicated injuries involving soft tissue and the craniomaxillofacial skeleton. The extracorporeal harvest of the inner table of the calvaria for reconstruction of craniofacial defects following trauma has been explored in this study. Twelve patients of craniomaxillofacial injuries were considered in this study from November 2007 to November 2009 (2 years). The inner table of the calvaria was utilized as a source of bone graft in patients who required concomitant craniectomy for management of associated intracranial injuries in this study. No complications pertaining to bone graft harvest or fixation were noted in any of the patients. All patients were satisfied with the aesthetic and functional outcome. The ease of bone graft harvest, along with marked absence of complications, makes this method an attractive and safe alternative for bone graft harvest, which may even be extended for the application in situations requiring elective cranioplasty.     

EBCT对严重的颅颌面骨折的诊断意义

目的 研究电子束CT对严重的颅颌面骨折的诊断意义.方法 对43例严重的颅颌面骨折的患者进行EBCT扫描,三维重建后的图像与X线片图像进行比较,结合临床检查及手术探查,评价EBCT对严重的颅颌面骨折的诊断意义,并进行统计学分析.结果 EBCT扫描速度快,图像清晰、立体,对严重的颅颌面骨折的诊断,与X线片比较,差异有非常显著的意义（P〈0.01）.结论 EBCT对严重的颅颌面骨折诊断,有较大的应用价值,对医患双方的交流和术前设计也有帮助.     

Morbidity of iliac bone grafts. A study apropos of 100 consecutive cases]

A study of the real morbidity after iliac bone graft harvesting was conducted on a homogenous series of 100 consecutive cases. Functional and aesthetic consequences were evaluated in relation to the immediate post-operative course and the long-term follow-up and in relation to the indication, the technique used and the amount of bone removed. Considering the small number of sequelae observed, autogenous iliac bone graft remains the best material for craniomaxillofacial reconstruction. The main disadvantage consists of the resorptions noted; which raises the possibility of using other types of bone grafts or bio-materials in some indications.     

Aesthetic and functional considerations in the reconstruction of large skin defects with free flaps

Free flaps can be used effectively in the primary reconstruction of large defects after resection of large tumors. The ultimate goal is radical excision of tumors and achievement of primary wound healing with a single procedure and long-term local control of disease. Although this can be obtained with the use of free tissue transfer, patients often seek more aesthetic results. Therefore, refinements of reconstructive techniques with minimal functional donor site morbidity are now the gold standard in our practice.