口内入路下颌角弧线形截骨术

目的:探索更好的下颌角肥大截骨缩小术式。方法:为获得更好的术后效果,我们采用口内入路下颌角弧形截骨术,将弧形截骨线延长到颏神经处,并对颏结节进行打磨,使截骨线延续流畅,伴小颏者同时行隆颏或颏截骨前移。结果:自2002年以来,我科采用口内入路下颌角长弧线形截骨术矫正320例下颌角肥大患者,均取得了良好的效果。结论:口内入路延长弧形截骨术缩小下颌角可以获得更好术后效果。     

Vertical interpositional augmentation genioplasty with porous polyethylene

Recent advances in the field of biomatrix porous implant technology has stirred the interest of the oral and maxillofacial surgical community. One such material (Medpor), is a biocompatible, large-pore, high-density polyethylene implant which has proven both experimentally and clinically to fulfil the criterion for maxillofacial reconstructive and aesthetic surgical grafting.     

颏形态综合分析在颏部水平截骨整形术中的应用

目的探讨分析小颏畸形的颏部形态特征及其在颏部水平截骨整形手术应用中的效果。方法通过头颅正侧位X线头影测量分析12例小颏畸形患者的颏部形态,按测量值与正常值之间的差值,计算截骨段移动范围,手术采用颏部水平截骨整形手术方法。结果12例患者均按照术前预测值移动截骨段,术后头颅正侧位X线头影测量结果与术前预测值相近,治疗效果满意。结论通过头颅正侧位X线头影测量分析小颏畸形的特点,精确计算截骨段的移动范围和方向,是保证颏部水平截骨整形术达到良好美容效果的基础。     

自体骨屑颏成形术

目的探索治疗下颌角肥大伴颏畸形时隆颏的新方法。方法对15例下颌角肥大患者，在磨削去骨同期，应用所磨削的骨屑植入颏部．颏成形塑形后石膏托固定改善下颌整体形态。结果15例术后随访6月-2年：12例患者表示满意；1例术后10d要求改变成形的颏部形状，调整后满意；2例分别于术后18、21d时因外力使颏部变形，调整后效果满意。结论该手术利用自体骨屑移植无排斥反应，并发症少；易塑形，与受骨融合快，美容效果理想。     

Chin shield osteotomy – a new genioplasty technique avoiding a deep mento-labial fold in order to increase the labial competence

The authors report a genioplasty technique in which the advancement of an anterior mandibular segment is executed with a specific osteotomy form that helps to avoid a deep mentolabial fold and improves labial competence. The osteotomy presented achieves this by creating a ‘chin shield’ where the mandibular segment advanced is relatively high on the side of the buccal cortex and lower on the lingual side and where the osteotomy or down-fracture in between is in an oblique angle in the sagittal plane.     

口内入路三角块截骨并外板去除和咬肌修薄矫正严重方脸畸形

目的：应用三角块截骨、外板去除和咬肌修薄联合颏部截骨治疗严重方脸畸形.方法：应用口内入路，改良的下颌骨矢状劈开去除外板、摆动锯去除下颌角和咬肌修薄矫正下颌角咬肌肥大，颏部截骨前下移动，取下的下颌骨块充填固定矫正颏部短小.结果：应用该方法治疗严重方脸畸形7例，效果良好，脸型改善明显.结论：三角块截骨、外板去除和咬肌修薄联合颏部整形对矫正严重方脸畸形具有良好的效果。     

颏前徙成形术矫正轻中度小颌畸形10例体会

目的通过手术改善轻中度颏部发育不足及矫治颏偏斜不对称畸形,改善面下部鼻唇颏正侧面的综合形态.方法对颏部发育不足或颏部偏斜不对称患者共10例进行颏前徙成形术,患者均不伴有明显咬合紊乱及颞下颌关节紊乱症状,其中颏部垂直向发育不足者2例,前后向发育不足者3例,前后及垂直向兼有者3例,颏部偏斜者2例,其中2例为硅胶假体隆颏术后外形不满意,术前本身就为颏部前后向发育欠佳.手术纠正了患者颏部垂直向及前后向的外形,并改善了鼻唇颏的正侧面综合形态.结果所有患者术后随访3～6个月,均恢复良好,术后面下部鼻唇颏综合外形满意,无不良反应.结论颏前徙成形术对于单纯的轻中度颏发育不足及颏部偏斜不对称患者的下颌部外形有明显的改善,术后面下部鼻唇颏形态效果良好,避免了硅胶假体隆颏术后继发局部骨质吸收、假体移位等弊端.     

Anaesthesia for orthognathic surgery

Anaesthesia for orthognathic surgery requires thorough preoperative planning and multidisciplinary involvement. Patients are generally young and healthy, though there is an increasing trend in treatment of patients with obstructive sleep apnoea syndrome, associated with increased premorbid disease burden. Principles of perioperative management include close cooperation between surgeon and anaesthetist, a multifaceted approach to minimizing blood loss, multimodal analgesia, anti-emesis prophylaxis, and a carefully planned, communicated and executed airway management strategy. Nasotracheal intubation is routinely performed to maximize surgical access and permit intraoperative dental occlusion, though retromolar or submental intubation may occasionally be indicated. Patients with temporomandibular joint pathology or some congenital syndromes may necessitate awake airway management techniques. A clear strategy for tracheal extubation should be established in advance, including a well-defined re-intubation plan, especially for patients with intermaxillary fixation devices. Patients should be managed in an appropriately equipped and staffed postoperative care facility.     

不对称性下颌角肥大的手术治疗

目的　探讨不对称性下颌角肥大的原因及手术治疗。方法　采用下颌角弧形截骨术、下颌骨外板截骨术、颏成形术及颊脂垫取出术等方法,治疗不对称性下颌角肥大患者70例。结果　70例患者术后面部对称性均明显改善。70例患者中仅3例出现并发症,包括术后出血、口唇拉伤增生性瘢痕及术后感染等。结论　治疗不对称性下颌角肥大应根据畸形的特点,选择性应用下颌角弧形截骨术、下颌骨外板截骨术、颏成形术及颊脂垫取出术等方法,其效果良好。