颧骨颧弓缩小联合下颌角截骨整形术后咀嚼肌群变化的研究

目的:探讨颧骨颧弓及下颌角截骨整形术后咀嚼肌群的动态变化。方法:随机选取颧骨颧弓肥大及下颌角肥大者59例,于术前、术后10天、术后3个月分别做三维CT检查,并对颜面部进行三维测量,采用q检验(Newman-Keuls法)进行方差分析。结果:咬肌、翼内肌的变化趋势相同,术后10天横截面积较术前增加,术后3个月横截面积较术前减少;翼外肌、颞肌横截面积术前与术后10天未见明显变化,颞肌术后3个月较术前降低,翼外肌术后3个月较术前增大。结论:颧骨颧弓缩小及下颌角截骨整形术后短期内由于术中截骨及对肌肉的剥离,使咬肌、翼内肌发生损伤,随着术后恢复,肌肉等组织重新附着发生适应性改变从而较术前减小;颧骨颧弓缩小术后可造成颞肌萎缩;由于术中很少累及到翼外肌,所以术前及术后10天变化不明显,术后3个月发生代偿性增大。

Study on masticatory muscles changes Pre-and post reduction plasty of mala and zygoma and mandibular angel ostectomy

Objective To investigate the change of masticatory muscles after reduction plasty of mala and zygoma and mandibular angel ostectomy.Methods 3DCT facial soft tissue measurement was performed before the surgery and at 10 days,3 months after the surgery in 59 cases of prominent malar-complex and mandibular angle.The q test （Newman-Keuls method） were used to analysis of variance.Results Masseter muscle and medial pterygoid muscle had the same chang trend,the cross sectional area was increased at 10 days after the surgery,reduced at 3 months after the surgery; lateral pterygoid muscle and temporal muscle had no statistical difference between the preand 10 days post-operative,however,the temporal muscle was increased while the lateral pterygoid muscle was reduced at three months after the surgery.Conclusion Because of osteotomy,muscles attached position are changed in the short term after reduction plasty of mala and zygoma and mandibular angel ostectomy,masseter muscle and medial pterygoid muscle are inevitably injuried during the operation.With the postoperative recovery,muscles have adaptive changes which reduced compared with the preoperative after their reattachment;reduction plasty of mala and zygoma can cause temporal muscle atrophy;while the operative rarely involving the lateral pterygoid muscle,the cross sectional area had no statistical difference between the pre-and 10 days post-operative,and the cross sectional area increase at 3 months post-operative may be due to a compensational enlargement.