下颌角缩小术三个关键点的分析

目的在下面部骨性轮廓改形的手术中，寻找下颌骨最佳截骨部位以获得更好的手术效果。方法对382例女性受术者，经口内入路，在气管插管全身麻醉下，利用电动往复锯片的弹性，原位调整锯片切入骨质的角度，一次性整体截除下颌骨升支下部、下颌角、下颌骨外板、下颌骨体下缘及部分颏骨，将残端磨削平滑圆润，线条流畅。结果早期为追求下颌角最大程度地截骨缩小下面部，致出现俗称“马脸”变形、第2下颌角，8例均是由于早期手术对下颌骨体及下缘、下颏处理不到位。术后随访101例，医患双方对效果非常满意61例，满意22例，基本满意11例，不满意5例，差2例。结论下面部骨性缩小的3个关键点足下颌角后份、下颌骨体中份和颏骨前份。

Three key points in mandibular angle reduction surgery

Objective To find out the best osteotomy site in the surgery of lower facial skeletal diminution to achieve a better surgical effect. Methods A total of 382 female patients after endotra- cheal intubation for general anesthesia were treated through an intraoral approach, utilizing the elastic ity of electric reciprocating saw blade and by adjusting in situ cut angle of the saw blade into the sclero- tin, with one time integral resection of lower part of the ascending ramus of the mandible, complete mandibular angle, mandibular outer cortex, complete sclerotin at lower edge of the mandibular body and part of the mandible, in particular, lower edge at both sides of the mandible must be treated in place, which had great significance in reducing width of the anterior body of the lower face, the residu- al side was ground smooth and round with smooth lines. Results In the early time, there were often consequences commonly called as ＂horse face＂ and mandibular incisure fracture due to pursuing the maximum diminution of lower face by mandibular osteotomy, 8 cases of repair surgeries were all the early improper treatment of mandible, mandibular inferior border and chin, but the more recent effect was better, and it was noted that it was not good for lower facial skeletal diminution to saw off more bones at one site. Conclusions Three key points of lower facial skeletal diminution are posterior man- dibular angle, middle mandible body and anterior chin.