全下颌下缘环形截骨术与T形颏成形术合并下颌角截骨术对比研究

Comparison of total mandibular inferior border ostectomy versus T-shape genioplasty for chin narrowing combined with mandibular contouring

目的比较下颌轮廓整形中应用全下颌下缘环形截骨术与T形颏成形术合并下颌角截骨术来缩窄颏部的临床效果并评估全下颌下缘环形截骨术的适应证。方法回顾性分析2015年1月至2019年1月就诊于四川大学华西口腔医院正颌及关节外科行下颌角轮廓整形及颏部缩窄术的患者临床资料。根据手术方式将患者分为全下颌下缘环形截骨术组(Ⅰ组)和T形颏成形术合并下颌角截骨术组(Ⅱ组),收集患者术前及术后末次随访的CT影像资料,术后通过随访观察患者下面高、颏部宽度、颏部偏移量、面部比例、患者满意度及术后并发症等情况对手术效果进行评估。采用SPSS 20.0软件对数据进行统计分析,计量资料以±s表示,计数资料以例(%)表示,2组患者年龄、平均满意度评分及术前术后相关测量指标差异比较采用t检验,2组患者性别构成比、并发症比较采用卡方检验,P<0.05表示差异具有统计学意义。结果共纳入102例患者,其中Ⅰ组42例,男7例,女35例,年龄(24.9±3.6)岁(19~43岁);Ⅱ组60例,男11例,女49例,年龄(26.3±3.4)岁(19~32岁)。术后随访6~24个月,所有患者外貌均有改善,无严重并发症发生。患者满意度,Ⅰ组30例非常满意,11例满意,1例一般;Ⅱ组43例非常满意,15例满意,2例一般。Ⅰ组和Ⅱ组的年龄、性别构成比、下唇麻木、血肿、严重血肿、术后感染、软组织下垂、患者满意度分别比较,差异均无统计学意义(P均>0.05)。Ⅰ组与Ⅱ组的术前下面高[(63.05±4.15)mm vs.(52.87±4.07)mm],术前下面高与中面高比值[(107.89±3.11)%vs.(91.29±7.94)%],术前颏部宽度与下面高比值[(90.31±3.19)%vs.(104.32±5.28)%],术后颏部宽度缩窄量[(12.11±2.59)mm vs.(8.39±1.89)mm],术后颏部偏移量[(0.17±0.09)mm vs.(0.36±0.20)mm],术后颏部宽度与下面高比值[(76.80±1.85)%vs.(80.95±3.75)%],差异均有统计学意义(P均<0.01);术前颏部偏移量、术前中面高、术后下面高、术后下面高与中面高比值分别比较,差异均无统计学意义(P均>0.05)。结论与T形颏成形术合并下颌角截骨术相比,全下颌下缘环形截骨术颏部缩窄量更大,术后颏部偏移量更小,更适用于颏部长、宽、不对称的患者,术后可获得更优美的下颌轮廓线。

Objective To compare the outcomes of the total mandibular inferior border ostectomy and the T-shape genioplasty for chin narrowing combined with mandibular contouring and to assess the indications of the total mandibular inferior border ostectomy.Methods In this retrospective study,the clinical data were collected from the patients who received mandibular contouring and chin narrowing at the Department of Orthognathic and Temporomandibular Joint Surgery,West China Hospital of Stomatology,Sichuan University from January 2015 to January 2019.According to the surgical procedure,patients were divided into Total inferior border ostectomy(Group I)and T-shaped genioplasty combined with mandibular contouring(Group II).Computed tomography scans,combined with medical records and photographs,were collected preoperatively and in the final follow-up postoperatively.Lower facial height,chin width,chin symmetry,facial proportions as well as patients’satisfaction and complications were investigated to assess the clinical outcomes.Statistical analyses were performed using IBM SPSS Statistics,version 20.0(IBM Corp.,Armonk,NY,USA).The measurement data were expressed as Mean±SD,and the counting data were expressed as case(%).T-test was performed to compare the age difference,average satisfaction score and the relative measurements between the two groups.Pearson’s chi squared test was used to compare the sex composition ratio and complication ratio between the two groups.P<0.05 was considered statistically significant.Results 102 patients were involved in this study,including 42 patients in group I,7 males and 35 females;60 patients in groupⅡ,11 males and 49 females.All patients improved lower facial contours.No severe complications were observed during the follow-up period(6~24 months)Regarding appearance satisfaction,30 cases were very satisfied,11 cases were satisfied,and 1 case was neutral in group I.43 cases were very satisfied,15 cases were satisfied,and 2 cases were neutral in group II.There was no significant difference(P>0.05)between group I and group II in age,sex,inferior lip numbness,hematoma,severe swelling,infection,soft tissue ptosisand appearance satisfaction.There was a statistically significant difference(P<0.01)in preoperative lower facial height[(63.05±4.15)mm vs.(52.87±4.07)mm],Preoperative lower and midfacial height ratio[(107.89±3.11)%vs.(91.29±7.94)%],and preoperative chin width and lower facial height ratio[(90.31±3.19)%vs.(104.32±5.28)%],chin width change[(12.11±2.59)mm vs.(8.39±1.89)mm],postoperative chin deviation[(0.17±0.09)mm vs.(0.36±0.20)mm]and Postoperative chin width and lower facial height ratio[(76.80±1.85)%vs.(80.95±3.75)%].No statistical difference(P>0.05)was found in preoperative chin deviation,midfacial height,postoperative lower facial heigh,postoperative lower and midfacial height ratio.Conclusion In conclusion,compared to T-shape genioplasty combined with mandibular contouring,total mandibular inferior border ostectomy had a large amount of chin narrowing and better postoperative symmetry and is well suited for a longer,wider,and more asymmetrical chin.The surgical options should be considered and chosen quantitatively to achieve aesthetically satisfactory results.