下颌骨角全层截骨加下颌骨外板劈除行方形脸改型术

Combined mandibular angle resection with lateral cortex splitting ostectomy around mandibular angle by intraoral approach for correction of square face

目的寻求一种新的更有效的方形脸改型术式。方法对68例（年龄21～40岁，女65例，男3例）方形脸求术者用高速涡轮气钻和骨凿实施了口内入路下颌角全层三角形截骨加下颌外板劈除术，咬肌肥大者同时行咬肌内层切除术，颊部丰满者则行部分颊脂垫摘除。结果使用高速涡轮气钻和骨凿截除全层下颌角和劈除下颌外板极为容易。56例3～24个月术后随访，双下颌角间距明显缩小，脸型呈椭圆。无下颌不对称、下颌意外骨折。侧方轮廓自然。结论下颌角全层截骨加下颌外板劈除不仅可有效缩小下颌正面宽度，而且还能改善下颌侧方轮廓，是方形脸改型的一种有效术式。

Objective To search for a procedure for correction of square face. Methods 68 patients with square face （aged from 21-40 years, with 65 females and 3 males） underwent ostectomy combined mandibular angle triangle resection with lateral cortex around the mandibular angle-splitting by intraoral approach. The mandible outer cortex was splited with bone chisel and mandible angle was resected by the high-speed pneumatic drill. The bulky masseter muscle and the enbonpoint buccal fatpad were scissored. Results The application of high-speed pneumatic drill and bone chisel facilitated resection of the mandibular angle with lateral cortex splitting ostectomy. The operative effects were satisfactory in 56 patients during 3-24 months of follow-up. The bigonial distance was effectively reduced, and facial shape became ellipse. The gross asymmetry and mandibular fracture were not consequences. The lateral contour of the mandibular angle was natural. Conclusion Ostectomy of mandible angle and lateral cortex of the mandible allows the reduction of the mandibular contour of the frontal view and the lateral contour of mandibular angle becomes soft, giving a more natural appearance. This new method is worthy to be applied widely because of the good result with effective reduction of the mandibular width.