下颌角测量与下颌角半盲视下改良截骨术

Measurement of mandibular angle protrusion and semi-blind amputation of hypertrophied mandibular angle with the help of a pre-made mold

目的探索下颌角肥大的手术适应证及在半盲视下行经口下颌角肥大截骨术。方法对39例随机取样成年人群头颅X线片侧位像进行了下颌角角度的测量,初步判定肥大的角度标准,并自行设计和预制截骨模板(又称“制子”)。选用相应预制的合适截骨模板,对6例下颌角肥大者实行了半盲视下的口内入路改良截骨并去除肥大咬肌的术式,其中3例同时行肥大的下颌骨体外层骨皮质截骨去薄术。结果初步判定肥大的角度标准。下颌角截骨均取得了满意的效果。结论本术式的优点是:①手术在半盲视下进行,解决了因口内下颌角暴露不清楚而不易准确截骨的问题,可完全达到术前设计的要求。②由于手术操作进入“程序化”,截骨手术时间大为缩短,创伤减少,术后肿胀消失快。

Objective Mandibular hypertrophy is a subjective diagnosis to some extent. The au- thors tried to find a way for true objective diagnosis of mandibular hypertrophy. Methods Radiographic cephalometry was performed in 39 randomly selected adults. The degree of the mandibular angle was measured and summarized. According to measurement of the mandibular angle and the extent to be am- putated, we designed and made various molds. Results With this pre-made mold,we amputated semi- blindly and exactly the desirable size and shape of the mandibular angle. This technique has been used in 6 patients for mandibular amputation and masseter thinning. In three patients shaving of the out layer of the hypertrophied mandible was also done. Conclusion The new technique using the pre-made opera- tive mold shortens operating time, reduces surgical bleeding and tissue swelling, and can help to remove the bony block precisely.