改良的面部轮廓整形术在临床中的应用

Application of modified osteotomies in facial contour reshape

目的 回顾性总结近20年来颧弓缩窄和下颌角截骨技术的演变及改进,通过比较各种手术方法,探索一套相对安全、有效、易操作的面部轮廓整形技术.方法 自1988年5月至2008年11月,对585例患者行颧弓缩窄术和下颌角截骨术.2002年之前采用文献报道的多种方法对颧弓及下颌角行截骨整形;2002年之后改进了截骨方法,采用楔形截颧骨法及斜形全厚下颌角和下颌下缘截骨法行面部轮廓整形.口内切口的颧骨复合体楔形截骨联合耳前颧弓不完全骨折截骨后,可将颧弓向内、向前移位,以达到缩窄中面部的目的 ;采用口内入路的下颌角和下颌下缘的斜彤全厚截骨,于下颌角截骨时,保持去除下颌角和下颌下缘的外板大于内板,以使术后面中下部轮廓较完美.并总结各类方法的手术指征、主要并发症等,比较改进后的楔形截颧骨法及斜形全厚下颌角和下颌下缘截骨法较之常规术式的优缺点.结果 口内切口入路在颧骨和下颌角整形中有明显的优势.楔形截颧骨法较常规的更有效、可靠.同时,接受斜形下颌角和下颌下缘截骨整形的患者获得了良好的疗效,而且术后并发症发生率较低.结论 楔形截颧骨法及斜形全厚下颌角和下颌下缘截骨手术是相对安全、有效且易掌握的改良的面部轮廓整形术式.

Objective To establish optional, effective and reliable surgical procedures by retrospectively summarizing the 20 years development and improvement of zygoma arch reduction and mandible angle osteotomy techniques and by comparing different operative methods. Methods From May 1998 to November 2008, 585 cases received zygoma arch reduction and mandible angle osteotomy by several kinds of techniques of zygoma arch or mandible angle reduction introduced in literature records before 2002 and improved osteotomy techniques after 2002, including facial contour reshaping of zygomatic wedge osteotomy and oblique full-thickness mandibular angle and mandibular inferior margin osteotomy which obtained the satisfactory results. After zygo- matic complex wedge osteotomy through intraoral incision combined with preauricula zygomatic arch incomplete fracture, zygomatic arch was moved inward and forward to reduce the midface ; during oblique full-thickness osteotomy of mandibular angle and mandibular inferior margin through intraoral approach, removed outer plate of mandibular angle and mandibular inferior margin was bigger than inner plate to make the postoperative mid and lower face more perfect. Operation indications and main complications of several kinds of techniques were summarized and merits and demerits of improved zygomatic wedge osteotomy and oblique full-thickness mandibular angle and mandibular inferior margin osteotomy and routine techniques were compared. Results Intraora/incision showed apparente dominance in both osteotomies. Compared with other conventional methods, zygomatic wedge osteotomy was more effective and reliable. The patients treated by the oblique full-thickness osteotomy of mandibular angle and mandibular inferior margin were satisfied with the results and few complications. Conclusion Zygomatic wedge osteotomy and oblique full-thickness osteotomy of mandibular angle and mandibular inferior margin trough intraoral incision were relative safe and wield for the facial reshaping.