口内入路下颌角弧形截骨术218例回顾性分析

Retrospective analysis of barrel vault osteotomy of mandibular angle via intraoral incision

目的 总结口内入路下颌角弧形截骨术的手术经验,分析并发症原因并探讨其防治方法.方法 回顾性分析2004年10月至2008年11月收治的218例骨性下颌角肥大求美者,行口内入路下颌角弧形截骨术.对咬肌肥大者,切除部分咬肌;颊部过度丰满者,去除部分颊部脂肪;对过于要求窄下颌者,同期行咬肌内注射A型肉毒毒素.总结临床经验并针对常见并发症制定合理的解决方案.结果 经随访3个月至2年,所有求美者均获得了较好的面下部轮廓.5例求美者术后口唇有不同程度的肿胀,经激素治疗辅助张口锻炼后恢复;7例术后轻度颏神经损伤,1～3个月自行恢复;2例术后轻度血肿,应用抗生素治疗后恢复.结论 口内入路下颌角弧形截骨术,有足够的截骨量,只要规范手术操作并注意防治其有可能发生的并发症,可作为下颌角肥大缩小术的安全、有效的方法.

Objective To summarize the clinical experiences of barrel vault osteotomy of mandibular angle via intraoral incision, to analyze the causes of postoperative complications and to explore the treatments of prevention and cure. Methods A retrospective analysis was performed based on 218 patients with osseous hypertrophy of mandibular angle from October 2004 to November 2008. For the patients with masseter hypertrophy, part of masseter was resected ; for the patients with cheek over-fullness, part of cheek fat was removed ; for meeting those patients needs of over-narrow lower mandible, the injection of botulinum toxin type A was performed simultaneously. Results After 3 to 24 months follow-up, all cases received satisfactory lower facial contour except for 5 cases with swelling of mouth and lip which were healed after hormonotherapy treatment and open-mouth training, 7 cases with mild nervus mentalis injury which were recovered spontaneously at 1 to 3 months postoperatively and 2 cases with mild hematoma healed by antibiotic therapy. Conclusion Enough and precise osteetomy could be received by barrel vault osteotomy via intraoral incision. It could be a safe and effective method for the treatment of prominent mandibular angle based on the normative operative performance and preventions of the complications.