改良颧骨颧弓截骨缩小术的临床应用

Clinical application of modified reduction plasty of malar and zygoma

目的探讨矫正颧骨复合体肥大的一种新的手术方法和效果。方法采用口内切口，首先对术前标记的颧骨最高点进行磨骨，然后用微型来复锯进行颧骨体部的L形不完全截骨；采用耳前切口在颧弓结节前1cm垂直截断颧弓，将颧骨复合体向后内移位，不需要进行内固定。结果650例伤口均I期愈合。1例于2周后出现上颌窦炎，经静脉用抗炎药物、局部引流后1周自愈。1例由于同时进行局部脂肪抽吸术后出现直径约1cm的局限性皮肤坏死，经换药后愈合。1例术后1周复查出现单侧额纹消失，2周后完全恢复。随访2～24个月，所有受术者均对面型改善表示满意。结论该术式设计简单，不需要内固定，手术时间短、手术创伤小、恢复时间短、并发症少，是一种比较安全、有效的矫正颧骨复合体肥大的手术方法。

Objective To introduce a new method for correcting prominent malar complex deformity. Methods Through an intraoral incision, the highest area of zygomatic body marked preoperatively was grinded. Then an L shape incomplete osteotomy of the zygomatic body was performed with a reciprocating saw, and a complete osteotomy just 1 cm anterior to the articular tubercle of the zygomatic arch was made. Light pressure on the posterior part of the arch produced a greenstiek fracture of the anterior osteotomy site, resulting in posterior-inward repositioning of the malar complex. Internal fixation was unnecessary. Results Operative procedures for reductive malar complex plasty were performed in 650 cases, which included 60 males and 590 females whose age ranged from 19 to 39 years. Incisions of all cases healed well. One case had maxillary sinusitis 2 weeks postoperatively, and recovered after 1 week by using antibiotics and drainage. There was 1 case with skin necrosis about 1 cm in diameter in the area of zygomatic body because of local liposuction, and the wound was healed by changing dressing. The forehead wrinkle of one side had disappeared in 1 case 1 week postoperatively, but had recovered 2 weeks later. Postoperative follow-up for 2-24 months showed satisfactory results. Conclusions This modified method has many advantages, such as simplicity, without internal fixation, short operation and recovery time, and little complications. The authors conclude that this technique is an effective and safe method of reduction malarplasty.