不同术式下颌角缩小术的临床应用体会

Clinical application of different surgical methods of reduction mandibuloplasty

目的探讨不同术式下颌角缩小术的临床适应证及操作要点。方法将95例患者根据临床表现分为3型:下颌角轻度肥厚型、下颌角肥大伴内翻型、下颌角肥大伴外翻型。对下颌角轻度肥厚型,行口内入路单纯下颌角磨削术,对下颌角肥大伴内翻型,在磨削的基础上,加下颌角的弧线截骨术,对下颌角肥大伴外翻型,在磨削的基础上,加下颌角的矢状截骨术。结果在95例手术患者中,术后12个月内得以随访者57例,大部分患者术后脸形变尖、变小,患者均自觉满意。其中4例因咬肌较肥厚,术后行肉毒素咬肌内注射后自觉效果满意;有3例患者因术中损伤面动脉出血,术后引流不畅,出现下颌角处积血、肿大,其中2例经穿刺抽出积血,1例经口外切开小口,清除积血引流后肿胀消除,3个月后自觉效果满意。结论根据患者下颌角肥大的不同临床表现,分别选择单纯下颌角磨削术、下颌角弧线截骨术或下颌角矢状截骨术,治疗效果好,值得临床推广。

Objective To explore the clinical indications and operation points of different surgical methods of reduction mandibuloplasty.Methods Ninety-five patients were divided into three groups according to their clinical manifestations＇ mild hypertrophic mandibular angle,mandibular angle hypertrophy with varus,and mandibular angle hypertrophy with valgus.A simple abrading procedure through the intraoral approach was performed on patients with mild hypertrophic mandibular angle.The arc line osteotomy was added to correct the introversion of hypertrophic mandibular angle,and the sagittal split osteotomy was added for eversion of hypertrophic mandibular angle.Results Among the 95 patients who underwent surgery,57 patients had postoperative follow-up within 12 months.Most of the patients＇ faces became shaper and smaller,and the patients were satisfied with the improvement in their facial appearance.There were 4 patients of masseter muscle hypertrophy.These patients then received masseter injection of kreotoxin and were satisfied with the effect.Three patients had postoperative hematoma and swelling because of facial artery injury during the operation and obstructed drainage after the operation.Swelling subsided after blood was cleared and drained by puncture in 2 patients and small extraoral incision in the third.The appearances were satisfactory 3 months later.Conclusion Choosing the proper surgical method of reduction mandibuloplasty according to different clinical manifestations of patients with mandibular angle hypertrophy has good treatment outcome and is suitable for clinical application.