下颌角肥大截骨术的常见并发症及处理

Common complications of osteotomy of mandibular angle prominence and their treatments

目的探讨下颌角肥大截骨术的常见并发症及其防治措施。方法白2005年1月至2010年12月，采用下颌角截骨术治疗856例下颌角肥大患者。采取15内切口，利用气动高速骨切割钻自下颌升支中份后缘，向前至颏孔前缘下方，全层弧形截除下颌角。结果856例患者中，17例患者术中出血。其中，15例患者给予结扎、压迫止血。1例患者因止血不当，留有偏瘫后遗症。1例患者出血引起呼吸道梗阻死亡；6例患者术中意外骨折，均于口内行微型钛板固定。1例髁突骨折留有开口受限，开口偏斜的症状，其余患者骨折愈合；3例患者严重感染，1例患者局部形成凹陷性瘢痕，其余患者伤口愈合；4例患者神经损伤，1例患者出现面瘫，其余患者患侧下唇永久性麻木。结论术中严格遵守手术操作规范及无菌操作原则，是避免出血、骨折、神经损伤等并发症发生的关键。而及时并有针对地处理并发症是避免发生严重后果的保障。

Objective To explore the cmnmon compilications after mandibular angle ostectomy and their measurements of prevention and treatment. Methods From January 2005 to December 2010, 856 cases with mandibular angle prominence were treated by mandibular angle ostectomy through the intraoral approach, along the posterior border of the ascending branch midpiece of lower mandible, the full-thickness and arcuated exci- sion of redundant mandibular angle was performed upward to the bottom of the anterior border of mental foramen by super-speed bone drill according to the preoperative design. Results Analysis results from 856 patients who performed mandibular angle ostectomy showed that 17 cases were with bleeding which were cured by ligated and compression except one case with hemiparalysis because of incorrect hemostasis and one case died because of respiratory tract obstruction; 6 cases with accidental fracture which were healed with intraoral mini-titanium plate fixation, one of them was with effect of limitation of mouth opening because of fractura condylaris ; 3 cases with serious infection which were all cured except one with local depressed scar; 5 cases with nerve injurey, a- mong them, one case was with facial paralysis and the others with permanent numbness of lower lip on affected side. Conclusion To strictly keep the standards of operative procedure and the principles of sterile operation is the key to avoid such complications as bleeding, fracture, nerve injuries. The security to avoid serious consequence is to timely and directly deal with these complications.