颏下颌下颈阔肌成形术在下颌角截骨术中的应用

Application of submentum and submaxilla platysma plasty in mandibular angle osteotomy

目的通过手术方法预防下颌角截骨手术后下颌软组织松垂,观察手术效果,探讨更有效的手术方式。方法对18例下颌角方大患者同期行下颌角截骨术及颏下颌下颈阔肌成形术,纠正患者下颌角方大及预防颏下颌下脂肪堆积、松垂。结果所有患者术后随访半年至2年,无1例面神经下颌缘支损伤致下唇歪斜;所有患者张口度正常;术后16例患者对术后外形比较满意;1例患者术后感染后取出提升线;1例患者颏下颌下仍较肥厚松垂,效果不明显。结论颏下颌下颈阔肌成形术在下颌角截骨术中同期施行对下颌角方大患者面部轮廓改善效果良好,安全可靠,同时面部神经血管丰富,术者应熟悉其分布走行,重视钝性分离,不断积累手术经验及操作技巧才能达到满意的手术效果。

Objective To observe the effects of preventing through operation the soft tissue sag after mandibular angle osteotomy,and to explore more effective operation methods. Methods 18 patients with the prominent mandibular angle were treated by mandibular angle osteotomy combined with submentum and submaxilla platysma plasty in order to improve the shape of prominent mandibular angle and prevent mandibular parenchyma sag. Results During the follow-up period of six months to two years,no patients suffered from injuries in the marginal mandibular branch of the facial nerve which may cause lower lip skew. Mouth opening of all patients was normal.16 patients were satisfied with their postoperative appearance. As to the remaining two patients,the lifting line was taken out from one because of postoperative infection,and postoperative effect was not obvious for the other since submentum and submaxilla was considered still hypertrophic and sagging. Conclusions Mandibular angle osteotomy combined with submentum and submaxilla platysma plasty can improve properly and safely the facial shape of patients with prominent mandibular angle. Because the face is rich in nerves and vessels,operators must be familiar with their distribution,pay attention to blunt dissection and keep accumulating experience and surgical skills so as to obtain satisfactory operation results.