保留下颌角自然形态的下颌角整形术

Keeping Mandibular Angle Points in Hypertrophied Mandibular Angle Plasty

目的:探讨通过保留下颌角顶点对下面部软组织的支撑,来设计手术去骨量,保留下颌角自然形态的下颌角整形术的安全性和美学效果。方法:2006年1月-2016年12月,笔者科室对126例下颌角肥大就医者,根据术前正侧面外观、下颌角顶点体表位置、三维CT设计去骨量,采用口内入路,少量多次去骨,保留下颌角支撑点与自然形态行下颌角整形术,术后分析治疗效果,观察不良反应情况。结果:所有就医者切口均I期愈合,无感染、下颌神经管损伤、双角畸形等并发症发生,5例发生暂时性单侧下唇感觉减退,3个月内恢复。随访1~3年,就医者下面部宽度明显变窄,下颌角轮廓清晰,面部轮廓流畅自然,效果满意。结论:保留下颌角支撑点及自然形态的下颌角整形术能安全、有效地矫正下颌角肥大,术后形态与生理功能恢复良好,临床效果满意。

Objective To explore the safety and aesthetic effect of mandibular angle plasty with natural mandibular angle morphology by preserving the vertex of mandibular angle to support the soft tissue of lower face. Methods From January 2006 to December 2016, 126 patients with hypertrophied mandibular angle in authors＇ department underwent the preoperative design according to the front and lateral appearance and the surface location of the vertex of mandibular angle. The resected bone volume was calculated according to the three-dimensional CT. Through the intraoral approach, a repeated small quantity bone removal was performed, retaining the supporting point of mandibular angle and the natural morphology. Postoperative effects and complications were observed and analyzed. Results All incisions were primary healed, no complications such as infection, mandibular neural tube injury and double angle deformity occurred. Temporary unilateral lower lip hypoesthesia occurred in 5 cases and all recovered in 3 months. During the 1 to 3 years follow-up, all the patients were satisfied with postoperative results including the significantly narrowed width of lower face, the clear contours of mandibular angle and the smooth and natural facial contours. Conclusion Mandibular angle plasty could correct the hypertrophied mandibular angle safely and effectively by preserving the supporting point of mandibular angle and the natural morphology.The postoperative morphology and physiological function are well restored with satisfactory results.