改良限制性切口额颞部除皱术

Frontotemporal rhytidectomy with modified limited insicion

目的 为提高额颞部除皱术的效果 ,延长有效时间 ,从理论与实际观察探讨额颞部老年化改变形成的原因 ,并采用相应的手术术式进行矫正。方法 肿胀麻醉下 ,通过颞部发际缘切口入路 ,在颞深筋膜浅面剥离 ,内达颞肌前缘及眶外缘 ,下达颧弓上缘 ,后达耳屏前线。额部切口入路在帽状腱膜下剥离 ,下达眶上缘外至颞线后至枕外隆突。口腔内上颊龈沟入路在颧骨及颧弓骨膜下剥离。上述各剥离区域相互贯通 ,最后将颞区皮瓣上提 ,并将颞浅筋膜与颞深筋膜缝合固定。结果 本组共 32例 ,术后眉外侧平均上提 8mm ,鼻唇沟变浅 ,获随访的 7例为术后 3～2 4个月 ,除皱效果满意。结论 本术式旨在通过广泛剥离解除了额颞部皮肤筋膜上提的羁绊 ,同时减少上面部降肌的作用 ,相对增强提肌的作用 ,再辅以筋膜及皮肤上提固定达到除皱的目的 ,效果确实、可靠、安全、持久。

Objective To improve the effect of frontotemporal rhytidectomy and prolong the effective lasting time, to explore the reason of ageing changes in frontotemporal area for choosing appropriate operation. Methods With temporal hair-line incison under tumersent anesthesia dissection was carried out superficial to deep layer of temporal fascia,anteromedial bordline was anterior temporal muscular margin and external orbital margin, inferior bordline was superior zygomatic arch margin, posterior bordline was anterior line of antilobium. Frontal incision dissection was made in subgalia layer, inferior limit was superior orbital margin laterally to temporal line and posteriorly to external occipital protuberance. Superior buccal gingival sulcus incision dissection was made inferior to zygomatic bone and zygomatic arch periosteum. Dissection regions mentioned above were joined together, then temporal skin flap was lifted with suturing and fixation of superficial temporal fascia and deep temporal fascia. Results This group has 32 cases, external eyebrow was averagely raised 8mm with dimple nasolabial sulcus. 7 cases were followed-up for 3 to 24 months, the results were satisfactory. Conclusion The operation was done with extensive dissection and frontotemporal flap lifting, the effect of depressor muscle was decreased on upper face enhancing the effect of levator. In the same time, fascia and skin were lifted, the effect is sure, safe and lasting.