男性下颌角截骨前后下颌骨形态变化的三维测量与手术要点的研究

Study on three-dimensional measurement and technical points of mandible morphological changes before and after mandibular angle osteotomy in male patients

目的探讨男性下颌角截骨整形术对下颌骨形态的影响及手术要点。方法回顾性分析2015年4月至2018年11月收治的20例男性下颌角肥大患者手术前后的CT三维重建结果,评估下颌角区域的形态变化,同时总结手术技巧。结果20例患者术后获随访6~12个月,手术效果较满意,均未出现血肿、感染、面神经损伤等并发症。手术前后第二磨牙下的下颌体高度均有明显差异,但下颌角间距比较差异无统计学意义(P>0.05);术中去除骨量与下颌体的高度、截骨区最大宽度、下颌升支在咬平面上的宽度呈正相关;术后的出血量与术中去除骨量无相关性。结论下颌角截骨整形术对男性面下部轮廓改善效果较佳,但应注意术中的操作细节和技巧,以期在实现美学效果的同时降低出现术后并发症的风险。

Objective To explore the effect of mandibular angle osteotomy(MAO)on morphological changes in male patients and to summarize the critical surgical points.Methods Between April 2015 and November 2018,20 male patients with mandibular angle hypertrophy in our department were retrospectively analyzed.Morphological changes of the mandible were accurately evaluated by three-dimensional computed tomography(CT)reconstruction before and after the MAO.The surgical techniques were also summarized.Results All patients were followed up from 6 to 12 months and were satisfied with the efficacy of MAO.No complications such as hematoma,infection and facial nerve injury occurred.Before and after the MAO,the height of mandibular body under the second molar was significantly different,but there was no significant difference in the distance between the mandibular angle(P>0.05).The osteotomy volume was positively correlated with the height of the mandible,the maximum width of the osteotomy area and the width of mandible ramus at the level of occlusal plane.There was no correlation between the volume of postoperative blood loss and the osteotomy volume.Conclusion MAO has a good effect on the improvement of lower facial contour in male patients.Attention should be paid to the operation details and techniques to obtain better aesthetic outcomes and reduce the risk of postoperative complications.