A型肉毒毒素咬肌联合微滴注射改善面下部轮廓的临床观察

Clinical observation of botulinum toxin type A injected in masseter combined with micro-drop injection to improve the lower contour of the face

目的 研究中年女性行A型肉毒毒素咬肌注射同时结合面下部以及颈部微滴注射,改善面下分面部轮廓,提升下颌缘的同时,预防口角囊袋、木偶纹出现的临床效果。方法 回顾性分析2020年1月—2021年12月就诊于空军军医大学口腔医院颌面整形科的咬肌肥大的中年女性患者临床资料。咬肌注射采用稀释浓度为40 U/ml的A型肉毒毒素分三点注射进入咬肌后,并将稀释浓度为20 U/ml的A型肉毒毒素以1.5 cm为间隔,广泛、微量注射于下面部和颈部真皮层以及真皮下层,单点注射0.6 U。术后患者于1-2个月复诊,复诊时拍摄标准照片,并进行满意度调查。第三方医生将治疗前后的标准照片进行对比,评价下面部轮廓改善的满意度,以及口角囊袋和木偶纹术前术后的差异性。结果 共纳入20例患者,均为女性,平均年龄(36±3.2)岁,随访时间1.3月。患者主观满意度90%(18/20),认为口角囊袋及木偶纹均无明显加重。1例不满意者认为治疗时疼痛较明显,不愿再次注射,1例出现颈部淤青,影响美观。所有患者均未出现口角歪斜,吞咽困难,发声困难,面瘫等并发症。结论 应用A型肉毒毒素行咬肌注射并同期进行面下部颈部的微滴注射,在改善面部轮廓的同时,避免面部松垂的出现。

Objective To study the clinical effects of performing botulinum toxin type A masseter injections combined with micro-drop injections in the lower face and neck in middle-aged women to improve the facial contour of the inferior facial division and lift the mandibular rim while preventing the appearance of orofacial pouches and marionette lines.Methods The clinical data of middle-aged female patients with hypertrophy of the bite muscle,those attending the department of maxillofacial surgery in stomatology hospital of air force military medical university from January 2020 to December 2021,were retrospectively analyzed.The bite muscle injection was performed using botulinum toxin type A with a dilution concentration of 40u/ml into the occlusal muscle in three spots,and botulinum toxin type A with a dilution concentration of 20u/ml was injected widely and in micro amounts at 1.5 cm intervals into the dermis of the lower part and neck as well as the subdermis with a single spot injection of 0.6u.Patients were rechecked within 1 to 2 months after the procedure,and standard photographs were taken at the recheck and satisfaction surveys were conducted.A third-party physician compared the standard photographs before and after treatment to evaluate satisfaction with the lower facial contour improvement and the difference between preoperative and post-operative orofacial capsular pockets and marionette lines.Results A total of 20 patients,all female,with a mean age of(36±3.2) years and a follow-up period of 1.3 months,were included in the study.The subjective satisfaction of patients was 90%(18/20),and they thought that both orofacial pouch and marionette were not significantly aggravated.Because the pain was more obvious during treatment,1 patient unsatisfied with the surgery and did not want to inject again.Neck bruising appeared in another 1 case,which affected the aesthetics,so she did not satisfied with the surgery.All patients did not have complications such as crooked corners of the mouth,swallowing difficulties,vocal difficulties,or facial paralysis.Conclusions The application of botulinum toxin type A for bite muscle injection and simultaneous micro-drop injection in the lower face and neck could improve the facial contour and avoid the appearance of facial sagging at the same time.