颏部W形截骨矫正颏部宽短畸形的效果

Efficacy of W-genioplasty on the broad and short chin

目的:探讨颏部W形截骨成形矫正颏部宽短畸形的临床效果。方法:2019年1月至2021年12月,南京医科大学附属友谊整形外科医院接受颏部截骨整形患者38例,男5例、女33例,年龄20~41岁,平均27.3岁。术前行头颅锥形束CT扫描及三维重建,设计颏部延长、缩窄及前移或后退的距离。口内切口行颏部W形截骨,调整两侧游离骨块间夹角、下移及前移距离,改变颏部下缘弧度、宽度、长度、突度。随访3~24个月,通过患者手术前后影像学检查、照片来评估手术效果。结果:38例患者颏部垂直延长2~5 mm,平均3.0 mm。水平变窄宽度3~7 mm,平均5.6 mm。术后随访3~24个月,平均随访10.6个月。术后无血肿、伤口裂开、意外骨折、手术部位感染、永久性神经感觉障碍等并发症出现。38例患者均有不同程度下唇区域短暂神经感觉丧失,在随访期间均自行恢复,所有患者对面型改善满意。结论:颏部W形截骨术保留颏部中央骨质与颏舌肌和颏舌骨肌的附着,不影响口腔正常解剖与生理功能,截骨后去除骨质及双侧骨块移动灵活,可三维有效地改变颏部的下缘弧度、宽度、长度、突度,达到矫正颏部宽短畸形的效果。

Objective To investigate the clinical effect of W-shaped genioplasty in the correction of broad and short chin deformity.Methods Thirty-eight patients(5 males,33 females,aged 20 to 41 years,mean 27.3 years)complained with broad and short chin were admitted to the Affiliated Friendship Plastic Surgery Hospitalof Nanjing Medical University from January 2019 to December 2021.CBCT scan and three-dimensional reconstruction were performed to design osteotomy line and determine the distance of chin lengthening,narrowing and advancing or retrocession preoperatively.Under general anesthesia,the W-shaped osteotomy was performed using an intraoral incision,and the angle between the bilateral free bone fragments,the distance of downward and forward movement were adjusted to change the curvature,width,length and prominence of the lower edge of the chin according to the preoperative designs.The results were evaluated by clinical appearances and image analyses at a follow-up of 3-24 months.Results The amount of vertical lengthening of the chin in 38 cases were 2 mm to 5 mm,with an average of 3.02 mm.The horizontal narrowing width distances were 3-7 mm,with an average of 5.6 mm.The patients were followed up for 3-24 months,with an average of 10.6 months.There were no complications such as hematoma,wound dehiscence,accidental fracture,surgical area infection and permanent neurosensory disorder.38 patients had transient sensory loss in the lower lip region of varying degrees,but all recovered spontaneously during routine follow-up period.All patients were satisfied with the improvement of facial contour.Conclusions W-shaped geinoplasty preserves the central bone of the chin and the attachment of genioglossus muscle,which does not affect the normal anatomy and physiological function of the oral cavity.After osteotomy,the bone is removed and the bilateral bone fragments move flexibly.It can effectively change the radian,width,length and protrusion of the lower edge of the chin in three dimensions,so as to correct the wide and short deformity of the chin.