下颌角截骨联合外板打磨术后面下部组织形态特征的研究

Morphological characteristics of the lower face after mandibular angle osteotomy combined with outer cortex grinding

目的探讨下颌角截骨联合外板打磨术治疗面下部宽大的术后长期效果及术后面下部骨组织和软组织形态变化特征.方法回顾性分析自2016年1月至2019年12月,中国医学科学院北京协和医学院整形外科医院颅颌面整形科收治的10例接受下颌角截骨联合外板打磨术治疗面下部宽大的患者术前及术后长期(11~13个月)随访的CT资料,并对面下部软硬组织厚度变化及下颌角间距的测量结果分析.结果术后所有患者长期随访数据测量结果显示,第二磨牙下方10 mm及15 mm处,下颌骨厚度较术前减小(P<0.05);该处面部软组织厚度较术前增加(P<0.05).术后下颌骨升支前缘与咬合平面交点下方10 mm及15 mm处,下颌骨厚度较术前减小(P<0.05);该处软组织厚度手术前后比较,差异无统计学意义(P>0.05).结论下颌角截骨术后外板打磨区域骨质变薄,具有长期稳定的效果,但近外斜线区域其表面软组织增厚,术前应考虑该特点针对性设计手术方案,以达到预期的手术效果.

Objective To investigate the long-term postoperative effects and morphological characteristics of bone and soft tissue in the lower face after mandibular angle osteotomy combined with outer cortex grinding for broad lower faces.Methods From January 2016 to December 2019,10 patients who underwent mandibular angle osteotomy combined with outer cortex grinding with the preoperative and long-term(11-13 months)follow-up CT data at the Cranio-maxillo-facial Surgery Department of the Plastic Surgery Hospital,Chinese Academy of Medical Sciences were retrospectively reviewed.Measurements and analyses were performed on the changes in the thickness of the soft and hard tissues in the lower face and the mandibular angle distances.Results Long-term follow-up data measurements revealed a decrease in the thickness of the mandibular bone at 10 mm and 15 mm below the second molar compared to preoperative measurements(P<0.05).An increase in the thickness of the facial soft tissue at these locations was also observed compared to preoperative measurements(P<0.05).The thickness of the mandibular bone at 10 mm and 15 mm below the intersection of the anterior margin of the mandibular ramus and the occlusal plane decreased compared to preoperative measurements(P<0.05).However,no significant statistical difference was ob-served in the soft tissue thickness at these locations between preoperative and postoperative measurements(P>0.05).Conclusion The bone in the outer cortex grinding area after mandibular angle osteotomy becomes thinner,resulting in long-term stable effects.However,the soft tissue overlying the area near the oblique line thickens.Preoperative attention should be paid to these characteristics to design targeted surgical plans to achieve the desired surgical outcomes.