颧骨颧弓前后段斜行截骨联合下颌角成形术矫治单侧面部肥大

目的:研究颧骨颧弓前后段斜行截骨联合下颌角成形术治疗单侧面部肥大的效果。方法:报告2008年7月～20012年7月间9例单侧面部肥大患者,应用颧骨颧弓前后段斜行截骨联合下颌角成形术矫治患侧。结果:所有9例患者矫治后Ⅰ期愈合。6个月后随访,所有患者肥大侧颧骨颧弓明显降低,肥大侧下颌角正侧面观明显缩小,面中下部由明显不对称变为基本对称,表情自然,生理功能良好。结论:颧骨颧弓前后段斜行截骨联合下颌角成形术可有效地矫治单侧面部肥大。     

磨削去骨术和截骨术在面部轮廓整形中的应用

面部轮廓主要由上下颌骨、额骨、颧骨体及颧弓组成。下颌角肥大、颧骨／颧弓过高及颏部短小均影响人的面部轮廓美。自2005年3月至2008年1月，笔者应用骨骼动力系统对颧骨、颧弓、下颌角及下颌体行磨削去骨和截骨术，效果满意。现报道如下。     

颧骨颧弓内推及下颌角截骨同时隆颏一次性面部轮廓整形术临床研究

目的:探讨下颌角截骨及颧骨颧弓内推一次性面部轮廓整形术的可行性,手术技巧及注意事项。方法:选取2010年8月-2015年10月来笔者科室接受面部轮廓整形的患者25例,经充分沟通后接受颧骨颧弓内推及下颌角截骨同时隆颏术,定期随访并观察术后效果。结果:整个手术过程平均耗时3.5h,所有患者术后随访6个月~5年,手术切口均一期愈合。其中1例患者术后口角轻度歪斜,经神经营养对症治疗3周后恢复正常。结论:同时进行下颌角截骨及颧骨颧弓内推术能一次性解决面部轮廓问题,既减少患者手术次数,又缩短恢复时间,并能取得良好效果。     

改良的面部轮廓整形术在临床中的应用

目的 回顾性总结近20年来颧弓缩窄和下颌角截骨技术的演变及改进,通过比较各种手术方法,探索一套相对安全、有效、易操作的面部轮廓整形技术.方法 自1988年5月至2008年11月,对585例患者行颧弓缩窄术和下颌角截骨术.2002年之前采用文献报道的多种方法对颧弓及下颌角行截骨整形;2002年之后改进了截骨方法,采用楔形截颧骨法及斜形全厚下颌角和下颌下缘截骨法行面部轮廓整形.口内切口的颧骨复合体楔形截骨联合耳前颧弓不完全骨折截骨后,可将颧弓向内、向前移位,以达到缩窄中面部的目的 ;采用口内入路的下颌角和下颌下缘的斜彤全厚截骨,于下颌角截骨时,保持去除下颌角和下颌下缘的外板大于内板,以使术后面中下部轮廓较完美.并总结各类方法的手术指征、主要并发症等,比较改进后的楔形截颧骨法及斜形全厚下颌角和下颌下缘截骨法较之常规术式的优缺点.结果 口内切口入路在颧骨和下颌角整形中有明显的优势.楔形截颧骨法较常规的更有效、可靠.同时,接受斜形下颌角和下颌下缘截骨整形的患者获得了良好的疗效,而且术后并发症发生率较低.结论 楔形截颧骨法及斜形全厚下颌角和下颌下缘截骨手术是相对安全、有效且易掌握的改良的面部轮廓整形术式.     

双侧颧骨及下颌角截骨整形术矫正方脸畸形

目的　探讨矫正方脸畸形的一种新术式。方法　针对方脸畸形多表现为颧骨突出合并下颌角肥大的特点 ,采用双侧颧骨截骨降低加双侧下颌角截骨整形术 ,1次或分 2次手术完成矫治 ,操作完全在口内进行。结果　本组 2 1例 ,其中 1 2例为 1次手术完成 ,9例为分 2次手术完成。术后中面部宽度 (双侧颧点间距 )减少 (1 5 .3± 3.2 )mm ,下面部宽度 (双侧下颌角间距 )减少 (1 4 .2± 2 .5 )mm。伤口均愈合良好 ,无感染、血肿等并发症发生。仅 1例术后下唇麻木 ,1个月后自行恢复。术后 3个月以上复查 ,全部受术者外观改善均满意。结论　双侧颧骨及下颌角截骨术可有效降低面中 1 / 3宽度、突度及面下 1 / 3宽度 ,从而使整个面部轮廓变得圆滑、柔美 ,方形面型得到满意改善。     

11例面部改形术分析

目的　对颧骨及下颌骨部分切除手术施行面部改形 ,重塑面部轮廓 ,改善面部外观。方法　采用头皮冠状切口进路颧骨缩小术、口内进路下颌角肥大矫正术以及两者的联合手术 ,纠正患者颧骨和下颌角肥大 11例 ,其中 3例术中同时进行面上 1/ 3除皱美容术。结果　术后面部外形均得以改善 ,面型比例协调 ,双侧对称 ,11例患者术后随访 3个月 ,面部轮廓均得以改善 ,效果满意 ,X线复查截骨线圆钝 ,愈合好。结论　手术行骨膜下剥离不易损伤面部神经 ,切口隐蔽 ,术后面部不留瘢痕 ,如同时需行面部除皱 ,则简单易行 ,术后效果好 ,患者满意 ,是符合爱美者要求的一种手术方法     

11例面部改形术分析

目的对颧骨及下颌骨部分切除手术施行面部改形,重塑面部轮廓,改善面部外观.方法采用头皮冠状切口进路颧骨缩小术、口内进路下颌角肥大矫正术以及两者的联合手术,纠正患者颧骨和下颌角肥大11例,其中3例术中同时进行面上1/3除皱美容术.结果术后面部外形均得以改善,面型比例协调,双侧对称,11例患者术后随访3个月,面部轮廓均得以改善,效果满意,X线复查截骨线圆钝,愈合好.结论手术行骨膜下剥离不易损伤面部神经,切口隐蔽,术后面部不留瘢痕,如同时需行面部除皱,则简单易行,术后效果好,患者满意,是符合爱美者要求的一种手术方法.     

颧骨颧弓梭形截骨内推钛钉锚定术治疗颧骨颧弓肥大的疗效观察

目的探讨颧骨颧弓梭形截骨内推钛钉锚定术治疗颧骨颧弓肥大的临床效果。方法 2011年7月-2015年1月,采用颧骨颧弓梭形截骨内推钛钉锚定术,对58例高颧弓患者在盲视下行颧骨颧弓缩小整形。其中男3例,女55例;年龄18~33岁,平均23岁。均为先天性双侧颧骨颧弓肥大。术前摄头面部正位、侧位、仰位、45°斜位照片,并行面部三维CT重建,其中单纯性颧骨肥大30例,颧骨肥大伴颧弓突出28例;颧骨颧弓对称51例,不对称7例。结果术后患者切口均Ⅰ期愈合,无感染、血肿发生。4例出现并发症,其中2例上唇麻木,1例张口受限,1例鼻唇沟加深,均于术后3个月左右自行恢复。58例均获随访,随访时间6~12个月,平均10个月。颧骨间距缩窄10.6~13.9 mm,平均11.2 mm。无面部软组织下垂、颧骨台阶感、面神经损伤,抬眉、闭眼功能障碍及颞下颌关节紊乱综合征等发生。术后骨愈合良好,颧面部感觉无明显异常,所有患者对外观改善均满意。结论颧骨颧弓梭形截骨内推钛钉锚定法可有效缩小颧骨并保持颧骨颧弓的自然曲线,手术方法简便、并发症少、固定稳固,是一种较理想的颧骨颧弓缩小整形术。     

微创下颧骨颧弓缩小术的临床应用

目的:探讨微创下颧骨颧弓缩小术的临床应用效果及操作要点.方法:对41例颧骨颧弓复合体肥大的患者采用微创下颧骨颧弓缩小术,术中应用MEDIKAN微动力面部改形手术系统,在微创下将颧骨根部及颧弓后侧截断,使游离的颧骨颧弓内移,术后面颊部弹力套外固定一月.结果:本组41例,术后2天-12个月,得以随访者37例,有3例患者因术中颧骨骨膜下剥离范围较多,术后肿胀恢复较慢,但术后6个月恢复自然,其余患者术后效果均良好,患者自觉满意.结论:微创下颧骨颧弓缩小术,手术在微创下进行,组织损伤小,术后恢复快,手术效果明显,值得临床推广.     

11例面部改形术分析

目的 对颧骨及下领骨部分切除手术施行面部改形，重塑面部轮廓，改善面部外观。方法 采用头皮冠状切口进路颧骨缩小术、口内进路下领角肥大矫正术以及两者的联合手术，纠正患者颧骨和下领角肥大11例．其中3例术中同时进行面上1／3除皱美容术。结果 术后面部外形均得以改善，面型比例协调，双侧对称，11例患者术后随访3个月，面部轮廓均得以改善，效果满意，X线复查截骨线圆钝，愈合好。结论 手术行骨膜下剥离不易损伤面部神经，切口隐蔽，术后面部不留瘢痕，如同时需行面部除皱，则简单易行，术后效果好，患者满意，是符合爱美者要求的一种手术方法．     

下颌骨外板劈除术联合颏前下滑行内缩术矫治短面型方颌

目的 探讨应用下颌骨外板劈除术及颏前下滑行内缩并配合嵌入式植骨术矫治短面型方颌的可行性及效果评价.方法 2005年7月至2009年10月,对57例短面型方颌伴颏部过方、过短及后缩的患者,应用下颌骨外板劈除术及颏前下滑行内缩并配合嵌入式植骨术进行矫治,以缩小下颌宽度、增大下颌平面角、延长并缩窄颏部,从而获得协调流畅的面部轮廓.术前和术后拍摄定位标准面像、X线头影测量片、全景片等,以评价矫正效果.术后进行6～24个月的随访,调查患者满意度.结果 术后57例患者伤口均一期愈合,下颌平面角增大至25°～30°,下颌角开张度增大至120°,两下颌角间距明显减小,下颌整体宽度缩窄,颏部尖翘,下颌轮廓协调,效果评价均满意.结论 联合应用下颌骨外板劈除术及颏前下滑行内缩术,可有效地矫治短面型方颌,使下颌骨轮廓达到较为理想的美学标准.

Abstract：

Objective To evaluate the the feasiblility and effectiveness of narrowing and sliding genioplasty combined with mandibular outer cortex ostectomy technique to reshape a square jaw in short face. Methods From July 2005 to October 2009, a total of 57 patients received narrowing and sliding genioplasty combined with mandibular outer cortex ostectomy procedure to correct square jaw in short face.All the patients had standard frontal and lateral cephalometric radiographs, panoramic radiographs, and were photographed preoperatively and postoperatively to assess their face contour. The alteration of mandibular angle, mental contour and width of lower face was observed for 6 to 24 months postoperatively.Questionnaires were used to assess the patients' satisfactory. Results It showed that the postoperative lower face had narrowed and become softer, slender and oval, with a slick mental region. The final aesthetic outcomes were quite satisfactory in all cases from both the view of surgeons and patients.Conclusions Narrowing and sliding genioplasty combined with mandibular outer cortex ostectomy procedure could efficiently adjust the shape and position of chin to obtain a good proportion of the lower face, and to change square and short face to slender oval one by single operation in accordance with the fashionable aesthetics in orientals.     

方型脸改型术

目的为方型脸的改观提供一种改良术式。方法采用截除肥大下颌角和部分肥厚咬肌以及摘除颊脂垫的综合改型术式。结果临床应用10例,随访4～28个月,均取得良好疗效。结论本术式可行。     

方型脸改型术

为方型脸的改观提供一种改良术式。方法 采用截除肥大下颌角和部分肥厚咬肌以及摘除颊脂垫的综合改型术式。结果 临床应用１０例，随访４－２８个月，均限得良好疗效。结论本术式可行。     

方型脸改型术

目的为方型脸的改观提供一种改良术式。方法采用截除肥大下颌角和部分肥厚咬肌以及摘除颊脂垫的综合改型术式。结果临床应用１０例，随访４～２８个月，均取得良好疗效。结论本术式可行。     

口内入路三角块截骨并外板去除和咬肌修薄矫正严重方脸畸形

目的：应用三角块截骨、外板去除和咬肌修薄联合颏部截骨治疗严重方脸畸形.方法：应用口内入路，改良的下颌骨矢状劈开去除外板、摆动锯去除下颌角和咬肌修薄矫正下颌角咬肌肥大，颏部截骨前下移动，取下的下颌骨块充填固定矫正颏部短小.结果：应用该方法治疗严重方脸畸形7例，效果良好，脸型改善明显.结论：三角块截骨、外板去除和咬肌修薄联合颏部整形对矫正严重方脸畸形具有良好的效果。     

睑袋切口行中面部提升术的应用研究

目的：进一步研究睑袋切口行中面部提升的术式选择以及临床效果。方法：收集了2009年1月～2010年1月来我院进行中面部提升的27例患者的,临床资料进行详细研究,上述患者均采用睑袋切口行中面部提升术。结果：上述患者没有出现眼睑外翻、血肿、感染等并发症。2例患者不满意,后采用脂肪移植填充鼻唇沟,改善明显,满意。25例患者满意,下眼睑皮肤老化、松弛现象以及皱纹显著减轻,明显改善中面部衰老、松弛状,鼻唇沟变浅。结论：外入路去睑袋切口联合中面部提升手术,设计新颖合理,创伤小、伤口较隐蔽,手术效果良好,能够有效改善患者中面部老化、松弛下垂等现象,有效解决脂肪突出、皱纹加深、老化下垂等问题,对于鼻唇沟加深也有着非常显著的效果。恢复陕,并发症少,持续时间长,是进行中老年中面部提升手术的首选方式。     

内镜辅助方型脸改型术

目的探讨内镜在方型脸改型术中的临床应用效果。方法采用口内入路，在内镜辅助下，用高速涡轮气钻截除肥大下颌角、切除部分咬肌和颊脂垫，进行方型脸的面部改型。结果本组共38例，其中男3例，女35例，年龄21～40岁。内镜完全可以清楚显示下颌升支、下颌角、下颌体下缘，视野清晰。使用高速涡轮气钻截除肥大下颌角可以更加精确和容易，且创伤小，出血少，手术时间短，感染风险低。下面部轮廓改善满意。结论内镜辅助方型脸改型术，有助于获得良好的手术效果。     

额颞部微创内镜除皱术对眉眼形态的改善

目的探讨内镜下额颞部除皱术对眉眼形态的改善情况。方法采用传统的额颞部小切口方法微创行内镜除皱术,并观察内镜除皱对眉眼形态的改变和影响。结果60例术后眉眼间距较术前增大（5．0±1．2）mm,有效实现眉提升,改善下睑缘松弛下垂;内镜下额颞部除皱后眼周围皮肤紧致,长久去除外眼角鱼尾纹,并可在一定程度上对眉形进行调整。结论额颞部内镜除皱术可以矫正眉下垂及双侧眉毛不对称,改善眉眼形态,达到年轻化的效果。     

Analysis of facial skeleton shape in patients with complete unilateral cleft lip and palate: geometric morphometry

The study is based on a longitudinal cephalometric follow-up of X-ray films of patients with a complete unilateral cleft lip and palate during puberty. Carthesian x, y coordinates of the total of 22 landmarks on the lateral films of 25 patients with the same diagnosis and therapy were established, which served as outcome data for shape analysis. The changes in facial shape experienced by patients between their 10th and 15th year were evaluated by the thin-plate splines (TPS) method. We used the TPS method to find a function which transforms the shape of the face at the age of 10 as well as the square TPS grid into the facial shape at the age of 15 years with the deformed TPS grid. With the help of Geometric PCA for Bookstein's coordinates we found individuals with different shapes who develop abnormally during puberty and whose development is not well predictable. During puberty the face becomes relatively elongated. The most pronounced deformation is caused by the shift of the first permanent molar anteriorly, or a relative shortening of the frontal part of the dental arch. In the anterior direction the position of landmarks changed only in the area of nose; the alveolar process shows retrusion. The position of the mandible in relation to the maxilla change mainly in the inferior direction; the mandibular angle shifts posteriorly. The shape of skeletal profile was compared with a group of patients with the same diagnosis who underwent different therapy.     

Classification and Treatment of Prominent Mandibular Angle

In Oriental culture, the contour of the mandibular angle is important for feminine facial shape because a woman who has a wide and square face is thought to have had an unhappy life. A prominent mandibular angle, which does not coincide with the natural look, produces a characteristic quadrangle, coarse, and muscular appearance. So Oriental women who have a prominent mandibular angle want to have an ovoid, reduced, and slender face by aesthetic mandibular angle resection. Many satisfactory corrections of a prominent mandibular angle by various operative techniques have been reported. But reasonable morphologic classification and treatment were not reported. So we classified prominent mandibular angles into four groups by morphology and operated on the patients according to their classification with different modalities: no square shape but only a reduced gonial angle in the profile view—class I, mild form; severe mandibular angle protrusion with lateral protrusion—class II, moderate form; a definite square-shaped angle (class II) with masseteric hypertrophy—class III, severe form; and combined prominent mandibular angle and chin deformity—class IV, complex form. We use angle ostectomy through the intraoral route alone or with an additional external stab incision for class I. An external stab incision to set up the reciprocating saw is sometimes helpful in class I cases because there is no lateral protrusion of the angle. For class II cases, we use conventional intraoral angle ostectomy only or angle splitting ostectomy with contouring. For class III cases, we use angle splitting ostectomy and contouring with partial masseteric myectomy. In class IV, we use angle ostectomy and additional genioplasty. During 7 years, we have performed 46 cases of mandibular angle resection. Of the mandibular angle resection cases, 19 were class I, 15 were class II, 9 were class III, and 3 were class IV. A total of 42 patients were satisfied with the postoperative results. For reasonable and satisfactory final results, classification according to the mandibular angle shape and suitable treatment according to the classification are essential.