下颌角弧形截骨术18例临床分析

目的观察双侧下颌角肥大、突出行弧形截骨术的治疗效果。方法18例下颌角截骨术患者,10例同时行颏部截骨加植骨,8例取颊脂垫,2例部分咬肌切除,观察疗效,分析探讨相关问题。结果术后患者面形曲线圆滑,但均有不同程度的肌萎缩。结论下颌角弧形截骨术术前应作阻生智齿预防性拔除,咬肌切除应慎重。     

颏下颌下颈阔肌成形术在下颌角截骨术中的应用

目的通过手术方法预防下颌角截骨手术后下颌软组织松垂,观察手术效果,探讨更有效的手术方式。方法对18例下颌角方大患者同期行下颌角截骨术及颏下颌下颈阔肌成形术,纠正患者下颌角方大及预防颏下颌下脂肪堆积、松垂。结果所有患者术后随访半年至2年,无1例面神经下颌缘支损伤致下唇歪斜;所有患者张口度正常;术后16例患者对术后外形比较满意;1例患者术后感染后取出提升线;1例患者颏下颌下仍较肥厚松垂,效果不明显。结论颏下颌下颈阔肌成形术在下颌角截骨术中同期施行对下颌角方大患者面部轮廓改善效果良好,安全可靠,同时面部神经血管丰富,术者应熟悉其分布走行,重视钝性分离,不断积累手术经验及操作技巧才能达到满意的手术效果。     

不对称性下颌角肥大的手术治疗

目的　探讨不对称性下颌角肥大的原因及手术治疗。方法　采用下颌角弧形截骨术、下颌骨外板截骨术、颏成形术及颊脂垫取出术等方法,治疗不对称性下颌角肥大患者70例。结果　70例患者术后面部对称性均明显改善。70例患者中仅3例出现并发症,包括术后出血、口唇拉伤增生性瘢痕及术后感染等。结论　治疗不对称性下颌角肥大应根据畸形的特点,选择性应用下颌角弧形截骨术、下颌骨外板截骨术、颏成形术及颊脂垫取出术等方法,其效果良好。     

下颌角弧形截骨术对口腔生理功能影响的研究

目的　研究下颌角弧形截骨术对口腔颌面系统生理功能的影响。方法　 2 3例双侧下颌角肥大患者 ,均接受双侧下颌角弧形截骨术 ,术前和术后 1周、2个月、3个月、6个月测定最大咬合力、最大开口度及最大前伸度。结果　所有患者术后短期内上述三项指标均明显低于正常值 ,但 3个月后 ,恢复至正常范围 ,无明显临床意义。结论　下颌角弧形截骨术对患者口腔颌面系统的功能无明显长期不良影响。     

快速原型技术及石膏模型外科技术在下颌骨不对称畸形中的应用及效果评价

目的 探讨快速原型(rapid prototyping, RP)技术制作的高仿三维头颅模型与精确制取的牙弓石膏模型在面弓介导下精确结合,进行模型外科,用于指导下颌骨不对称畸形患者正颌手术的可行性,并评价其应用效果。方法 15例下颌骨不对称畸形、需要正颌手术的患者均进行全头颅三维螺旋CT扫描,将数据输入快速原型机,制作三维头颅模型,然后将牙弓石膏模型按等比例替换三维头颅模型的牙弓,以组成RP-石膏模型复合体;利用RP-石膏模型复合体进行术前模拟截骨,评价截骨位置及截骨量,评估患者颏部的对称性以及颞下颌关节的改变情况,术后6个月评估手术效果。结果 15例患者术前建立RP-石膏模型复合体,很好地预测了手术效果;2例发现经双侧下颌骨矢状劈开截骨术（BSSRO）后,颏部仍有偏斜,增加颏成形术。术后半年随访,患者对外形感到满意,无颞下颌关节紊乱综合征(TMJ)等并发症。结论 RP-石膏模型复合体可精确模拟截骨,对患者术后颏部及TMJ的改变,正颌手术的效果及可能出现的问题都具有重要指导价值。     

咽旁间隙巨大肿瘤的手术径路探讨

目的:探讨咽旁间隙巨大肿瘤切除的最佳手术径路。方法:2009-11—2011-05,笔者对6例咽旁间隙巨大肿瘤患者施行肿瘤切除手术,其中4例采用下颌正中截骨径路,2例采用了颏孔前截骨径路。结果:采用下颌正中截骨及颏孔前截骨径路,术野暴露充分,肿瘤切除安全、完整,术后愈合良好,无1例术后出现咬合关系紊乱。平均随访22个月(14～31个月),均未发现肿瘤复发。除1例下颌神经血管束因与瘤体粘连而切除外,无任何神经损伤症状。结论:下颌正中截骨和颏孔前截骨径路是咽旁间隙巨大肿瘤切除术的理想手术径路,符合肿瘤外科、美容外科和功能外科原则。     

下颌骨外旋入路切除颞下窝肿瘤手术分析

目的：：分析颞下窝肿瘤下颌骨外旋手术入路的效果。方法：回顾11例下颌骨外旋入路切除颞下窝肿瘤的临床资料,5例在下颌骨颏孔前方截骨,4例在下颌角前截骨,2例在颏正中截骨。结果：下颌骨外旋入路根据肿瘤的性质、部位、大小及与周围神经血管的关系,灵活的选择下颌骨截骨部位,均可充分显露颞下窝肿瘤达到较好的切除效果。结论：下颌骨外旋入路是切除颞下窝肿瘤安全有效术式。     

经下颌下下颌骨角部前方截骨入路颞下窝颅底肿瘤的外科治疗

目的:探讨颞下窝颅底肿瘤的手术入路和手术方法。方法:对9例位于颞下窝颅底的肿瘤采用下颌下切口、下颌骨角部前方截骨入路进行手术治疗,观察手术效果,评价手术方法。结果:9例手术术野暴露充分,手术操作顺利,术后愈合良好,无严重并发症,其中良性肿瘤6例,恶性肿瘤3例,随访12～36个月肿瘤无复发。结论:下颌下、下颌骨角部前方截骨入路进行颞下窝颅底部肿瘤切除治疗效果满意。     

口腔颌面部整复

羟基磷灰石修复颌骨缺损的临床应用；胸锁乳突肌肌皮瓣修复口腔癌术后组织缺损16例分析；单侧下颌发育过度畸形的正颌治疗及手术时机的探讨；深冷冻异体骨复合自体髂骨修复免下颌骨缺损的实验研究；计算机辅助和制作单侧眼眶部缺损的修复；方脸综合改形术；     

高仿真牙颅颌模型外科技术辅助手术优先矫正颌面部不对称畸形

目的：探讨快速原型技术制作的高仿真牙颅颌模型与牙弓石膏模型精确结合用于手术优先指导矫正颌面部不对称畸形的可行性。方法：5例颌面部不对称畸形患者均进行全头颅三维螺旋CT扫描,将数据输入快速原型机,制作三维打印头颅模型,然后将牙弓石膏模型按等比例替换三维打印模型的牙弓,以组成高仿真牙颅颌模型复合体。利用该复合体进行术前模拟截骨,评价截骨位置及截骨量,评估患者颏部的对称性以及颞下颌关节的改变,术后 6 个月评估手术效果。结果：5 例患者术前建立高仿真牙颅颌模型复合体,很好地预测了手术效果。术后随访半年,患者对外形感到满意,无颞下颌关节紊乱综合征（TMD）等并发症。结论：高仿真牙颅颌模型复合体更好地预测偏颌畸形患者术后颏部及髁突的改变,为该类患者的“手术优先”治疗模式提供了有益的参考。     

Management of bilateral masseter muscle hypertrophy

Masseter muscle hypertrophy is characterized by unilateral or bilateral enlargement of the masseter muscles affecting both females and males after puberty. Limitations on mouth opening, swollen cheek, and also tension in the region of the hypertrophied muscle are symptoms reported. Also, masseter hypertrophy can cause aesthetic and functional problems. A 40-year old woman was referred to our clinic with the chief complaint of facial appearance with square-face type. To eliminate undesirable facial appearance, surgical intraoral approach compromising reduction of deep masseter muscle with monocortical and bicortical ostectomy of the angle of the mandible was performed. The patient was satisfied with both functional outcomes and aesthetic outcomes on both facial profile and frontal view. No complication was seen intraoperatively and postoperatively after a 12-month follow-up period. This treatment modality would be suggested to gain optimal aesthetic results especially in a square face from the lateral profile.     

Intraoral multistage mandibular angle ostectomy: 10 years' experience in mandibular contouring in Asians

In Asia, a round face rather is more acceptable than a square face. Intraoral mandibular angle ostectomy is a common aesthetic procedure for correcting a prominent mandibular angle. However, an operation of sheer straight-lined prominent mandibular angle resection would sometimes create extramandibular angles or palpable bone steps in the margin of mandibular body and produce unnatural lower one-third facial appearance, especially for a square and disproportional mandibular angle even extending to the middle mandibular body. This article describes the method of multistage mandibular angle ostectomy to produce a natural lower one-third facial contour. This method mainly focused on the posterior area of mandibular ostectomy by intraoral approach, although it has modifications. Mandibular contouring is realized first through bone cutting from antegonial notch posteriorly upperward, reaching to the middle ramus of the mandible near the earlobe; second ostectomy followed along mandible lower part is to get rid of extramandibular angle according to the preoperative design; sometimes necessarily, third ostectomy creates a smooth mandibular contour. From January 2000 to January 2010, 379 patients were operated on, and satisfactory results were achieved. Thus, this procedure could avoid excessive bone cutting, extramandibular angles, unnatural appearance, and palpable bone steps.     

Dens evaginatus and dens invaginatus in a maxillary lateral incisor: report of a rare occurrence and review of literature

A case of dens evaginatus (DE) and dens invaginatus (DI) concurrently affecting the maxillary right permanent lateral incisor in a 25-year-old Hispanic male is reported. DE, referred to as Talon's cusp in the anterior teeth and Leong's premolar in the pre- molar teeth, is a relatively rare condition by itself. An association of DI with this rare anomaly within the same tooth has never been reported before although it has been known to occur within the same patient. Since it is known that DE may be composed of normal enamel and dentine, as well as varying amounts of pulpal tissue, care should be exercised while performing any aesthetic procedures to remove or recontour it.     

全口义齿与美学

作者在门诊为40例牙列缺失患者制作全口义齿时，将数学上占有重要地位的“黄金分割”方法用来确定前牙定位堤平面及尖牙的排列位置，同时采用美国正畸学家Richetts设计的“审美平面”确定上下后的丰满度。并将用该方法排列的全口义齿与常规方法排列的全口义齿进行了自身的比较研究（每例患者排列两副全口义齿），40例患者中有35例选择了前一种方法排列的全口义齿，2例认为两副义齿均可，2例选择常规方法排列的义齿，1例对两种方法的排牙均不满意。临床实践表明：将“黄金分割法”、“审美平面”应用于制作全口义齿中，可使绝大多数患者的容貌更加美观、协调、自然。     

Scar flap for extension of the nasal and lip soft tissue shell in secondary cleft deformities: final aesthetic touches in clefts-part iii

A scar flap is formed with the pedicle at the lateral part of the columella base at the cleft side, that is, in the center of the affected region. It enables flap placement according to individual need. A prospective evaluation was performed in a group of 76 patients with cleft lip and palate, all operated on by the same plastic surgeon. The flap was used to improve the height of the columella and the extent of nasal mucosa on the frontal septum and on the nostril base in the vestibule. In the lip, the flap raised its height and improved proportionality. The average area of flap used in a unilateral deformity was 42 mm. Both flaps in a bilateral deformity were 77 mm. The average follow-up was 22.4 months. Neither local nor general complications were noted apart from a recurrence of the deformity of the nasal septum in 7.9% of patients. The nasal passage was improved in 59.9% of patients and normalized in 19.6% upon follow-up rhinomanometry, but nevertheless, only one third of patients overcame their dynamic stereotype of breathing by the mouth. Anthropometric measurements showed an absence of statistically significant differences between patients after surgery and healthy individuals in crucial parameters (nasal tip projection, length of columella, nasolabial angle, nasal angle, and lip angle). The loss of the stigmatizing deformity is based on rotation of the nasolabial angle in relation to the aesthetic axis of the face. Direct examination proved aesthetic and functional improvement as statistically significant in 92.1% of patients.     

Total lower eyelid reconstruction using paranasal flap

The main aim of this study is to evaluate the advantages, disadvantages, and aesthetic results of the total lower eyelid reconstruction with paranasal flap. The other reconstruction methods are also revisited.Ten patients, who were operated for the reconstruction of total lower eyelid defects between November, 1999 and April, 2005 in our department were included in this study. The total lower eyelid defects of all patients were reconstructed using paranasal flap for anterior lamella and chondromucosal, chondrocutaneous or mucosal graft for posterior lamella. Follow-up time was ranged between 3-35 months. The advantages, disadvantages and complications were defined and aesthetic results of the patients were also evaluated by using a questionnaire which was filled by patients at third month after reconstruction.All flaps and grafts survived, partial or total necrosis was not encountered but one patient with ectropion had a secondary reconstructive procedure. The aesthetic results of the patients were also satisfactory. The paranasal flap is very reliable and safe method for total lower eyelid reconstruction.     

Facial transplantation: A concise update

Objectives: Update on clinical results obtained by the first worldwide facial transplantation teams as well as review of the literature concerning the main surgical, immunological, ethical, and follow-up aspects described on facial transplanted patients. Study design: MEDLINE search of articles published on “face transplantation” until March 2012. Results: Eighteen clinical cases were studied. The mean patient age was 37.5 years, with a higher prevalence of men. Main surgical indication was gunshot injuries (6 patients). All patients had previously undergone multiple conventional surgical reconstructive procedures which had failed. Altogether 8 transplant teams belonging to 4 countries participated. Thirteen partial face transplantations and 5 full face transplantations have been performed. Allografts are varied according to face anatomical components and the amount of skin, muscle, bone, and other tissues included, though all were grafted successfully and remained viable without significant postoperative surgical complications. The patient with the longest follow-up was 5 years. Two patients died 2 and 27 months after transplantation. Conclusions: Clinical experience has demonstrated the feasibility of facial transplantation as a valuable reconstructive option, but it still remains considered as an experimental procedure with unresolved issues to settle down. Results show that from a clinical, technical, and immunological standpoint, facial transplantation has achieved functional, aesthetic, and social rehabilitation in severely facial disfigured patients. Key words:Face transplantation, composite tissue transplantation, face allograft, facial reconstruction, outcomes and complications of face transplantation.     

Endoscopic resection of forehead osteomas

BACKGROUND: Endoscopic brow lift has become widely accepted as a procedure for restoring a youthful brow. Sometimes, a patient seeking a solution for rejuvenation of the upper third of the face may present other problems such as a forehead lesion. The authors describe their clinical experience in surgical endoscopic excision of forehead osteomas. PATIENTS AND METHODS: In nine patients with a forehead osteoma, seeking for a solution in rejuvenating the upper third of the face, we performed a combination of endoscopic brow lift and endoscopic excision of the forehead osteoma. We also performed an endoscopic excision of a forehead osteoma in two patients that did not request any additional aesthetic face procedure. RESULTS: No complication and no recurrence have been reported. The aesthetic result satisfied the patients. CONCLUSIONS: Endoscopic resection of a forehead osteoma offers sufficient, effective and safe access for dissection and suspension of the tissues released. It offers a superbly hidden scar and is well appreciated by the patients.     

"Spectaclesplasty" periorbital rotation advancement in Crouzon syndrome

Facial deformity in Crouzon syndrome is characterized by exophthalmos, exorbitism, mild hypertelorism, and maxillary hypoplasia with a Class III occlusion. The G?teborg craniofacial unit corrects this deformity in selected patients by the 2-stage procedure of "spectaclesplasty" followed by a Le Fort I maxillary osteotomy at skeletal maturity. "Spectacles" is a reference to the bilateral circumferential periorbital bony skeleton, and a spectaclesplasty is a differential rotation and advancement of this complex. Spectaclesplasty has been integrated as part of our protocol in managing Crouzon syndrome from birth to maturity. All patients who have undergone spectaclesplasty were retrospectively reviewed. A composite scoring system analyzing periorbital anatomy and aesthetics was used to compare the preoperative and most recent postoperative photographs. Complications and the need for ancillary procedures were recorded. Twenty-one patients have undergone spectaclesplasty since this technique was introduced in 1984. Mean follow-up time is 5 years 10 months. Compared with their preoperative aesthetics, the improvement was rated as excellent for 8 patients (38%), very good for 7 patients (33%), good for 5 patients (24%), and minimal for 1 patient (5%). No patient was rated as having no improvement. Mean perioperative blood loss was 111% of estimated red cell mass. Mean operative time was 6.4 hours. The mean duration of stay in the intensive care unit was 28 hours, and the mean hospital stay was 11 days. There were few complications and no incidences of mortality. Spectaclesplasty yields high-quality aesthetic results in most cases. It is our impression that spectaclesplasty en bloc rotation advancement of the periorbital bony skeleton can be safely performed before skeletal maturity of the lower face. Correction of the bony periorbital anatomy in early adolescence is important in alleviating psychosocial distress in this age group. In our hands, spectaclesplasty produces a more normal anatomic position of the periorbital soft tissues facilitating both function and aesthetics.     

Total or partial inferior border ostectomy for mandibular contouring: Indications and outcomes

Among the East Asian population, a long or square face produces a characteristic coarse and masculine appearance and is therefore considered undesirable and unattractive. Because of this many Orientals seek to achieve a harmonious contour of their face by undergoing various cosmetic surgical procedures. Mandibular contouring for a long or asymmetrical face with/without square jaw is rarely reported in the literature and the objective of this study was to investigate the effectiveness of total or partial inferior border ostectomy for mandibular contouring and to discuss its indications. From July 2005 to November 2009, 74 patients in this study received mandibular contouring by total or partial inferior border ostectomy procedure to correct a disharmonious facial contour. Postoperatively the appearance of all 74 cases showed that the length of the lower 3rd of the face and the width of the mandible were decreased effectively, and the mandibular contour was improved. The final aesthetic outcomes were satisfactory for both the surgeons and the patients.The results suggest that facial contour could be improved by using total or partial inferior border ostectomy of the mandible thus achieving a harmonious facial outline based on East Asian aesthetics.