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目的探讨不同术式下颌角缩小术的临床适应证及操作要点。方法将95例患者根据临床表现分为3型:下颌角轻度肥厚型、下颌角肥大伴内翻型、下颌角肥大伴外翻型。对下颌角轻度肥厚型,行口内入路单纯下颌角磨削术,对下颌角肥大伴内翻型,在磨削的基础上,加下颌角的弧线截骨术,对下颌角肥大伴外翻型,在磨削的基础上,加下颌角的矢状截骨术。结果在95例手术患者中,术后12个月内得以随访者57例,大部分患者术后脸形变尖、变小,患者均自觉满意。其中4例因咬肌较肥厚,术后行肉毒素咬肌内注射后自觉效果满意;有3例患者因术中损伤面动脉出血,术后引流不畅,出现下颌角处积血、肿大,其中2例经穿刺抽出积血,1例经口外切开小口,清除积血引流后肿胀消除,3个月后自觉效果满意。结论根据患者下颌角肥大的不同临床表现,分别选择单纯下颌角磨削术、下颌角弧线截骨术或下颌角矢状截骨术,治疗效果好,值得临床推广。
Objective To investigate the clinical indications and operative points of different surgical mandibular angle reduction. Methods Ninety-five patients were divided into three types based on clinical manifestations: mild hypertrophy of mandibular angle, hypertrophy of mandibular angle with varus, mandibular angle hypertrophy with valgus. On the mandibular angle mild hypertrophy, the line of mouth simple mandibular angle grinding, mandibular angle hypertrophy with inverted type, on the basis of grinding, plus the mandibular angle arc osteotomy, mandibular angle hypertrophy with external Fan type, based on the grinding, plus sagittal sagittal osteotomy. Results Of the 95 surgical patients, 57 cases were followed up within 12 months after operation. Most of the patients showed sharp and narrow facial appearance after operation, and patients were satisfied with the results. Among them, 4 patients were more hypertrophic due to masseter muscle, and satisfactory results were obtained after intramuscular injection of botulinum toxin intramuscularly after surgery. Three patients suffered from bleeding due to intra-articular injury and poor drainage after operation. , Of which 2 cases of hemorrhage by puncture, 1 case of small incision outside the mouth to clear the swelling and drainage after hemorrhage eliminated, 3 months after the consciously satisfied. Conclusion According to the different clinical manifestations of mandibular angle hypertrophy, the patients were treated with simple mandibular angle grinding, mandibular angle arc osteotomy or mandibular angle sagittal osteotomy, respectively. The curative effect is good and worthy of clinical promotion.