重度进行性半侧颜面萎缩骨骼和软组织的轮廓重建  

Skeleton and soft tissue contour reconstruction for severe progressive hemifacial atrophy

作　　者：唐晓军[1] 张智勇[1] 石蕾[1] 尹琳[1] 尹宏宇[1] 杨仁凯[1] 阮姝婕 

机构地区：[1]北京协和医学院中国医学科学院整形外科医院颌面整形外科中心,北京100144

出　　处：《中华整形外科杂志》2012年第6期411-415,共5页Chinese Journal of Plastic Surgery

摘　　要：目的总结治疗重度半侧颜面萎缩症的手术方法。方法2004年1月至2012年5月，对25例重度半侧颜面萎缩的患者，综合应用自体脂肪游离移植、股前外侧筋膜脂肪瓣、自体真皮游离移植等方法进行软组织重建，应用下颌骨延长技术、正颌技术、自体组织移植或假体植入等方法进行骨骼轮廓重建。结果25例患者中有24例接受了颧骨增高术和面部脂肪注射；17例接受了正颌手术：LeFort I型截骨3例，颏部截骨整形4例，下颌骨延长配合二期LeFort I型截骨3例，颏部截骨整形联合下颌骨bledpor贴附整形7例；股前外侧筋膜脂肪瓣10例；背阔肌肌瓣修复1例。术后随访6个月至5年，25例患者通过骨骼轮廓和软组织结构重建，倾斜的咬合平面和错颌畸形获得纠正，面部不对称和扭曲畸形得到明显改善。结论对于重度半侧颜面萎缩患者，只有综合应用各种治疗手段进行软组织和骨骼轮廓重建，才能获得良好的治疗效果。Objective To sum up the various procedures for skeleton and soft tissue contour reconstruction in severe progressive hemifacial atrophy. Methods From Jan 2004 to May 2012, 25 patients with severe progressive hemifaeial atrophy underwent the procedures of lipoinjeetion, microsurgieal flap transplantation, dermis grafting, distraction osteogenesis, orthognathie surgery and so on for both skeleton and soft tissue reconstruction. Results Among them, zygomatic augmentation and lipoinjection were performed in 24 cases, anterolateral thigh adipofascial flap in 10 cases and latissimus dorsi flap in one case, orthognathic surgery in 17 cases, including Le Fort I osetoectomy in 3 cases, genioplasty in 4 cases, mandibular distraction osteogenesis combined with secondary Le Fort I osteotomy in 3 cases, genioplasty combined with mandibular augmentation with Medpor implant in 7 cases. The patients were followed up for 6 months to 5 years. Through skehon and soft tissue reconstruction, the oblique occlusion plane and malocclusion were corrected with great improvement in face asymmetry. Conclusions For severe progreassive hemifacial atrophy, comprehensive procedures should be adopted for both skehon and soft tissue reconstruction to achieve good results.

关 键 词：进行性半侧面萎缩症 骨骼 软组织 

分 类 号：R622[医药卫生—整形外科]