抽屉式截骨颏成形术在长颏畸形矫正中的应用  

Drawer-genioplasty for the reduction of long-chin deformity

作　　者：王郁 宋国栋 曾涵 陈宗 赖晨智 郭小双 靳小雷 WANG Yu;SONG Guodong;ZENG Han;CHEN Zong;LAI Chenzhi;GUO Xiaoshuang;JIN Xiaolei(Department of Craniomaxillofacial Surgery,Plastic Surgery Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing100144,China)

机构地区：[1]中国医学科学院北京协和医学院整形外科医院颅颌面外科,北京100144

出　　处：《中国美容整形外科杂志》2024年第8期452-455,共4页Chinese Journal of Aesthetic and Plastic Surgery

摘　　要：目的探讨颏部"抽屉式"截骨颏成形术矫正长颏畸形并预防颏下软组织脱垂的应用效果.方法自2020年10月至2023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外科收治42例长颏畸形患者,采用口内切口入路行下颌根尖下联合下颌下缘弧形截骨改良颏部的"抽屉式"截骨术,术中截骨线最大程度的避开二腹肌前腹、下颌舌骨肌及颏舌肌的骨附着区域,以充分保护口底肌肉.采用数字化技术分析患者骨组织三维重建及面部三维扫描数据以评估手术效果,术后随访6~12个月.结果术后所有患者唇龈沟切口均一期愈合,无血肿、感染、骨坏死等并发症发生.数字化分析结果显示,手术所致的颏部骨与软组织的变化比为1:0.86.经测量患者术后面中下比例R1由术前的0.82±0.09增长为术后的0.92±0.11,上下唇比例R2同样由术前的0.52±0.06增长为术后的0.63±0.05.虽然颏颈角也由术前的104.90°±8.02°增长为术后的111.50°±7.03°,但仍在正常生理范围内.以上结果差异均有统计学意义(P<0.05).术后2例患者出现下唇麻木,分别于术后4个月和术后10个月症状消失.全部患者对术后面部轮廓形态满意.结论改良颏部"抽屉式"截骨术可以安全、有效地矫正患者长颏畸形并预防术后颏下软组织下垂,具有临床推广应用价值.Objective To investigate the efficacy of drawer-genioplasty in correcting the long-chin deformity and preventing postoperative sagging of submental soft tissues.Methods Forty-two patients with long-chin deformity admitted to the Department of Craniomaxillofacial Surgery,Plastic Surgery Hospital from October 2020 to December 2023 were selected for this study.The modified drawer-genioplasty was performed through an intraoral incision approach,using subapical and mandibular contouring osteotomy.The os-teotomy lines were designed and performed during surgery to minimize damage to the bone attachments of the anterior belly of the digastric muscle,mylohyoid muscle,and geniohyoid muscle to protect the floor-of-mouth muscles adequately.Digital technology enabled the as-sessment of surgical outcomes through the analysis of three-dimensional reconstruction of bone and facial scanning.Follow-up visits were conducted 6-12 months post-surgery.Results All patients achieved uncomplicated primary healing at gingiva-labial sulcus incisions,without any occurrences of hematoma,infection,or bone necrosis.The digital analysis revealed a postoperative ratio change of 1:0.86 be-tween the chin bones and soft tissues.Measurements demonstrated an increase in R1(the ratio of the middle and lower face)from preoper-ative 0.82±0.09 to postoperative values 0.92±0.11,as well as an increase in R2(the ratio of the upper and lower lips)from preoperative 0.52±0.06 to postoperative values 0.63±0.05.However,there was an increase in the mentocervical angle from preoperative 104.90°±8.02°to postoperative 111.50°±7.03°,this value was still within the normal range.The results above demonstrated statistically significant differences(P<0.05).Two patients experienced transient lower lip numbness postoperatively,which resolved at four months and ten months respectively.All patients expressed satisfaction with their postoperative facial contour morphology.Conclusion The modified drawer-genioplasty demonstrates both safety and efficacy in correcting

关 键 词：长颏畸形 下颌角截骨术 颏成形术 口底肌肉 骨愈合 

分 类 号：R782.2[医药卫生—口腔医学]