超声骨刀在颧骨颧弓肥大矫正术中应用.docVIP

超声骨刀在颧骨颧弓肥大矫正术中应用 　　[摘要]目的：探讨超声骨刀在颧骨颧弓肥大矫正术中各部位骨质截骨的临床应用方法、效果和价值。方法：颧骨颧弓肥大整形就医者30例（男1例，女29例），均采用经鼻腔插管全身麻醉，口内联合耳屏前小切口，骨膜下分离颧骨体部及颧弓后端，注意妥善保护颧神经及面神经颧颞支，采用超声骨刀不同部位截骨和打孔相结合的技术操作。结果：超声骨刀可以准确安全截断颧骨体部及颧弓后端，顺利完成预先设计的各项操作，比传统的截骨工具有着明显的优越性。所有受术者均未出现截骨部位的热损伤、截骨不整齐及软组织损伤现象，术后随访6个月以上，截骨处愈合良好，外形稳定，形态效果满意。结论：采用超声骨刀进行颧骨颧弓肥大矫正术，可较好地提高手术精确度和安全性，但较传统截骨工具（如来复锯及裂钻），超声骨刀截骨时需要掌握一定的操作技巧。 　　[关键词]颧骨；颧弓；肥大；超声骨刀；颧骨颧弓整形 　　[中图分类号]R782 [文献标志码]A [文章编号]1008-6455（2015）15-0026-04 　　Abstract： Objective To evaluate the result of the use of piezosurgery osteotome for treatment of zygoma and zygomatic arch hypertrophy. Methods Under intraoral combined with anterior to tragus approach and general anesthesia，30 patients （1 male patient and 29 female patients） underwent malar reduction with piezosurgery osteotome.The zgyomatic body and posterior end of arch under periosteum was explored and the zygoamtic nerve and facial nerve were protected. According to the clinical features of zygoma and zygomatic arch hypertrophy，L-shaped osteotomy in body，shaped osteotomy in arch end and perforation were performed. Results The osteotomy of malar reduction could be completed with Piezosurgery osteotomy.After 6 months following-up，the out-lines of all cases were natural and concordant.There were no complications of osseous heat injury，soft tissue and nerve injury.Compared with traditional osteotome devices.piezosurgery osteotome was safe and precise. Conclusion piezosurgery osteotome can improve the precision and safety of malar reduction.But compared with traditional osteotomy devices，it need surgery master sufficient skill. 　　Key words：zygoma；zygomatic arch；hypertrophy；piezosurgery osteotome；malar reduction 　　颧部的外突，在东方女性中比较常见，现在对面部美观的认识中越来越多的人追求柔和的面部轮廓，也使得颧骨颧弓肥大矫正术成为整形美容外科常见手术之一。为了符合美容原则，不遗留体表瘢痕，目前手术已经逐渐淘汰大的冠状切口及颞部发际内切口，往往采用口内双侧前庭沟合并耳屏前小切口入路，临床主要通过颧骨颧弓前后端截骨内推并坚强内固定实现颧骨的美容效果[1-3]。针对口内操作视野狭小，采用来复锯、磨头等电动骨切割工具不易精确掌控，容易出现骨热损伤、截骨线偏斜，易引起血管神经及软组织的损伤，甚至会出现反复截骨导致骨块游离缺损的严重并发症。笔者对30例就医者采用超声骨刀进行颧骨颧弓肥大矫正术，手术可精准地进行截骨，楔状骨块劈除，固定位