Medpor充填结合截骨在颅面外科中的应用(1)
The applications of the Medpor porous polyethylene flexblock implant and osteotomy remove in the Craniofacial Surgery The department of Plastic surgery, 3rd Hospital, Beijing Medical University, Beijing 100083 Wang Xia, Ma Yongguang, Li Jianning. Li Bi, Chen Yuzhe, Qi Rongsheng.
Objective: The congenital craniofacial deformities are often demonstrated the hypoplasia of maxillary, zygomatic, mandibular, temporal and their related soft tissue. The skeletal hypoplasia are their mainly deformities. The greater omentum, the sheet of dermo-subcutanous flap and the bone graft have been used seperately. Not only complex of surgical procedure, but also showing clumsy contour when the artificial material was used. The Medpor implantation is much simple procedure and useful for those hypolasia. Method: The surgery included both osteotomy and Medpor transplantation as a large-scale filling stuff transfer under periosteum for Hemifical microsomia (3 cases) and simple mandibular hypoplasia (6 cases) reconstruction. Result: The result is setesfaction and shows a good nature skeleton facial contour. A half year following-up after operation shows that implants is stableness without coming out or any uncomfortable. The advantages of the surgery are short operation time, much less surgical trauma, surgery can be finish at once time and a quick recovery. Conclusion: 1. The Medpor could be used in large-scale areas and multiple places compositely in one operation. 2. It will be a good facial outline if the transplants are put deep to the muscles, if put just under the subcutaneous the material will be conglutination with superficial skin. 3. The result will be more precision if the surgery combine with osteotomy.
, http://www.100md.com
Key word: Osteotomy, Medpor, Craniofacial hypoplasia, implant.
有关先天性下颌骨发育不良疾病主要有半侧颅面矮小(Hemifacial microsomia)本组3例。单纯性下颌骨发育不良，先天性面下颌骨发育不全(Mandibulofacial dysostosis)其中包括Treacher Collins综合征本组6例。Hemifacial microsomia 又被称之为半侧颅面矮小，或第一、二鳃弓发育不良综合征等等。以上这些疾病均可表现为半侧颅面骨、下颌骨、颞骨和软组织的部分发育不良或完全性发育不良。其中患侧上颌骨、颧骨、下颌骨和耳发育不良是其影响外观的主要因素。对于这些先天性颅面骨发育不良，如采取其它手术方法如大网膜移植、真皮脂肪瓣移植往往需经多次手术。我们用多孔聚乙烯 (Medpor)作为充填材料代替骨移植结合截骨矫正，手术一次完成。
设计及术前测量：
, 百拇医药
手术设计及术前测量准确是手术能否顺利完成和影响术后效果的关键，颅面畸形患者外形千差万别，即使是同样一种病(如： Hemifacial microsomia)，因畸形的程度不同，不同患者之间的临床外形表现亦可有明显的差异。所以术前必须认真分析和较为精确的设计十分必要。9例患者：对单纯性单侧下颌骨发育不良采用Medpor下颌骨体单侧置入3例。先天性面下颌骨发育不全采用双侧颧骨、下颌骨体Medpor填充2例，双侧颧骨、下颌骨体及颏部填充1例。半侧颅面矮小单侧下颌骨体、颏部填充2例，单侧下颌骨体填充1例。9例患者术后均无假体外露，无感染，双侧对称性较术前有明显改善占90%以上，患者满意率80%以上。术后随访半年移植物稳定，患者无不适、无异物感。
典型病例：
病例1、(图2-8)
女性，22岁，患先天性半侧颅面矮小症(第一、二鳃弓综合征)(图4)。双眼发育，双睑裂位置，颞下颌关节活动均正常。咬合平面偏向患侧(左侧)，但咬合关系基本吻合，下颌骨后缩畸形，患侧上颌骨、颧骨发育不良较健侧明显缩小，患侧乳突发育较健侧小，患侧咀嚼肌(颞肌、翼内肌、翼外肌和咬肌等)均发育不良，特别是咬肌明显较健侧小。外耳廓向前下方移位，听力正常。下颏向患侧偏转移位，立体CT：(图1底顶位)颧弓左侧(患侧)较右侧小，患侧颧骨明显后缩。下颌骨发育双侧明显不对称，患侧下颌骨体较健侧小而短且向中线内翻。患侧下颌升支-喙突、下颌小头(下颌髁)均发育不良。下颏向患侧偏转移位。
, http://www.100md.com
手术口腔切口入路：
颧骨充填术：沿患侧上牙龈沟切开粘膜、粘膜下和骨膜至上颌骨骨面，切口长5-6厘米。沿骨膜下向上钝性剥离，剥开附着在颧骨上的颧大小肌、提口角肌、提上唇肌和附着在颧骨颧弓的部分咬肌完全暴露颧骨颧弓。在剥离颧骨表面时会不可避免地损伤“颧面神经”，此神经从颧骨的颧面神经孔走出支配颧骨表面的皮肤，属三叉神经分支上颌神经。术后1/2-1年患者会出现颧部皮肤麻木感。剥离颧骨内侧时避免损伤眶下神经。将颧骨假体Medpor置入，使假体与颧骨表面贴合，如两者曲率不同，或塑形假体或在两者之间植入自体骨碎块。
下颌骨截骨假体充填术：沿患侧下牙龈沟切开粘膜、粘膜下和骨膜至下颌骨骨面，切口长约6厘米。于骨膜下钝性剥离，注意保护颏神经，分离附着在下颌骨体的咬肌。下颌骨向患侧偏转，截除患侧突出的颏角。将下颌角和颏Medpor假体(图9-11)置入。, 百拇医药(王侠)
Objective: The congenital craniofacial deformities are often demonstrated the hypoplasia of maxillary, zygomatic, mandibular, temporal and their related soft tissue. The skeletal hypoplasia are their mainly deformities. The greater omentum, the sheet of dermo-subcutanous flap and the bone graft have been used seperately. Not only complex of surgical procedure, but also showing clumsy contour when the artificial material was used. The Medpor implantation is much simple procedure and useful for those hypolasia. Method: The surgery included both osteotomy and Medpor transplantation as a large-scale filling stuff transfer under periosteum for Hemifical microsomia (3 cases) and simple mandibular hypoplasia (6 cases) reconstruction. Result: The result is setesfaction and shows a good nature skeleton facial contour. A half year following-up after operation shows that implants is stableness without coming out or any uncomfortable. The advantages of the surgery are short operation time, much less surgical trauma, surgery can be finish at once time and a quick recovery. Conclusion: 1. The Medpor could be used in large-scale areas and multiple places compositely in one operation. 2. It will be a good facial outline if the transplants are put deep to the muscles, if put just under the subcutaneous the material will be conglutination with superficial skin. 3. The result will be more precision if the surgery combine with osteotomy.
, http://www.100md.com
Key word: Osteotomy, Medpor, Craniofacial hypoplasia, implant.
有关先天性下颌骨发育不良疾病主要有半侧颅面矮小(Hemifacial microsomia)本组3例。单纯性下颌骨发育不良，先天性面下颌骨发育不全(Mandibulofacial dysostosis)其中包括Treacher Collins综合征本组6例。Hemifacial microsomia 又被称之为半侧颅面矮小，或第一、二鳃弓发育不良综合征等等。以上这些疾病均可表现为半侧颅面骨、下颌骨、颞骨和软组织的部分发育不良或完全性发育不良。其中患侧上颌骨、颧骨、下颌骨和耳发育不良是其影响外观的主要因素。对于这些先天性颅面骨发育不良，如采取其它手术方法如大网膜移植、真皮脂肪瓣移植往往需经多次手术。我们用多孔聚乙烯 (Medpor)作为充填材料代替骨移植结合截骨矫正，手术一次完成。
设计及术前测量：
, 百拇医药
手术设计及术前测量准确是手术能否顺利完成和影响术后效果的关键，颅面畸形患者外形千差万别，即使是同样一种病(如： Hemifacial microsomia)，因畸形的程度不同，不同患者之间的临床外形表现亦可有明显的差异。所以术前必须认真分析和较为精确的设计十分必要。9例患者：对单纯性单侧下颌骨发育不良采用Medpor下颌骨体单侧置入3例。先天性面下颌骨发育不全采用双侧颧骨、下颌骨体Medpor填充2例，双侧颧骨、下颌骨体及颏部填充1例。半侧颅面矮小单侧下颌骨体、颏部填充2例，单侧下颌骨体填充1例。9例患者术后均无假体外露，无感染，双侧对称性较术前有明显改善占90%以上，患者满意率80%以上。术后随访半年移植物稳定，患者无不适、无异物感。
典型病例：
病例1、(图2-8)
女性，22岁，患先天性半侧颅面矮小症(第一、二鳃弓综合征)(图4)。双眼发育，双睑裂位置，颞下颌关节活动均正常。咬合平面偏向患侧(左侧)，但咬合关系基本吻合，下颌骨后缩畸形，患侧上颌骨、颧骨发育不良较健侧明显缩小，患侧乳突发育较健侧小，患侧咀嚼肌(颞肌、翼内肌、翼外肌和咬肌等)均发育不良，特别是咬肌明显较健侧小。外耳廓向前下方移位，听力正常。下颏向患侧偏转移位，立体CT：(图1底顶位)颧弓左侧(患侧)较右侧小，患侧颧骨明显后缩。下颌骨发育双侧明显不对称，患侧下颌骨体较健侧小而短且向中线内翻。患侧下颌升支-喙突、下颌小头(下颌髁)均发育不良。下颏向患侧偏转移位。
, http://www.100md.com
手术口腔切口入路：
颧骨充填术：沿患侧上牙龈沟切开粘膜、粘膜下和骨膜至上颌骨骨面，切口长5-6厘米。沿骨膜下向上钝性剥离，剥开附着在颧骨上的颧大小肌、提口角肌、提上唇肌和附着在颧骨颧弓的部分咬肌完全暴露颧骨颧弓。在剥离颧骨表面时会不可避免地损伤“颧面神经”，此神经从颧骨的颧面神经孔走出支配颧骨表面的皮肤，属三叉神经分支上颌神经。术后1/2-1年患者会出现颧部皮肤麻木感。剥离颧骨内侧时避免损伤眶下神经。将颧骨假体Medpor置入，使假体与颧骨表面贴合，如两者曲率不同，或塑形假体或在两者之间植入自体骨碎块。
下颌骨截骨假体充填术：沿患侧下牙龈沟切开粘膜、粘膜下和骨膜至下颌骨骨面，切口长约6厘米。于骨膜下钝性剥离，注意保护颏神经，分离附着在下颌骨体的咬肌。下颌骨向患侧偏转，截除患侧突出的颏角。将下颌角和颏Medpor假体(图9-11)置入。, 百拇医药(王侠)