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口内下颌角截骨

2018-03-17 12页 doc 49KB 20阅读

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口内下颌角截骨口内下颌角截骨 口内下颌角截骨 --- 黑龙江瑞丽国际整形医院 官方网站:www.ruiliguoji.com 用微动力带冷光源和自动保护装置的颌面骨成形磨骨系统去去下颌角肥大,通过口内切口,进行磨除。由于视野清楚出血很少,不会损伤面神经,磨骨面流畅,去下颌角肥大(方脸)的问题。操作安全,口外无疤痕,改脸形更科学、更安全、更精确,磨切骨后脸型流畅自然,尽显女性妩媚和温柔之美。 适合对相:小于40岁或脸部软组织仍然保有弹性的国字脸病患。 去下颌角手术时间:约1小时(全身麻醉)。 恢复需要时间:消肿到不惹人注意大约需要...
口内下颌角截骨
口内下颌角截骨 口内下颌角截骨 --- 黑龙江瑞丽国际整形医院 官方网站:www.ruiliguoji.com 用微动力带冷光源和自动保护装置的颌面骨成形磨骨系统去去下颌角肥大,通过口内切口,进行磨除。由于视野清楚出血很少,不会损伤面神经,磨骨面流畅,去下颌角肥大(方脸)的问题。操作安全,口外无疤痕,改脸形更科学、更安全、更精确,磨切骨后脸型流畅自然,尽显女性妩媚和温柔之美。 适合对相:小于40岁或脸部软组织仍然保有弹性的国字脸病患。 去下颌角手术时间:约1小时(全身麻醉)。 恢复需要时间:消肿到不惹人注意大约需要7-10天,完全消肿约需3个月。 前3天喝流质食物,之后的一周渐改成软性饮食再恢复正常。 去下颌角手术后注意事项:前3天喝流质食物,之后的一周渐改成软性饮食再恢复正常。 去下颌角手术方法: 1.去下颌角手术在全麻或强化局麻下进行。 2.切口及剥离:于颊龈沟底部自第二前磨牙至上颌结节后缘切开黏膜下组织及骨膜,用剥离器沿骨面向后下方剥离显露下颌角。于下颌缘部分离开咬肌附着处。沿该部分向前剥离达第二前磨牙处时注意勿损伤颏神经血管束。 3.截骨线设计:根据截骨线设计方法,在该部分曲面断层片或在骨侧位片上,标出骨升支前缘的垂线与咬合平面的平行线与骨下缘及升支后缘交点的连线为安全截骨线。 4.截骨:先用裂钻或瓜形磨头沿截骨线磨出一骨槽,而后用摆锯将下颌角截除。而后用磨头将截骨后创基打磨平滑。 5.咬肌肥大者将咬肌中层用组织钳提起后,用7号丝线缝合3,4针牵引线。提起牵引线,用电刀切除中层咬肌。 6.彻底止血后缝合切口加压包扎,必要时可放置负压引流48小时。 application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image check 下颌角截骨 下颌角截骨术 下颌角截骨术目前也有二种方式,一是截骨术,二是磨削术 截骨术:切口起自下颌升支前缘咬合平面上外侧,沿前庭沟偏颊侧5,,至下颌第一双尖牙,切开黏膜骨膜。利用“脱套”技术骨膜下分离,暴露下颌骨升支的中下部、下颌角和下颌体的后部。按术前设计用小圆钻标记,用长柄圆钻和摆动锯弧形截骨,截透下颌骨外板及部分内板,尚存的部分骨连结用弯形骨凿凿开。分离内侧的翼内肌的附丽,将截下的下颌角完整取出,截骨线打磨修整至光滑流畅。 磨削术:又称铣骨术,切口设计及骨膜剥离同前,利用铣头磨削下颌骨外下侧,使之成楔状改变,故此手术的效果,与前者方法有相当的不同,前者外观及触摸均感到到明显改变,而此方法术后触摸时可能仍感有明显的方形下颌骨,但外观却无此症状,故一样有明显的手术效果,目前比较流行~ 术前准备 1身体健康无重要脏器的器质性病变如:无心脏病无肝炎肾炎肺炎等疾病 2无口腔感染源如:龋齿牙周炎口腔溃疡等 3女性手术应避开月经期 4还应作术前血尿的常规化验检查胸透和心电图等常规健康检查 5常规拍摄面部正侧位照片以备术后对比和疗效评功定有条件的可以做三维头颅CT拍摄上颌骨X线片了解上颌窦发育程度个别病例应取面模准备测量颧骨需要削除的骨量 手术方式 1手术在全麻或强化局麻下进行 application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image check 2切口及剥离:于颊龈沟底部自第二前磨牙至上颌结节后缘切开黏膜下组织及骨膜用剥离器沿骨面向后下方剥离显露下颌角于下颌缘部分离开咬肌附着处沿下颌缘向前剥离达第二前磨牙处时注意勿损伤颏神经血管束 3截骨线设计:根据Kamiishi截骨线设计方法在下颌曲面断层片或在下颌骨侧位片上标出下颌骨升支前缘的垂线与咬合平面的平行线与下颌骨下缘及升支后缘交点的连线为安全截骨线 4截骨:先用裂钻或瓜形磨头沿截骨线磨出一骨槽而后用摆锯将下颌角截除而后用磨头将截骨后创基打磨平滑 5咬肌肥大者将咬肌中层用组织钳提起后用7号丝线缝合3,4针牵引线提起牵引线用电刀切除中层咬肌 6彻底止血后缝合切口加压包扎必要时可放置负压引流48 h 下颌角截骨术可能发生的并发症 下颌角手术毕竟不是很小的手术,它可能的并发症包括: 下颌骨骨折: 与医生的操作有很大关系,但患者自身骨质的脆弱性会增加这种风险,可能要颌间固定或其他的及时处理,一般不会遗留严重后遗症,但术后恢复时间会增加。 神经损伤: 常见患者术后下唇感觉麻木,最长可达半年,因术中牵拉颏神经所致,是可以恢复的,不用特别担心。 出血: 与很多因素有关,比较迅猛的见于面动脉破裂,但是及时处理不会引起术后严重后果。 下颌角不平滑: 与截骨方式有很大关系,与医生的经验及其审美观均有一定关系,主要是由于角区直线截骨导致的角区与下颌骨体连接处未衔接好导致下颌体部出现一明显突起( application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image check 下颌角复发: 有文献报道术后远期角区骨质有再生,但上般不会恢复至术前状态,我们认为这往往与术中骨碎屑冲洗不净有关。 此外还有血肿,感染,双侧不对称的可能以及术后肿胀( 什么是下颌角 方脸就是在双侧耳下俗称腮部的部位膨大突出,正面观时,面部两侧轮廓垂直向下,与下轮廓线近简直角相交,使面部下三分之一显得宽而阔,这就是所谓方脸形,也叫下颌角肥大。 从解剖上讲,主要是由于下颌角(下颌角的一部分)骨质发育过大,或者咬肌过度肥厚造成,两者也可兼而有之,医学上称之为下颌角肥大(或良性咬肌肥大)。下颌角肥大一般以双侧为多,单侧的也不少见,往往与青少年身体发育期过多吃零食、嚼口香糖(或槟榔)有关,也可能是由于夜间磨牙引起。这些都使提上颌肌群(肌肉、翼肉肌等)过度锻炼,刺激下颌角区的肌肉和骨骼发育,最终外观呈现“方脸畸形”。 下颌角肥大形成的原因 下颌角肥大一般以双侧为多,单侧的也不少见。下颌角肥大是如何形成的呢,这往往与青少年身体发育期过多吃零食,嚼口香糖有关,也可能由于夜间磨牙引起。这些都使提颌肌群(咬肌、翼内肌等)过度锻炼,刺激下颌角区的肌肉和骨骼发育,最终外观呈现“方脸畸形”。所以可认为,下颌角肥大的成因有三个。 1 下颌角部的骨性肥大 2 咬肌的过度发育凸出于两侧腮部。具体到每个患者,两部分病因所引起的影响可能不一样,骨性为主或肌性为主都有可能。但从临床经验上看,两者往往同时伴发。 3 也有一部分患者是由于遗传引起,追溯到其父母或亲属往往也有下颌角肥 根据下颌角截骨肥大的形态,可将下颌角肥大分为以下三种类型:?下颌角后突型 ?下颌角外翻型 ?下颌角突外翻型 对东方人而言,下颌角骨质的肥大突出是主要原因,包括下颌角过于后突、外翻或两者兼而有之,所以治疗的重点主要集中在下颌角的截骨整形上,手术被认为是目前治疗下颌角肥大者首选也是最有效的途径。 application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image check 下颌角整形手术切口选择 目前较流行的是口内切,各种切口如下: 口外切口:是在下颌角处做一个3-5厘米的切口切除下颌角。优点:手术是在直视下进行,比较安全;不需要复杂的设备、器械,可以同时将咀嚼肌部分切去。 耳后切口:是在耳后做一个3-4厘米切口切除下颌角。优点:切口相对隐蔽,操作相对简单。 下颌下微切口:就是应用口内外联合切口插入电锯的0.5厘米,0.8厘米微小切口完成所有的手术过程,切口在下颌的下面,3,6个月后该切口将不明显。优点:该方法口内没有切口,因此手术创伤小、术后恢复快。 口内外联合切口:应用口腔内3厘米,4厘米切口和下颌下两个0.5厘米,0.8厘米大小切口,非常方便地去除肥大的下颌角,同时可以切除或磨削下颌骨外板和下颌缘,切除部分咬肌。优点:手术非常方便,许多初学者均采用该方法。下颌下的微切口经过一段时间恢复,痕迹将不明显。 完全口内切口:是目前最好的手术方法。是应用口腔内3厘米,4厘米切口弧形截除肥大下颌角,同时可以切除或磨削下颌骨外板和下颌缘,可以切除部分咬肌。优点:因为整个手术只有口内切口,体不会遗留任何手术疤痕,手术创伤相对于口内外联合切口要小的多,恢复也明显加快。也是因为口内入路,避免了损伤面部血管、神经的机会。手术的技术要求较高。 术后 1术后要求患者必须留院观察3-5天 2术后头面罩加压包扎5至7天中途如无特殊情况不能拆开如拆开后应及时包扎注意检查有无压坏皮肤如口内伤口放置引流条则于术后48小时拨除; 3三个月内不得做面部美容按摩不得搓揉术区; 4术后6小时开始用漱口液漱口至拆线; 5术后吃流食至第五天且三个月内尽量避免用力咬较硬东西; 6术后7天拆线少食辛辣刺激食物尽量半流食 下颌角截骨恢复期: 下颌角截骨恢复期面部会有不同程度的肿胀,一般3-7天逐渐消退,术后一周左右即可拆线。但完全消肿需1个月左右,3—6个月咬肌由于附着点位置的改变及肌肉张力的变化,咬肌本身会发生自身重建性萎缩,所 [1]以6个月左右时达到最佳效果。 下颌角截骨术前注意事项 application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image check 1、下颌角截骨术前要拍头颅正、侧位X片,医生好准确判断去除的骨量。 2、下颌角截骨术前要保持良好的情绪,保持身体健康,预防感冒。 3、下颌角截骨术前要做好各项全身常规检查,术前二周应停止服用阿司匹林,维生素E,等活血药,及活血中药,月经期间不可做手术。 4、下颌角截骨术前一日应沐浴,洗净面部,去掉面部的化妆。 5、下颌角截骨术前一周禁止吸烟,术前三天禁止饮酒。 6、 术后饮食需要注意不要吃辛辣刺激的食物 下颌角截骨术术后饮食 防止下颌角截骨手术后感染,下颌角截骨手术后两天内禁食,主要靠输液维持生理需要。48小时后开始进流食,如:牛奶、果汁、肉汤等。72小时后可以进半流食,如:酸牛奶、鸡蛋羹、烂面汤、稀饭等。以后逐渐过渡过到正常饮食,但一个月内不应吃过硬的食品,也不宜大笑。病人除了不用担心下颌角截骨手术中的不适外,下颌角截骨手术后的疼痛也是完全可以避免的。目前有先进的;微泵;止痛仪器,能在下颌角截骨手术后48小时内持续、微量地给予止痛药,使病人的恢复处于一个愉快的心态。 application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image check
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