The jaw plane is an abstract line, which represents the jaw surface of mandibular teeth in the era of staggered cusp. The jaw plane has two characteristics, namely the horizontal height and inclination of the jaw plane. In comprehensive treatment, some patients may need to change their characteristics.
Extended data:
Clinical technology and application
1, mandibular angle hypertrophy is commonly known as "square face". In the west, it was called "benign masseter hypertrophy" in the early stage. However, in the eastern ethnic groups, it is mainly osteophyte, which is characterized by the backward proliferation and lateral turnover of mandibular horn bone, resulting in too wide lower face and often accompanied by short chin.
With the improvement of living standard and quality of life, many patients with mandibular angle hypertrophy require mandibular angle osteotomy and plastic surgery to improve the shape of face and mandibular angle.
2, surgical methods:
Intravenous rapid induction and nasal intubation inhalation anesthesia were used. Pull one lip and cheek with a hook at the mandibular angle, and the movement should be gentle to prevent strain and quarrel. When performing subperiosteal dissection through oral gingival sulcus incision, the periosteum should be kept intact to reduce bleeding, prevent swelling of buccal fat pad and expose the lower part of mandibular branch, mandibular angle, mandibular body and mental nerve.
During the arc osteotomy of mandibular angle, according to the pre-designed bone cutting amount, a small round drill is used to fix the point and connect it into an arc, which can be used to determine the osteotomy range during the operation and protect the mental nerve under direct vision.
3. Complications and their treatment
(1) Hemorrhage and hematoma: The operation was smooth and there was no obvious bleeding during the operation. After 1.5h, the drainage volume in the operation area increased, and the intraoral incision oozed blood. Exploring the operating area, it was found that the wound showed diffuse oozing blood. It is invalid to input stock blood and conventional pressure packaging. After that, 800ml of fresh whole blood was injected, and the bleeding of the wound was improved. The operation area was filled with iodoform gauze, and it was taken out and sutured 3 days later.
The patient's preoperative coagulation mechanism was normal, and there was no history of anticoagulation and easy bleeding, which was considered to be related to menstrual surgery. The hematoma was discharged and pressure bandaged. Or narcissism. Because the existence of hematoma after operation greatly increases the probability of secondary infection, the larger hematoma should be removed in time after operation, and the smaller hematoma can be closely observed temporarily.
(2) Nerve injury: After operation, the chin of the lower lip complained of numbness, which generally recovered within 2 weeks 1 month. It is believed that it is related to pulling mental nerve during operation. If there is still partial loss of sensation in one jaw 2 years after operation, it may be related to excessive traction during operation.
Generally, there is no danger of facial nerve injury through oral incision, but the mandibular marginal branch of facial nerve may be injured through oral incision. Especially when the masseter is removed at the same time, it is easier to damage the mandibular marginal branch, and when the masseter is removed, it should be noted that only the medial masseter can be removed.
(3) Hypertrophic scar caused by oral and lip strain.
(4) Infection: The patient underwent submandibular liposuction at the same time, and recovered after operation. On the eighth day after operation, his body temperature suddenly increased, his right face and submandibular region swelled, and his pain and white blood cell count increased. After being treated with high-dose antibiotics, it will be relieved and gradually subsided after 3 days, and the therapeutic effect will not be affected.
(5) Bilateral asymmetry: Some cases think that bilateral asymmetry is obvious. After trimming the mandibular lower edge again, the mandibular angle was reconstructed with molded Medpor prosthesis.
(6) Malshape of mandibular angle: After operation, it was considered that the angle of mandibular angle was too large and the lower edge of mandible was too steep and unnatural, so it was required to reconstruct the shape of mandibular angle. Medpor prosthesis was implanted, and the newly formed mandibular angle was about 105.
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