Cervelli D, Gasparini G, Moro A, Pelo S, Foresta E, Grussu F, D'Amato G, De Angelis P, Saponaro G
Maxillo-Facial Surgery Unit, Complesso Integrato Columbus, Università Cattolica del Sacro Cuore, Rome, Italy.
Plastic Surgery Unit, Policlinico Universitario "A. Gemelli", Università Cattolica del Sacro Cuore, Rome, Italy.
Acta Otorhinolaryngol Ital. 2016 Oct;36(5):368-372. doi: 10.14639/0392-100X-857.
Maxillo-mandibular asymmetry has numerous aetiologies: congenital, traumatic, iatrogenic and post-oncologic. Patients with congenital dentofacial malformations are generally submitted to orthognathic surgery and/or additional procedures (genioplasty, alloplastic implants) with satisfactory results. However, despite achieving skeletal symmetry, noticeable facial asymmetry may persist.This study was performed in 45 patients (29 women and 16 men) operated between December 2012 and June 2014. All patients were affected by maxilla-mandibular asymmetry and underwent orthognatic surgery for hard tissue correction of the deformity. Residual facial alterations were then treated with lipofilling refinement proceure. In all cases good integration of the grafted fat was observed in the recipient sites. Retrospective analysis of photographic documentation showed progressive volumetric decrease for up to approximately 6 months after surgery; after that graft volume remained relatively stable. There were no significant surgical complications, either from the fat harvest site or the reconstructed site. Mild oedema and bruising were frequent during the first post-operative week. No haematomas, infections, vascular or nervous injuries were recorded. Twenty-four patients felt the need to have a second procedure. A second fat transfer was performed in 22 cases, and a third in 2 (total of 69 procedures). Based on the observations of our study, fat grafting is a simple, effective and reproducible technique, with a high satisfaction rate and few disadvantages or complications. We demonstrated that the success of lipofilling is dependent on the treated aesthetic subunits of the face. The malar and lateral cheek regions seem to be highly favourable for fat grafting, unlike the upper and lower lips subunits. Composite procedures using orthognathic surgery and autologous fat provide the surgeon with an additional, more customisable option for patients with maxillo-mandibular malformations.
颌骨-下颌不对称有多种病因：先天性、创伤性、医源性和肿瘤后因素。先天性牙颌面畸形患者通常接受正颌外科手术和/或其他手术（颏成形术、异体植入物），效果令人满意。然而，尽管实现了骨骼对称，但明显的面部不对称可能仍然存在。本研究对2012年12月至2014年6月间接受手术的45例患者（29名女性和16名男性）进行。所有患者均患有颌骨-下颌不对称，并接受正颌外科手术以矫正硬组织畸形。然后采用脂肪填充细化程序治疗残留的面部改变。在所有病例中，均观察到移植脂肪在受区良好整合。对照片资料的回顾性分析显示，术后约6个月内移植脂肪体积逐渐减小；此后移植脂肪体积保持相对稳定。无论是取脂部位还是重建部位，均未出现明显的手术并发症。术后第一周轻度水肿和瘀斑较为常见。未记录到血肿、感染、血管或神经损伤。24例患者认为需要进行二次手术。22例患者进行了第二次脂肪移植，2例患者进行了第三次脂肪移植（共69次手术）。基于我们的研究观察，脂肪移植是一种简单、有效且可重复的技术，满意度高，缺点或并发症少。我们证明脂肪填充的成功取决于面部接受治疗的美学亚单位。与上唇和下唇亚单位不同，颧骨和脸颊外侧区域似乎非常适合脂肪移植。使用正颌外科手术和自体脂肪的联合手术为颌骨-下颌畸形患者提供了一种额外的、更具个性化的选择。
