Park Sanghoon, Lee Tae Sung
Seoul, Republic of Korea.
From the Center for Maxillofacial Surgery, ID Hospital.
Plast Reconstr Surg. 2018 Jan;141(1):152-155. doi: 10.1097/PRS.0000000000003932.
Sagittal resection of the mandible has been widely used to reduce the width of the lower face and is usually carried out in combination with a mandibular contouring procedure. However, the surgical outcomes of this procedure are unclear because sagittal resection is rarely performed as a single procedure. The authors clarify misunderstandings regarding this procedure and introduce an improved strategic approach for sagittal resection of the mandible.
Under general anesthesia, mandible contouring was performed first with a curved osteotomy, followed by sagittal resection of the outer cortex of mandible. The amount and extent of each procedure was determined in accordance with preoperative analysis.
From 2012 to 2014, a consecutive series of 212 patients who underwent mandible contouring surgery without concomitant chin surgery were included in the study. A total of 189 patients underwent both mandibular contouring surgery and sagittal resection, whereas 13 underwent only sagittal resection and 10 underwent only mandibular contouring surgery. All operations were carried out successfully without any severe complications, and most patients had satisfactory aesthetic outcomes.
The authors found that the sagittal resection of the mandible should be performed in accordance with the shape of the mandible to effectively reduce facial width and achieve better aesthetic outcomes for both profile and frontal views. In an outcurved-type mandible, conventional mandibular contouring may be effective alone, whereas sagittal resection focusing on removing the mandible body region is essential for incurved-type mandibles. In straight line-type mandibles, both procedures are necessary.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
下颌骨矢状切除术已被广泛用于减小下脸部宽度，且通常与下颌轮廓整形手术联合进行。然而，由于矢状切除术很少作为单一手术进行，该手术的效果尚不清楚。作者澄清了关于此手术的误解，并介绍了一种改进的下颌骨矢状切除术策略。
在全身麻醉下，首先采用弧形截骨术进行下颌轮廓整形，然后进行下颌骨外皮质的矢状切除。每个手术的量和范围根据术前分析确定。
2012年至2014年，该研究纳入了连续212例未同时进行颏部手术的下颌轮廓整形手术患者。共有189例患者同时接受了下颌轮廓整形手术和矢状切除术，13例仅接受了矢状切除术，10例仅接受了下颌轮廓整形手术。所有手术均成功完成，无任何严重并发症，大多数患者获得了满意的美学效果。
作者发现，下颌骨矢状切除术应根据下颌骨形状进行，以有效减小面部宽度，并在侧面和正面视图中获得更好的美学效果。在下颌骨外凸型中，传统的下颌轮廓整形可能单独有效，而对于下颌骨内凹型，专注于切除下颌骨体区域的矢状切除术至关重要。在直线型下颌骨中，两种手术都有必要。
临床问题/证据水平：治疗性，IV级。
