Schmidt M, Ramelli E, Atlan M, Cristofari S
Service de chirurgie plastique, reconstructrice et esthétique, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France.
Service de chirurgie plastique, reconstructrice et esthétique, Hôpitaux Universitaires de Strasbourg, 1, avenue Molière, 67000 Strasbourg, France.
Ann Chir Plast Esthet. 2023 Apr;68(2):93-98. doi: 10.1016/j.anplas.2023.01.001. Epub 2023 Jan 25.
Little is known about the anatomical elements that allow safe and predictable performance of fronto orbital surgery for facial feminization. The primary objective of this study was to analyze the characteristics (dimensions, pneumatization rate, and anterior wall thickness) of the frontal sinus in MtF transgender patients. The secondary objective was to establish reproducible criteria for CT measurements that could guide preoperative planning of frontal impaction in feminization frontoplasty (FF).
Fifty preoperative facial mass scans of FF surgery patients were included. The mean age of the operated patients was 34 years. The F line represented the ideal forehead tilt in the absence of a frontal hump.
The height, width, depth, and thickness of the anterior sinus wall were 26.6mm (±5.7), 49.5mm (±11.3), 10.9mm (±3.3), and 3mm (±0.7), respectively. The mean sinus width to skull width ratio was 0.73 (±0.12). Six percent of patients had bilateral frontal sinus agenesis. An osteotomy of the anterior wall of the frontal sinus was performed in the 64% of patients with frontal sinus projection anterior to the F-line. The emergence of the supraorbital nerves from the frontal bone was through a bony notch in 73.8% of cases.
Knowledge of the anatomy of the frontal sinus and preoperative study of the scans of the facial mass is essential for planning the FF. These characteristics guide the surgical technique of bone remodeling as well as the procedure for releasing the supraorbital nerves.
关于在面部女性化额眶手术中实现安全且可预测手术效果的解剖学因素，我们了解甚少。本研究的主要目的是分析男变女（MtF）跨性别患者额窦的特征（尺寸、气化率和前壁厚度）。次要目的是建立可重复的CT测量标准，以指导女性化额成形术（FF）中额骨截骨术的术前规划。
纳入了50例FF手术患者的术前面部CT扫描。手术患者的平均年龄为34岁。F线代表无额部隆起时理想的额头倾斜度。
额窦前壁的高度、宽度、深度和厚度分别为26.6mm（±5.7）、49.5mm（±11.3）、10.9mm（±3.3）和3mm（±0.7）。平均窦宽与颅骨宽之比为0.73（±0.12）。6%的患者双侧额窦缺如。64%的额窦投影位于F线前方的患者进行了额窦前壁截骨术。73.8%的病例中眶上神经从额骨穿出通过骨切迹。
了解额窦解剖结构并对术前面部CT扫描进行研究对于FF手术规划至关重要。这些特征指导骨重塑的手术技术以及眶上神经松解手术。
