是 🐛 的 🕷 ，颧弓内推术可以改善高颧骨的外观。
颧弓内推术是一 🐅 种整形手术，通过将颧弓向内移动来降低颧骨的高度。这 🐎 ，可。以使面部轮廓看起来更加圆润并改善面部比例
适应症：颧弓内推术适用 🦄 于具有以下问题的 🐳 患 🌲 者：
高颧骨面部比 🌹 例 🐦 不协 🌺 调
想 🌴 让面部 🐅 轮廓看起 💮 来更圆润
手术过程：颧弓 💐 内推术通常在全身麻醉 ☘ 下进行。手术过程涉及以下步骤：
1. 在发际 🐠 线内做出切口。
2. 从颧骨周围 🦟 骨骼切除部分组织 🐅 。
3. 将 🌼 颧骨向 🌿 内移动并固 🐯 定到位。
4. 缝合 🕊 切 🐅 口 🦁 。
恢复：手术后，患，者 🐘 面部会有肿胀和瘀青这通常会持续 24 周手术 🌺 部。位，可。能会疼痛可以通过止痛药来控制
患者需要休息 12 周，并避免剧烈活动。手术后周 46 就。可以恢复正 🦉 常的活动
风险：与任何手术一 🌳 样，颧，弓内推术也存在一定的风险 🪴 包括：
感染面部不对 🐦 称
疤痕对于 🐎 不想接受手术的 🐠 患者，还，有其他方法可以改善高颧骨的外观 🐱 例如：
注射填充剂：可以向颧骨 🦄 周边注射填充剂以，使颧骨 🌼 看起来更低。
脂肪移植：可以将患者自身的脂肪移植到颧骨周围以，增加体积 🦉 并柔化颧骨的外观。
颧骨颧弓内推手术可 🦉 能的后遗症包括：
感觉丧失：手术过程 🦅 中可能会损 🐴 伤神经，导致手术区域或周围区域感觉丧 🌲 失。
血肿：手术部位 🐛 可能会积聚血 🐎 液，形成血肿。
感 🌵 染：手术部位可能会感染 🦊 细菌。
不对称：手术后两侧颧骨 🐒 的形状 🐎 和大小 💐 可能不完全对称。
皮肤松弛：手术后 🐈 ，颧骨部位的皮肤 🐴 可能会 ☘ 出现松弛。
疤痕：手术会在 🌼 切 ☘ 口处留下疤痕 💐 。
咬合改变：手术 🐒 可能 🦉 会改变咬合，导致咀嚼问 🌸 题。
颞下颌关节功能紊乱：手术可能会损伤颞下颌关节，导致关节疼 ☘ 痛和功能障碍。
面神经损伤：手术 💮 可能会损伤面神经，导致面部肌 🌼 肉无力或麻痹。
骨头愈合不 🦊 良：手术后颧骨可能会愈合不良，导致疼痛或畸形。
长期疼痛：手术后，有些人可能会出现持续性 🕷 的疼痛。
心理影响：手术可能会对患者的心 🦋 理产生负面影响，导致焦虑、抑郁或身体形象问题。
需要注意的是，这，些后遗症并不常 🐎 见但患者在 🐅 考虑手术前应充分了解潜在风险。
该手术可以通过去除多余的骨骼和软组织来减少颧骨的突出部分 🍁 ，从而改善高颧骨。在手术过，程，中。外，科，医。生会在颧骨上做切口然后小心地去除多余的骨骼和软组织手术完成后切口会被缝合起来患者需要佩戴面罩以保护手术部位
该手术通常需要 23 小时，并在全身麻醉下进行术。后，会。有 23 轻。微的不适感通常会在几天内消退患者通常需要周才能完 🦈 全恢复
该手术的费用会 🐱 根据患者的具体情 🌵 况而有所不同，但通常在 5,00010,000 美元之间。
在决定是否进行该手术之前，与合格的整形外科医生讨论手术的风 🦢 险和益处非常重要。
The maxillomandibular advancement with setback of the mandible will produce a more retruded and favorably positioned mandible, and the advancement of the maxilla will reduce the vertical dimension, thereby improving the appearance of the steep mandibular plane. The elevation and advancement of the maxilla will produce a decrease in the nasal crease. The upper lip will appear fuller, and the lower lip will appear to be in a more naturally retruded position. The advancement of the mandible will also result in a more favorable profile. In such cases, there is little indication for reduction genioplasty.
The next case presents a patient with a retrognathic mandible and a steep mandibular plane. The goal of treatment in this case was to move the mandible forward to a more acceptable position and to decrease the vertical dimension by elevating the maxilla. This would produce an improvement in the appearance of the nasal crease and the elimination of the lower lip sulcus. The full and protrusive upper lip would be made more acceptable.
The cephalometric tracing and the Panorex radiograph ( Figs. 825 and 826 ) demonstrate the patient's retrognathic mandible and the steep mandibular plane. The postoperative photograph ( Fig. 827 ) shows the improvement in the position of the mandible, the decrease in the vertical dimension, the elimination of the lower lip sulcus, and the improved appearance of the nasal crease. The preoperative and postoperative photographs ( Figs. 828 and 829 ) demonstrate the improvement in the facial profile. The airway was enlarged by means of the maxillomandibular advancement and the submental lipectomy. Base of Tongue Resection
The base of tongue resection is an occasionally necessary but difficult surgical procedure that is fraught with a number of potential complications. These complications can be minimized if the surgeon has a thorough knowledge of the anatomy of the submandibular area and the surrounding structures. The tongue is a highly mobile organ that can be manipulated into a number of positions. The muscles of the tongue that are attached to the mandible and the hyoid bone are highly resistant to manipulation. However, the genioglossus muscle can be readily separated from the symphysis menti and manipulated as necessary to achieve surgical access.
The base of tongue resection is a functionally destructive procedure that can have a significant impact on the patient's speech and airway. In cases of massive tumors of the base of the tongue, it may be necessary to perform a total glossectomy with a closure that results in permanent tracheostomy. Such a procedure should only be considered when all other alternatives have been exhausted.
Preoperative Considerations
The preoperative evaluation of the patient includes a thorough history and physical examination. The history should include questions regarding swallowing, speech, airway, pain, and recent weight loss. The physical examination should assess airway patency, speech, the extent of the tumor, and the presence of lymphadenopathy. All patients with cancer of the oropharynx or hypopharynx should have a laryngoscopy and a panendoscopy. The physical examination should also determine whether the patient is a smoker or a heavy alcohol consumer. These habits are often significant in the etiology of the cancer and may also influence the postoperative course.
Radiographic examination is an essential step in the preoperative workup. The radiographic evaluation should include a chest radiograph, a panoramic radiograph, and a transpharyngeal tomography of the oropharynx. Computed axial tomography (CAT scan) may also be valuable in determining the extent of the tumor and in ruling out regional metastases. In cases of recurrent cancer, a gallium scan may be useful in determining the extent of the tumor and the presence of regional or distant metastases.
All patients who are considered for a base of tongue resection should have a preoperative pulmonary evaluation. This may include pulmonary function testing and a chest radiograph. The airway should be assessed carefully. The patient should be able to lie flat on the operating table and be able to tolerate flexible fiberoptic nasopharyngoscopy and laryngoscopy without difficulty. The history and physical examination should be carefully reviewed to assess the risk of aspiration. Patients who are at high risk for aspiration may benefit from a preoperative tracheostomy.
Surgical Procedures
The surgical approach to the base of the tongue varies according to the size and the location of the tumor. Tumors on the lingual surface of the epiglottis and the valleculae are best managed through a median glossotomy approach. Tumors that involve the entire base of the tongue and those that include the lateral tongue and the posterior pharyngeal wall are best managed through a lateral pharyngotomy approach.
The median glossotomy approach is a useful procedure for lesions that are limited to the lingual surface of the epiglottis and the valleculae. The median glossotomy may be performed under general anesthesia or local anesthesia with sedation. The patient is placed in the supine position with the head extended. Before the airway is anesthetized, the patient's airway should be assessed to determine the need for a nasotracheal airway. Once the airway is secured, the patient's mouth is opened widely and a lighted Richardson or Weitlan retractor is inserted to retract the soft palate and the uvula. The surgeon takes the tongue with a sponge clamp and draws it forward and upward. This will bring the lingual surface of the epiglottis into view. The surgeon then inserts a 23gauge needle into the anterior free margin of the epiglottis and injects a small amount of anesthetic. A saggital incision is made in the center of the lingual surface of the epiglottis. The incision is extended proximally to the level of the vallecula and distally to the level of the hyoid bone. The incision should extend to the full thickness of the epiglottis. The epiglottis is then retracted laterally and the tumor is removed.
The lateral pharyngotomy approach to the base of the tongue is a more complex procedure than the median glossotomy. The lateral pharyngotomy is indicated for most tumors of the base of the tongue because it provides more access to the tumor than the median glossotomy. The lateral pharyngotomy is performed under general anesthesia with endotracheal intubation. The patient is placed in the supine position with the head extended. The lateral pharyngotomy may be performed either bilaterally or unilaterally. In most cases, the unilateral approach is preferred because it is technically easier and it causes less disturbance to the normal anatomy and function.
The unilateral lateral pharyngotomy is performed by making a curved incision through the skin in the submandibular triangle. The incision begins at the hyoid bone and extends inferiorly and posteriorly to a point just above the angle of the mandible. The incision should be made through skin and subcutaneous tissue only. The skin flap is then dissected and reflected posteriorly. The skin flap should be dissected in such a way as not to damage the mandibular branch of the facial nerve. The submandibular gland is then gently retracted medially and superiorly. The facial artery and vein are identified and ligated. The digastric muscle is then transected and the mylohyoid muscle is elevated from the hyoid bone. The mylohyoid muscle is then carefully separated from the geniohyoid muscle.
The surgeon then enters the submandibular space and identifies the hypoglossal nerve. The hypoglossal nerve should be carefully preserved. The geniohyoid and genioglossus muscles are then separated from the symphysis menti. A retractor is inserted between the genioglossus and mylohyoid muscles and the genioglossus muscle is retracted upward. This will expose the base of the tongue. The hyoid bone is then retracted caudally and the tumor is excised.
Postoperative Care
The postoperative care of patients who have undergone a base of tongue resection varies according to the size and the location of the tumor. Patients who have undergone a median glossotomy may be able to tolerate oral liquids and food immediately after surgery. Patients who have undergone a lateral pharyngotomy will require at least 2 weeks of postoperative NPO status. The patient's diet may then be gradually advanced to soft foods and liquids. The patient's diet should be high in calories and protein. All patients who have undergone a base of tongue resection should be closely monitored for pulmonary complications. The patient should be encouraged to deep breathe and to ambulate frequently. The patient should also be given antibiotic coverage for at least 2 weeks after surgery.
Complications of Base of Tongue Resection
The complications of base of tongue resection include bleeding, airway obstruction, aspiration, pneumonia, and speech impairment. Bleeding is the most common immediate complication. Bleeding may occur from the tumor bed or from the surgical site. Bleeding from the tumor bed can usually be controlled with electrocautery or with ligation of the bleeding vessels. Bleeding from the surgical site may
