耳后切口内镜辅助下下颌角肥大模拟整形术和相关解剖学研究
|
摘要
背景：
下颌角肥大(prominent mandibular angle)导致的方脸畸形在东方人群中比较常见,这不太符合东方人要求的曲线优美(以下面部较狭小的椭圆形或叫鹅蛋形为美)的审美标准,被称之为不美脸型。近年来,随着人们物质文化生活水平的提高,人们对自身型体美的要求也在不断提高。要求通过手术来改变面部轮廓,塑造完美脸型的整形患者也越来越多。国内国外学者也对其进行了多方面的研究。
目前,下颌角肥大整形的手术入路包括口内入路、口外入路和口内、口外联合入路,各有不同的优缺点。目前应用较为广泛,为医生和患者所普遍接受的是口内入路,但存在截骨的量不易准确控制,对器械的要求高,存在口腔感染因素,术后口腔护理不便等缺点。实际工作中,有部分患者因为口内入路的缺点而不愿采用口内切口,也有部分患者欲同时进行下颌角整形和面颈部除皱,此时耳后切口就比较适用。近年有学者应用耳后微创切口进行下颌角肥大整形手术,也取得了满意的疗效。但因其是在盲视下操作,有存在误伤正常组织的可能。
近一个世纪以来,内镜技术和应用得到了很大的发展,从最开始用于临床诊断,到广泛应用于临床各个手术领域。内镜手术一般适用于有自然体腔部位,如卵巢手术、胆囊手术、结肠手术等。近年开始有学者将其应用到口内入路行下颌角肥大整形手术。
以往,关于下颌角肥大整形的解剖研究不少,但缺乏有针对性的、符合内镜手术特点和耳后入路相关下颌角周围组织解剖学研究。
行耳后微创切口时,比较容易伤到耳大神经的分支。作为颈丛最大的皮神经,耳大神经经常被用作神经移植的供体,如面神经的缺损修复等。耳大神经浅段主干位置相对比较恒定。耳大神经浅段位于颈外静脉后方,胸锁乳突肌浅面,被颈阔肌所覆盖,位置比较表浅,容易在手术当中受到损伤。在以往的研究中,主要集中在对耳大神经主干的研究,而对于其分支的研究比较少。近年来,随着手术要求日趋微创化,有学者认为,对耳大神经分支的损伤可在一定时期内导致其支配区域感觉缺失或不适,建议尽可能的保护好其分支,尤其是耳后分支。手术中只要对耳大神经分支有意识的加以区分辨认,游离保护,往往可以不用占用很多手术时间。
目的：
1.进行有针对性的符合内镜手术特点和耳后入路相关下颌角周围组织解剖学研究。通过标本解剖观察,为进行耳后切口内镜辅助下模拟手术提供参考。
2.通过内镜技术的应用,在标本上探索耳后切口内镜辅助下下颌角肥大整形术的可行性,观察记录其镜下解剖结构,为应用到临床摸索经验。
材料和方法：
1.耳后切口内镜辅助下下颌角肥大整形术相关解剖学研究：新鲜头部标本两例,福尔马林防腐固定头部标本13例,其中男性9例,女性6例,由南方医科大学解剖教研室提供。解剖器械及测量仪器：常用手术刀、剪、镊子,双目显微镜、数码相机、数子显示游标卡尺(精度0.01mm)、量角器等。对头颈部标本按照原有解剖层次从浅入深进行细致解剖,观察耳后切口到达下颌角区域的合适入路层次和途经的重要解剖结构；测量耳根部到下颌角顶点的距离,面神经下颊支与下颌缘支之间在咬肌后缘处的距离；观察耳大神经的浅出点、位置、与颈外静脉的关系,及其分支分布情况；耳大神经各分支解剖到近耳廓处,用数码相机予以拍照记录：测量耳大神经的主干浅出段长度、宽度(以中点处测量值为准),耳大神经各个分支的长度、宽度(以中点处测量值为准),各分支到耳廓的近耳点到耳根部的距离,耳大神经主干的分支点到耳根的距离以及分支点与耳根连线与过分支点的水平线的夹角。利用统计学软件SPASS13.0对所测量的数值进行统计学分析,采用独立样本T检验方法分析数据。
2.耳后切口内镜辅助下下颌角肥大模拟整形术：5例经福尔马林固定处理的防腐头颈部标本,由南方医科大学解剖教研室提供。器械：图像采集系统、监视器、冷光源,0°和30°长17cm、直径4mm的鼻窦内窥镜,眼科剪、骨膜剥离子、弯镊及常用手术器械。切口设计和操作：在耳垂中点后方沿着颅耳沟向上作一长约2cm的切口,向下颌角方向,钝性分离,同时插入内镜,通过内镜视野,在监视器的影像指引下操作,观察入路的层次解剖结构,照相记录。
结果：
1.下颌角最突点距耳根的距离在男性为(3.45±0.50)cm,在女性为(3.22±0.52)cm。从耳后切口到下颌角区,有两个潜在的层次空间作为手术入路,即SMAS与浅面皮肤、皮下组织层之间的层面,以及SMAS与深面腮腺咬肌筋膜之间的层面。在咬肌后缘,面神经下颊支、下颌缘支之间的距离在男性左侧为(2.75±0.29)cm,男性右侧为(2.82±0.28)cm,女性左侧为(2.79±0.30)cm女性右侧为(2.83±0.28)cm。走行于咬肌筋膜中的神经、血管与耳后入路关系密切的包括面神经下颊支、下颌缘支,以及咬肌后缘的下颌后静脉,面动、静脉靠近咬肌前缘,与下颌角距离较远,只要不过度向咬肌前缘游离,损伤的几率较小。下颌角、下颌支后缘与下颌后静脉紧密相邻,两者之间仅有骨膜及少量薄层脂肪组织相隔,下颌后静脉为耳后入路容易损伤的血管。下颌缘支一般位于下颌骨下缘上下一横指范围内。
耳大神经源起第2、3颈神经,从颈丛发出以后,其深段走行于胸锁乳突肌深面,斜向外下方,在胸锁乳突肌后缘中点附近穿出深筋膜,到达皮下,在胸锁乳突肌表面斜行向前上方,到达胸锁乳突肌前缘后,走行于腮腺筋膜表面与颈阔肌深面之间,在下颌角水平附近分为3～4支,分别可称为耳后支、耳垂支和耳前支,分布到包括乳突区、耳廓颅侧、耳垂、耳垂前区的皮肤。大部分耳大神经走行于颈外静脉后方10mm左右,一部分与颈外静脉距离比较近,甚至紧贴着,呈伴行关系。大部分耳后静脉位于耳大神经深面,与下颌后静脉后支汇合成颈外静脉；有一部分耳大神经在颈外静脉后方走行一段后,先走行在耳后静脉深面,后移行至耳后静脉浅面,呈绕行状态。
耳大神经耳前支发出后,越过耳垂下端,分布到耳垂前区的皮肤(18侧,占69.2%)；也有部分分支进入腮腺(8侧,占30.8%)。除去耳前分支,耳大神经在耳后可以找到3支分支,其中前两支共干者居绝大多数(21侧,占80.8%)；部分为后两支共干(4侧,占15.4%)；有1侧(占3.8%)分成4支,前后两两共干。
统计分析结果：左侧耳大神经总干长度、耳后分支1和2的长度、主干分支点距耳根距离、耳后分支3的宽度在性别上有统计学差异(P<0.05),男性的测量值略大于女性,其余各值在性别上无统计学差异(P>0.05)；右侧耳大神经分支2的长度,各分支的近耳点距耳根的距离在统计学上有差异(P<0.05),其余各值在性别上无统计学差异(P>0.05)。
2.在标本模拟手术中,切开皮肤后,向着下颌角方向作钝性分离,在皮下容易发现耳大神经的分支。将皮下通道分离扩展为约2cm宽,使通道内可以同时容纳内窥镜和剥离器械。在游离过程中,如果耳大神经分支的部位比较高,则可以看到其分支点,和与其相邻的耳后静脉。继续向前下游离,到达腮腺咬肌筋膜表面。沿着腮腺咬肌筋膜向前下方到达下颌角后缘区域,可能看到沿下颌角后缘下行的下颌后静脉。钝性分离咬肌表面筋膜,可显露部分咬肌,钝性分离咬肌,可到达下颌骨骨膜表面。到达下颌骨骨膜表面后,用长柄尖刀切开骨膜,可直达下颌骨骨质。然后沿骨面用骨膜剥离子向前剥离,必要时可离断部分咬肌。充分暴露下颌角内、外侧需要切除的范围。充分暴露下颌角内、外侧后,利用微型锯按照预先设计好的截骨范围锯除突出下颌角骨质,因操作空间狭小,可分多次锯除。
结论：
1.通过内镜辅助,从耳后入路行下颌角肥大整形术具有可行性；手术入路可从SMAS与皮肤、皮下组织层之间的层面,或者SMAS与深面腮腺咬肌筋膜之间的层面进行；术中应注意对耳大神经分支、面神经下颌缘支、下颌后静脉、面动静脉的保护。
2.耳大神经主干具有较为恒定的位置和走行；耳大神经与颈外静脉的关系密切,临床手术中要加以重视；通过对耳大神经分支的测量统计,可以大致确定耳大神经分支在耳后的分布,为耳后切口手术设计、手术施行提供参考,减少耳大神经主干及分支的损伤；耳大神经分支可以作为耳后切口内镜辅助下下颌角肥大整形术手术入路分离层面参考标志。
3.耳后切口内窥镜辅助下下颌角肥大整形手术是一种新的、有效的手术方式的尝试。具有创伤小,操作简单易行的特点。手术通道需要人为创建,无自然腔隙,须熟悉局部解剖,手术过程中要避免损伤耳大神经分支、面神经分支和下颌后静脉等。
Background:
In the east,the people who had square face,because of prominent mandibular angle were very common.It didn't fit the beauty standard of the people,who thinked that the oval-shaped face was beautiful. Nearly, As the improving of the people's material and cultural living standards, there were more and more people had come to do the plasty operation to change the facial contour for the purpose of beauty.There were many researches about this in the world.
To the approach for prominent mandibular angle plastic surgery,there were intraoral approach,extraoral approach and combined intraoral, extraoral approach.Each approach had its own advantages and disadvantages.The intraoral approach was used widely now,but it had the disadvantages such as,the requiring for instrument was high,to control the scope of osteotomy was not easy,the possibility of oral cavity infection and the inconvenience after the operation.So there were people who didn't want to do the operation with intraoral approach for those reasons.When the people want to do both the face lifting and the prominent mandibular angle contouring surgery on the same time,the postauricular incision approach was suitable.
During the last centuries,the techniques and clinical applicaton of endscope have enjoyed great development.It was used for clinical diagnose in the first time,then used in a lot of regions of clinical operations.The endscope was used in the operation on the body where it had nature celom generally, such as operation on oarium,gallbladder,colon and so on. Endoscopically assisted prominent mandibular angle contouring surgery with intraoral approach was used widely.Some doctors did prominent mandibular angle contouring surgery with postauricular minimal incision and achieved satisfactory results.nearly,but it did with bad visual fields,the opportunity to hurt the normal tissues was existed.
There were many anatomy studies about the operation,but for the endoscopically assisted prominent mandibular angle contouring surgery with postauricular incision was absence.
When did the operations with postauricular minimal incision,the branches of the great auricular nerve were very easy to be hurted. As the great cutaneous nerve of the cervical plexus, the great auricular nerve(GAN) was used for the neural transplantation donors,such as it was used for repairing the facial never injury.The shalloe section of the GAN is traveling steadily.It is covered by platysma,behind the external jugular vein,above the sternomastoid muscle and it is easy to hurt during the operation.The early researchs were focus on the nerve trunk of the great cutaneous nerve and little about the branches of the nerve.Some doctors suggested to study and protect the branches of the great cutaneous nerve,because the injury to the GAN would lead to some sensory losses,especialy the posterio branches.It would not take a long time to protect the branches during the operations.
Objective:
1.To do the anatomy research with the tissues about the mandibular angle aimed at the purpose to operate endoscopically assisted prominent mandibular angle contouring surgery with postauricular minimal incision.
2. Try to operate endoscopically assisted prominent mandibular angle contouring surgery with postauricular minimal incision on the cadavers,to make sure the feasibility,to observe the anatomy structures through the endoscope.
Methods:
1. The clinical anatomical study to the endoscopically assisted prominent mandibular angle contouring surgery with postauricular incision.
15 cadavers(6 females,9 males) offered by Department of anatomy,School of basic medical sciences,Southern medical university were used in the study.
Instument:scalpel,scissors,forceps,binocular microscopes,digital camera, digital vernier,protractor.
With neck specimens, detailed dissected from shallow to deep-level according to the original anatomy, to observe important anatomical structures from the postauricular incision to the mandibular angle, and the appropriate approach of the regional level. To measure the distance between root of the ear to the mandibular angle vertices, distance between facial lower buccal nerves and marginal mandibular branch at the masseter muscle trailing edge.
To study the point where the great cutaneous nerve emerges from sternomastoid muscle,it's traveling line,the relationship with the external jugular vein, the branches's traveling line.To measure the length of the GAN trunk, the each length and width of the GAN's branches after the auricle, the distance from the point where the GAN divided into branches to the below end point of the auricle, the angle between the line 1 (from the point where the GAN divided into branches to the below end point of the auricle)and line2(the horizon line passing through the point where the GAN divided into branches), the distance from the points where the branches traveling into the auricle to the below end point of the auricle.
The software Spass13.0 was used for data statistics.The Independent-sample T Test was used to analysis the datas.
2. Endoscopically assisted prominent mandibular angle contouring surgery with postauricular incision
Five cadavers offered by Department of anatomy,School of basic medical sciences,Southern medical university were used in the study.Instument:Image acquisition system,PC monitor,luminescence source,endscopes(4cm×17cm,0°and 30°),eye scissors,periosteal strippings,bending forceps,and so on.
The incision design and operation:Cut the skin with postauricular minimal incision,the incision's length was about 2cm,then separated the tissues bluntly with endoscope assisted.Through the endoscope assisted, the anatomical structures were observed on the PC monitor and the photos were taken.
Results:
1. After section of the skin,the branches of the great auricular nerve could be found easily. Separating the tissues bluntly with endoscope assisted, then to made a internal port with 2cm width.In some of cases,we could find the point where the great auricular nerve divide into 3 or more branches and the posterior auricular vein nearly during the oprations.Along the surface of the parotid gland fasciae to surface of the mandibular angle,we may find the retromandibular vein nearly in the area.Then incised the periosteum with sharp pointed scalpel and stripped the periosteum with periostotome. Then stripped the region where the masseter muscle stick to the mandibular angle.To make sure that the mandibular angle was exposed fully include superficial surface and deep surface of the angle, before cut the prominent mandibular angle.Then cut off some bone of the mandibular angle with the minimal saw.lt could be saw for a few times,for the operation field was limited. All these were done with endoscope assisted.
2. The distance between root of the ear to the mandibular angle vertices was (3.45±0.50) cm in males,and (3.22±0.52) cm in females.There were two approach room for the operation, one was between the skin and the SMAS,another one was between the SMAS and masseteric fascia. The distance between facial lower buccal nerves and marginal mandibular branch at the masseter muscle trailing edge was (2.75±0.29) cm at left side of males, (2.82±0.28) cm at ringht side of males, (2.79±0.30) cm at left side of females, (2.83±0.28) cm at right side of females.
The lower buccal branches,marginal mandibular branches, retromandibular vein,facial vein,facial artery was located in the masseteric fascia and was easily to hurt during the operation. The retromandibular vein was much close to the mandibular angle,the marginal mandibular branches were located one finger upper or inferior of the bottom edge of the mandibular.
The great auricular nerve may originate from the anastomotic loop between the second and third cervica nerves, or directly from the latter.Immediately after its origin,it passes around the posterior margin of the sternocleidomastoid muscle and then proceed antero-superioly to parotid capsule and then divides into anterior and posterior terminal branches.
In most of the cases, the GAN was about 10mm behind the external jugular vein.In few of the cases,the GAN was very closer to the external jugular vein. In most of the cases, the GAN was nealy above the posterior auricular vein,but the GAN winded around the posterior auricular vein In some of cases.
The GAN divides into 3-4 branches in the plane of mandibular angle,those were called anterior auricular branch, lobe branch and posterior branch by some scholars.The anterior auricular branch spreaded into the skin(18sides,64%) or parotid(10sides,36%).There were three or more branches after the ear.In most of the cases,the first two branches had common trunk(23sides,82.1%).In some of the cases,the last two branches had common trunk.At one side there was four branches,each two had common trunk.
In the left side,the middle length of the GAN trunk, length of the GAN's branches(NO1,NO2), the distance from the point where the GAN divided into branches to the below end point of the auricle after the auricle, and the width of NO3 GAN's branches had statistic difference between sex (P<0.05); In the right side, the length of the GAN's branches(NO2)and each of the distance from the points where the branches traveling into the auricle to the below end point of the auricle had statistic difference between sex (P<0.05).
Conclusion:
1.With endoscopically assisted,to do the prominent mandibular angle contouring surgery was practicable;The approach could from the space between skin and SMAS,or the space between SMAS and parotid gland fascia; Pay attention to the GAN's branches, marginal mandibular branches, retromandibular vein,facial vein,facial artery during the operation.
2. The GAN has a constant traveling line and place.The relationship between the GAN and the external jugular vein was very close in some of the cases,which shoud arouse high attention by the operators.The study about the GAN branches would help the operators to design the postauricular incision,protect the GAN and it's branches during the operations. The GAN's branches could be the mark to the surgery approach space.
3.It was a new and effective way to do the operation of endoscopically assisted prominent mandibular angle contouring surgery with postauricular minimal incision. The trauma was limited and the process was not complicated.During the operation,in order to prevent injury to the branches of the great auricular nerve, branches of the face nerve, and the retromandibular vein,the anatomical structures should be mastered.
下颌角肥大(prominent mandibular angle)导致的方脸畸形在东方人群中比较常见,这不太符合东方人要求的曲线优美(以下面部较狭小的椭圆形或叫鹅蛋形为美)的审美标准,被称之为不美脸型。近年来,随着人们物质文化生活水平的提高,人们对自身型体美的要求也在不断提高。要求通过手术来改变面部轮廓,塑造完美脸型的整形患者也越来越多。国内国外学者也对其进行了多方面的研究。
目前,下颌角肥大整形的手术入路包括口内入路、口外入路和口内、口外联合入路,各有不同的优缺点。目前应用较为广泛,为医生和患者所普遍接受的是口内入路,但存在截骨的量不易准确控制,对器械的要求高,存在口腔感染因素,术后口腔护理不便等缺点。实际工作中,有部分患者因为口内入路的缺点而不愿采用口内切口,也有部分患者欲同时进行下颌角整形和面颈部除皱,此时耳后切口就比较适用。近年有学者应用耳后微创切口进行下颌角肥大整形手术,也取得了满意的疗效。但因其是在盲视下操作,有存在误伤正常组织的可能。
近一个世纪以来,内镜技术和应用得到了很大的发展,从最开始用于临床诊断,到广泛应用于临床各个手术领域。内镜手术一般适用于有自然体腔部位,如卵巢手术、胆囊手术、结肠手术等。近年开始有学者将其应用到口内入路行下颌角肥大整形手术。
以往,关于下颌角肥大整形的解剖研究不少,但缺乏有针对性的、符合内镜手术特点和耳后入路相关下颌角周围组织解剖学研究。
行耳后微创切口时,比较容易伤到耳大神经的分支。作为颈丛最大的皮神经,耳大神经经常被用作神经移植的供体,如面神经的缺损修复等。耳大神经浅段主干位置相对比较恒定。耳大神经浅段位于颈外静脉后方,胸锁乳突肌浅面,被颈阔肌所覆盖,位置比较表浅,容易在手术当中受到损伤。在以往的研究中,主要集中在对耳大神经主干的研究,而对于其分支的研究比较少。近年来,随着手术要求日趋微创化,有学者认为,对耳大神经分支的损伤可在一定时期内导致其支配区域感觉缺失或不适,建议尽可能的保护好其分支,尤其是耳后分支。手术中只要对耳大神经分支有意识的加以区分辨认,游离保护,往往可以不用占用很多手术时间。
目的：
1.进行有针对性的符合内镜手术特点和耳后入路相关下颌角周围组织解剖学研究。通过标本解剖观察,为进行耳后切口内镜辅助下模拟手术提供参考。
2.通过内镜技术的应用,在标本上探索耳后切口内镜辅助下下颌角肥大整形术的可行性,观察记录其镜下解剖结构,为应用到临床摸索经验。
材料和方法：
1.耳后切口内镜辅助下下颌角肥大整形术相关解剖学研究：新鲜头部标本两例,福尔马林防腐固定头部标本13例,其中男性9例,女性6例,由南方医科大学解剖教研室提供。解剖器械及测量仪器：常用手术刀、剪、镊子,双目显微镜、数码相机、数子显示游标卡尺(精度0.01mm)、量角器等。对头颈部标本按照原有解剖层次从浅入深进行细致解剖,观察耳后切口到达下颌角区域的合适入路层次和途经的重要解剖结构；测量耳根部到下颌角顶点的距离,面神经下颊支与下颌缘支之间在咬肌后缘处的距离；观察耳大神经的浅出点、位置、与颈外静脉的关系,及其分支分布情况；耳大神经各分支解剖到近耳廓处,用数码相机予以拍照记录：测量耳大神经的主干浅出段长度、宽度(以中点处测量值为准),耳大神经各个分支的长度、宽度(以中点处测量值为准),各分支到耳廓的近耳点到耳根部的距离,耳大神经主干的分支点到耳根的距离以及分支点与耳根连线与过分支点的水平线的夹角。利用统计学软件SPASS13.0对所测量的数值进行统计学分析,采用独立样本T检验方法分析数据。
2.耳后切口内镜辅助下下颌角肥大模拟整形术：5例经福尔马林固定处理的防腐头颈部标本,由南方医科大学解剖教研室提供。器械：图像采集系统、监视器、冷光源,0°和30°长17cm、直径4mm的鼻窦内窥镜,眼科剪、骨膜剥离子、弯镊及常用手术器械。切口设计和操作：在耳垂中点后方沿着颅耳沟向上作一长约2cm的切口,向下颌角方向,钝性分离,同时插入内镜,通过内镜视野,在监视器的影像指引下操作,观察入路的层次解剖结构,照相记录。
结果：
1.下颌角最突点距耳根的距离在男性为(3.45±0.50)cm,在女性为(3.22±0.52)cm。从耳后切口到下颌角区,有两个潜在的层次空间作为手术入路,即SMAS与浅面皮肤、皮下组织层之间的层面,以及SMAS与深面腮腺咬肌筋膜之间的层面。在咬肌后缘,面神经下颊支、下颌缘支之间的距离在男性左侧为(2.75±0.29)cm,男性右侧为(2.82±0.28)cm,女性左侧为(2.79±0.30)cm女性右侧为(2.83±0.28)cm。走行于咬肌筋膜中的神经、血管与耳后入路关系密切的包括面神经下颊支、下颌缘支,以及咬肌后缘的下颌后静脉,面动、静脉靠近咬肌前缘,与下颌角距离较远,只要不过度向咬肌前缘游离,损伤的几率较小。下颌角、下颌支后缘与下颌后静脉紧密相邻,两者之间仅有骨膜及少量薄层脂肪组织相隔,下颌后静脉为耳后入路容易损伤的血管。下颌缘支一般位于下颌骨下缘上下一横指范围内。
耳大神经源起第2、3颈神经,从颈丛发出以后,其深段走行于胸锁乳突肌深面,斜向外下方,在胸锁乳突肌后缘中点附近穿出深筋膜,到达皮下,在胸锁乳突肌表面斜行向前上方,到达胸锁乳突肌前缘后,走行于腮腺筋膜表面与颈阔肌深面之间,在下颌角水平附近分为3～4支,分别可称为耳后支、耳垂支和耳前支,分布到包括乳突区、耳廓颅侧、耳垂、耳垂前区的皮肤。大部分耳大神经走行于颈外静脉后方10mm左右,一部分与颈外静脉距离比较近,甚至紧贴着,呈伴行关系。大部分耳后静脉位于耳大神经深面,与下颌后静脉后支汇合成颈外静脉；有一部分耳大神经在颈外静脉后方走行一段后,先走行在耳后静脉深面,后移行至耳后静脉浅面,呈绕行状态。
耳大神经耳前支发出后,越过耳垂下端,分布到耳垂前区的皮肤(18侧,占69.2%)；也有部分分支进入腮腺(8侧,占30.8%)。除去耳前分支,耳大神经在耳后可以找到3支分支,其中前两支共干者居绝大多数(21侧,占80.8%)；部分为后两支共干(4侧,占15.4%)；有1侧(占3.8%)分成4支,前后两两共干。
统计分析结果：左侧耳大神经总干长度、耳后分支1和2的长度、主干分支点距耳根距离、耳后分支3的宽度在性别上有统计学差异(P<0.05),男性的测量值略大于女性,其余各值在性别上无统计学差异(P>0.05)；右侧耳大神经分支2的长度,各分支的近耳点距耳根的距离在统计学上有差异(P<0.05),其余各值在性别上无统计学差异(P>0.05)。
2.在标本模拟手术中,切开皮肤后,向着下颌角方向作钝性分离,在皮下容易发现耳大神经的分支。将皮下通道分离扩展为约2cm宽,使通道内可以同时容纳内窥镜和剥离器械。在游离过程中,如果耳大神经分支的部位比较高,则可以看到其分支点,和与其相邻的耳后静脉。继续向前下游离,到达腮腺咬肌筋膜表面。沿着腮腺咬肌筋膜向前下方到达下颌角后缘区域,可能看到沿下颌角后缘下行的下颌后静脉。钝性分离咬肌表面筋膜,可显露部分咬肌,钝性分离咬肌,可到达下颌骨骨膜表面。到达下颌骨骨膜表面后,用长柄尖刀切开骨膜,可直达下颌骨骨质。然后沿骨面用骨膜剥离子向前剥离,必要时可离断部分咬肌。充分暴露下颌角内、外侧需要切除的范围。充分暴露下颌角内、外侧后,利用微型锯按照预先设计好的截骨范围锯除突出下颌角骨质,因操作空间狭小,可分多次锯除。
结论：
1.通过内镜辅助,从耳后入路行下颌角肥大整形术具有可行性；手术入路可从SMAS与皮肤、皮下组织层之间的层面,或者SMAS与深面腮腺咬肌筋膜之间的层面进行；术中应注意对耳大神经分支、面神经下颌缘支、下颌后静脉、面动静脉的保护。
2.耳大神经主干具有较为恒定的位置和走行；耳大神经与颈外静脉的关系密切,临床手术中要加以重视；通过对耳大神经分支的测量统计,可以大致确定耳大神经分支在耳后的分布,为耳后切口手术设计、手术施行提供参考,减少耳大神经主干及分支的损伤；耳大神经分支可以作为耳后切口内镜辅助下下颌角肥大整形术手术入路分离层面参考标志。
3.耳后切口内窥镜辅助下下颌角肥大整形手术是一种新的、有效的手术方式的尝试。具有创伤小,操作简单易行的特点。手术通道需要人为创建,无自然腔隙,须熟悉局部解剖,手术过程中要避免损伤耳大神经分支、面神经分支和下颌后静脉等。
Background:
In the east,the people who had square face,because of prominent mandibular angle were very common.It didn't fit the beauty standard of the people,who thinked that the oval-shaped face was beautiful. Nearly, As the improving of the people's material and cultural living standards, there were more and more people had come to do the plasty operation to change the facial contour for the purpose of beauty.There were many researches about this in the world.
To the approach for prominent mandibular angle plastic surgery,there were intraoral approach,extraoral approach and combined intraoral, extraoral approach.Each approach had its own advantages and disadvantages.The intraoral approach was used widely now,but it had the disadvantages such as,the requiring for instrument was high,to control the scope of osteotomy was not easy,the possibility of oral cavity infection and the inconvenience after the operation.So there were people who didn't want to do the operation with intraoral approach for those reasons.When the people want to do both the face lifting and the prominent mandibular angle contouring surgery on the same time,the postauricular incision approach was suitable.
During the last centuries,the techniques and clinical applicaton of endscope have enjoyed great development.It was used for clinical diagnose in the first time,then used in a lot of regions of clinical operations.The endscope was used in the operation on the body where it had nature celom generally, such as operation on oarium,gallbladder,colon and so on. Endoscopically assisted prominent mandibular angle contouring surgery with intraoral approach was used widely.Some doctors did prominent mandibular angle contouring surgery with postauricular minimal incision and achieved satisfactory results.nearly,but it did with bad visual fields,the opportunity to hurt the normal tissues was existed.
There were many anatomy studies about the operation,but for the endoscopically assisted prominent mandibular angle contouring surgery with postauricular incision was absence.
When did the operations with postauricular minimal incision,the branches of the great auricular nerve were very easy to be hurted. As the great cutaneous nerve of the cervical plexus, the great auricular nerve(GAN) was used for the neural transplantation donors,such as it was used for repairing the facial never injury.The shalloe section of the GAN is traveling steadily.It is covered by platysma,behind the external jugular vein,above the sternomastoid muscle and it is easy to hurt during the operation.The early researchs were focus on the nerve trunk of the great cutaneous nerve and little about the branches of the nerve.Some doctors suggested to study and protect the branches of the great cutaneous nerve,because the injury to the GAN would lead to some sensory losses,especialy the posterio branches.It would not take a long time to protect the branches during the operations.
Objective:
1.To do the anatomy research with the tissues about the mandibular angle aimed at the purpose to operate endoscopically assisted prominent mandibular angle contouring surgery with postauricular minimal incision.
2. Try to operate endoscopically assisted prominent mandibular angle contouring surgery with postauricular minimal incision on the cadavers,to make sure the feasibility,to observe the anatomy structures through the endoscope.
Methods:
1. The clinical anatomical study to the endoscopically assisted prominent mandibular angle contouring surgery with postauricular incision.
15 cadavers(6 females,9 males) offered by Department of anatomy,School of basic medical sciences,Southern medical university were used in the study.
Instument:scalpel,scissors,forceps,binocular microscopes,digital camera, digital vernier,protractor.
With neck specimens, detailed dissected from shallow to deep-level according to the original anatomy, to observe important anatomical structures from the postauricular incision to the mandibular angle, and the appropriate approach of the regional level. To measure the distance between root of the ear to the mandibular angle vertices, distance between facial lower buccal nerves and marginal mandibular branch at the masseter muscle trailing edge.
To study the point where the great cutaneous nerve emerges from sternomastoid muscle,it's traveling line,the relationship with the external jugular vein, the branches's traveling line.To measure the length of the GAN trunk, the each length and width of the GAN's branches after the auricle, the distance from the point where the GAN divided into branches to the below end point of the auricle, the angle between the line 1 (from the point where the GAN divided into branches to the below end point of the auricle)and line2(the horizon line passing through the point where the GAN divided into branches), the distance from the points where the branches traveling into the auricle to the below end point of the auricle.
The software Spass13.0 was used for data statistics.The Independent-sample T Test was used to analysis the datas.
2. Endoscopically assisted prominent mandibular angle contouring surgery with postauricular incision
Five cadavers offered by Department of anatomy,School of basic medical sciences,Southern medical university were used in the study.Instument:Image acquisition system,PC monitor,luminescence source,endscopes(4cm×17cm,0°and 30°),eye scissors,periosteal strippings,bending forceps,and so on.
The incision design and operation:Cut the skin with postauricular minimal incision,the incision's length was about 2cm,then separated the tissues bluntly with endoscope assisted.Through the endoscope assisted, the anatomical structures were observed on the PC monitor and the photos were taken.
Results:
1. After section of the skin,the branches of the great auricular nerve could be found easily. Separating the tissues bluntly with endoscope assisted, then to made a internal port with 2cm width.In some of cases,we could find the point where the great auricular nerve divide into 3 or more branches and the posterior auricular vein nearly during the oprations.Along the surface of the parotid gland fasciae to surface of the mandibular angle,we may find the retromandibular vein nearly in the area.Then incised the periosteum with sharp pointed scalpel and stripped the periosteum with periostotome. Then stripped the region where the masseter muscle stick to the mandibular angle.To make sure that the mandibular angle was exposed fully include superficial surface and deep surface of the angle, before cut the prominent mandibular angle.Then cut off some bone of the mandibular angle with the minimal saw.lt could be saw for a few times,for the operation field was limited. All these were done with endoscope assisted.
2. The distance between root of the ear to the mandibular angle vertices was (3.45±0.50) cm in males,and (3.22±0.52) cm in females.There were two approach room for the operation, one was between the skin and the SMAS,another one was between the SMAS and masseteric fascia. The distance between facial lower buccal nerves and marginal mandibular branch at the masseter muscle trailing edge was (2.75±0.29) cm at left side of males, (2.82±0.28) cm at ringht side of males, (2.79±0.30) cm at left side of females, (2.83±0.28) cm at right side of females.
The lower buccal branches,marginal mandibular branches, retromandibular vein,facial vein,facial artery was located in the masseteric fascia and was easily to hurt during the operation. The retromandibular vein was much close to the mandibular angle,the marginal mandibular branches were located one finger upper or inferior of the bottom edge of the mandibular.
The great auricular nerve may originate from the anastomotic loop between the second and third cervica nerves, or directly from the latter.Immediately after its origin,it passes around the posterior margin of the sternocleidomastoid muscle and then proceed antero-superioly to parotid capsule and then divides into anterior and posterior terminal branches.
In most of the cases, the GAN was about 10mm behind the external jugular vein.In few of the cases,the GAN was very closer to the external jugular vein. In most of the cases, the GAN was nealy above the posterior auricular vein,but the GAN winded around the posterior auricular vein In some of cases.
The GAN divides into 3-4 branches in the plane of mandibular angle,those were called anterior auricular branch, lobe branch and posterior branch by some scholars.The anterior auricular branch spreaded into the skin(18sides,64%) or parotid(10sides,36%).There were three or more branches after the ear.In most of the cases,the first two branches had common trunk(23sides,82.1%).In some of the cases,the last two branches had common trunk.At one side there was four branches,each two had common trunk.
In the left side,the middle length of the GAN trunk, length of the GAN's branches(NO1,NO2), the distance from the point where the GAN divided into branches to the below end point of the auricle after the auricle, and the width of NO3 GAN's branches had statistic difference between sex (P<0.05); In the right side, the length of the GAN's branches(NO2)and each of the distance from the points where the branches traveling into the auricle to the below end point of the auricle had statistic difference between sex (P<0.05).
Conclusion:
1.With endoscopically assisted,to do the prominent mandibular angle contouring surgery was practicable;The approach could from the space between skin and SMAS,or the space between SMAS and parotid gland fascia; Pay attention to the GAN's branches, marginal mandibular branches, retromandibular vein,facial vein,facial artery during the operation.
2. The GAN has a constant traveling line and place.The relationship between the GAN and the external jugular vein was very close in some of the cases,which shoud arouse high attention by the operators.The study about the GAN branches would help the operators to design the postauricular incision,protect the GAN and it's branches during the operations. The GAN's branches could be the mark to the surgery approach space.
3.It was a new and effective way to do the operation of endoscopically assisted prominent mandibular angle contouring surgery with postauricular minimal incision. The trauma was limited and the process was not complicated.During the operation,in order to prevent injury to the branches of the great auricular nerve, branches of the face nerve, and the retromandibular vein,the anatomical structures should be mastered.
引文
[1]Fattahi T. Surgical anatomy of the mandibular region for reconstructive purposes[J]. Atlas Oral Maxillofac Surg Clin North Am,2006,14(2):137-142.
[2]Kim H J, Lee H Y, Chung I H, et al. Mandibular anatomy related to sagittal split ramus osteotomy in koreans[J]. Yonsei Med J,1997,38(1):19-25.
[3]Nason R W, Binahmed A, Torchia M G, et al. Clinical observations of the anatomy and function of the marginal mandibular nerve[J]. Int J Oral Maxillofac Surg,2007,36(8):712-715.
[4]Smith B R, Rajchel J L, Waite D E, et al. Mandibular ramus anatomy as it relates to the medial osteotomy of the sagittal split ramus osteotomy [J]. J Oral Maxillofac Surg,1991,49(2):112-116.
[5]Tom W K, Martone C H, Mintz S M. A study of mandibular ramus anatomy and its significance to sagittal split osteotomy [J]. Int J Oral Maxillofac Surg,1997, 26(3):176-178.
[6]Yu I H, Wong Y K. Evaluation of mandibular anatomy related to sagittal split ramus osteotomy using 3-dimensional computed tomography scan images [J]. Int J Oral Maxillofac Surg,2008,37(6):521-528.
[7]董博,王学东.面神经下颌缘支的应用解剖[J].局解手术学杂志,2008,17(03)：177-178.
[8]华泽权,邹明宇,李树华.下颌升支截骨手术相关下颌管解剖标志的多层ct测量研究[J].临床口腔医学杂志,2006,22(01)：3-4.
[9]廖进民,陈海芳,李忠华,等.下颌支截骨术手术入路的应用解剖学研究[J].解剖与临床,2007,12(03)：152-156.
[10]皮昕.下颌骨矢状劈开截骨术中下颌管的应用解剖[J].临床口腔医学杂志,1986(01)：16-17.
[11]王伦安,刘卫华,李鑫,等.下颌角肥大弧形截骨术中在下颌骨颊侧骨板表面定位截骨线的临床应用解剖[J].华西医学,2006,26(01)：9-10.
[12]徐永成,汪立川,原林.下颌角截骨术的应用解剖研究进展[J].中华医学美学美容杂志,2003,9(04)：55-56.
[13]孙坚,孙弘.外耳后进路手术治疗下颌角与咬肌肥大[J].中国美容医学,2001,10(01)：29-32.
[14]曹景敏,王慧,王标,等.耳后微创切口行下颌角肥大矫正术[J].中华整形外科杂志,2004,20(02)：73-74.
[15]张金,白晋,宋建星.耳后小切口矫正下颌角重度肥大的临床价值[J].临床军医杂志,2009,37(02)：212-214.
[16]Jost G, Levet Y. Parotid fascia and face lifting-a critical-evaluation of the smas concept[J]. Plast Reconstr Surg,1984,74(1):42-51.
[17]Thaller S R, Kim S, Patterson H, et al. The submuscular aponeurotic system (smas)-a histologic and comparative anatomy evaluation[J]. Plast Reconstr Surg, 1990,86(4):690-696.
[18]Ghassemi A, Prescher A, Riediger D, et al. Anatomy of the smas revisited[J]. Aesthetic Plast Surg,2003,27(4):258-264.
[19]姜平,钟世镇,徐达传.面部表浅肌肉腱膜系统(smas)的解剖学研究[J].中国临床解剖学杂志,1999,17(04)：320-322.
[20]廖进民,陈海芳,李忠华,等.下颌支截骨术手术入路的应用解剖学研究[J]. 解剖与临床,2007,12(3)：152-156.
[21]雷涛,徐达传,高建华.除皱术中防止面神经下颌缘支损伤的解剖学研究[J].中华医学美学美容杂志,2004,10(1)：18-20.
[22]洪丽,安高,彭田红.面神经下颌缘支主干的定位解剖学研究[J].南华大学学报：医学版,2005,33(4)：485-488.
[1]蒋常文,陆明深,邵正仁.耳大神经移植治疗面神经麻痹的应用解剖学研究[J].解剖学杂志,1995,18(06)：502-503.
[2]姚向阳,王林,冯梅,等.耳大神经移植修复面神经缺损[J].山西医科大学学报,1999,30(03)：275.
[3]陈海芳,廖进民,李忠华,等.枕小和耳大神经移植修复面神经缺损的应用解剖[J].四川解剖学杂志,2009,17(02)：15-17.
[4]张引成,胡永升,党汝霖.耳大神经的应用解剖[J].实用口腔医学杂志,1987(03)：145-146.
[5]涂心明,李伟.耳大神经的体表定位[J].河南科技大学学报(医学版),2003,21(01)：40-41.
[6]瞿佐发,汤桂成,徐锐,等.耳大及腓浅神经移植的应用解剖[J].解剖科学进展,2001,7(02).100-102.
[7]殷之平,徐贤寅,杨代茂,等.远端蒂耳大神经营养血管筋膜皮瓣的应用解剖与临床应用[J].中国临床解剖学杂志,2006,24(05)：573-576.
[8]郑天中,李伟.耳大神经的表面投影[J].临床应用解剖学杂志,1985(01)：58-59.
[9]刘大庸,胡耀民,董敬朋.耳大神经移植体的应用解剖学[J].临床应用解剖学杂志,1985(02)：95-97.
[10]Ryan W R, Fee W E. Long-term great auricular nerve morbidity after sacrifice during parotidectomy[J]. The Laryngoscope,2009,119(6):1140-1146.
[11]王磊,吕改玲,刘平平.改良切口保留耳大神经在腮腺手术中的应用[J].实用诊断与治疗杂志,2008,22(04)：313-314.
[12]汪立鑫,黄瀛,党瑞山,等.耳大神经的应用解剖[J].解剖学杂志,1995,18(06)：499-501.
[13]盛瑶环,曾祥福,刘仰斌.耳大神经的形态学观测及其临床意义[J].赣南医学院学报,2002,22(04)：335-336.
[14]余崇仙,刘业海,陶冶.颈部ⅱ～ⅳ区副神经和耳大神经及颈横神经临床解剖学研究[J].中国耳鼻咽喉头颈外科,2008,15(06)：339-342.
[15]Aboudib J J H C, Cardoso De Castro C. Anatomical variations analysis of the external jugular vein, great auricular nerve, and posterosuperior border of the platysma muscle[J]. Aesthetic Plast Surg,1997,21(2):75-78.
[16]牙祖蒙,张纲,王建华,等.耳大神经及腮腺筋膜解剖的再认识与腮腺切除手术的改良[J].中国临床解剖学杂志,2006,24(02)：212-214.
[17]Zohar Y, Siegal A, Siegal G, et al. The great auricular nerve; does it penetrate the parotid gland? An anatomical and microscopical study[J]. J Craniomaxillofac Surg,2002,30(5):318-321.
[18]Brown J S, Ord R A. Preserving the great auricular nerve in parotid surgery[J]. Br J Oral Maxillofac Surg,1989,27(6):459-466.
[19]Silvester K C. Preserving the great auricular nerve in parotid surgery[J]. J Oral Maxillofac Surg,1990,48(9):1015.
[20]Porter M J, Wood S J. Preservation of the great auricular nerve during parotidectomy[J]. Clin Otolaryngol Allied Sci.1997,22(3):251-253.
[21]Biglioli F, D'orto O, Bozzetti A, et al. Function of the great auricular nerve following surgery for benign parotid disorders[J]. J Craniomaxillofac Surg,2002, 30(5):308-317.
[22]Hui Y, Wong D S Y, Wong L-Y, et al. A prospective controlled double-blind trial of great auricular nerve preservation at parotidectomy[J]. Amer J Surg,2003, 185(6):574-579.
[23]王涛.腮腺良性肿瘤切除术中保留耳大神经耳后、耳垂支的应用[J].实用医学杂志,2009,25(20)：3435-3436.
[24]李雅冬,杨凯,张劲松,等.保留颈外静脉,耳大神经和颈神经丛深支的根治性颈清扫术疗效评价[J].口腔医学研究,2009,25(03)：322-324.
[25]李明月,张伟,刘宁,等.腮腺筋膜和耳大神经保留的改良方法[J].中国口腔颌面外科杂志,2009,7(04)：366-369.
[26]李军,王建功,韩晓晨,等.腮腺肿瘤术中保留耳大神经后支的临床价值[J].山东医药,2008,48(06)：95.
[27]李彬,李春华,江剑桥,等.保留耳大神经颈淋巴结清扫术临床分析[J].中国耳鼻咽喉头颈外科,2008,15(08)：437-439.
[28]李建虎,孙沫逸,陈伟,等.腮腺良性肿瘤手术中耳大神经的解剖与保留[J].现代肿瘤医学,2007,15(03)：322-325.
[29]Min H J, Lee H S, Lee Y S, et al. Is it necessary to preserve the posterior branch of the great auricular nerve in parotidectomy?[J]. Otolaryngol Head Neck Surg, 2007,137(4):636-641.
[30]温玉明,王昌美,李龙江,等.保留颈外静脉、颈神经丛深支和耳大神经的根治性颈淋巴清扫术疗效评价[J].中国口腔颌面外科杂志,2006,4(01)：8-13.
[31]赵科,罗洪,黄光磊.腮腺良性肿瘤切除术中保留耳大神经后支减少术后并发症的疗效观察[J].贵州医药,2003,27(10)：899-900.
[32]陈杰,田勇泉,肖健云,等.保留耳大神经及枕小神经的功能性颈廓清术[J].中国耳鼻咽喉颅底外科杂志,2003,9(05)：19-21.
[1]Brosi N, Deckardt R. Endoscopic surgery in patients with borderline tumor of the ovary:A follow-up study of thirty-five patients[J]. J Minim Invasive Gynecol, 2007,14(5):606-609.
[2]Bonatz G, Lehmann-Willenbrock E, Mettler L, et al. Ten-year experience with endoscopic surgery on the ovary [J]. J Am Assoc Gynecol Laparosc,1995,2(4, Supplement 1):S5.
[3]Takahata S, Tsutsumi K, Yasui T, et al. Preserved gallbladder prevents recurrent common bile duct stones after endoscopic sphincterotomy[J]. Gastrointest Endosc, 2009,69(5):158.
[4]Ghazal a H, Sorour M A, El-Riwini M, et al. Single-step treatment of gall bladder and bile duct stones:A combined endoscopic-laparoscopic technique [J]. Int J Surg, 2009,7(4):338-346.
[5]Dhiman R K, Phanish M K, Chawla Y K, et al. Gallbladder motility and lithogenicity of bile in patients with choledocholithiasis after endoscopic sphincterotomy[J]. J Hepatol,1997,26(6):1300-1305.
[6]Dill JE, Dill B, Palmer ST. Diagnosing gallbladder carcinoma:Percutaneous cholecystoscopy or endoscopic ultrasound?[J]. Gastrointest Endosc,1997,46(3): 288.
[7]Sakamoto T, Kato H, Okabe T, et al. A large inflammatory fibroid polyp of the colon treated by endoclip-assisted endoscopic polypectomy:A case report[J]. Dig Liver Dis,2005,37(12):968-972.
[8]Conio M, Caroli-Bosc F X, Filiberti R, et al. Endoscopic nd:Yag laser therapy for villous adenomas of the right colon[J]. Gastrointest Endosc,1999,49(4): 504-508.
[9]Romagnuolo J, Morris J O, Palesch S, et al. Natural orifice transluminal endoscopic surgery versus laparoscopic surgery for inadvertent colon injury repair: Feasibility, risk of abdominal adhesions, and peritoneal contamination in a porcine survival model[J]. Gastrointest Endosc,2010,71(4):817-823.
[10]Chang E H, Wright S K. Open vs. Total endoscopic approach to the thyroid[J]. Otolaryngol Head Neck Surg,2008,139(2, Supplement 1):42.
[11]Pritchyk K M, Thompson L D R, Malekzadeh S. Endoscopic management of intratracheal ectopic thyroid[J]. Otolaryngol Head Neck Surg,2004,130(5): 630-632.
[12]Kitagawa W, Shimizu K, Akasu H, et al. Endoscopic neck surgery with lymph node dissection for papillary carcinoma of the thyroid using a totally gasless anterior neck skin lifting method[J]. J Am Coll Surg,2003,196(6):990-994.
[13]Shimizu K, Akira S, Jasmi a Y, et al. Video-assisted neck surgery:Endoscopic resection of thyroid tumors with a very minimal neck wound [J]. J Am Coll Surg, 1999,188(6):697-703.
[14]Ma S, Fang R H. Endoscopic mandibular angle surgery:A swine model[J]. Ann Plast Surg,1994,33(5):473-475.
[15]孙伟,黄晓明,郑亿庆,等.内镜辅助下腮腺浅叶部分切除术与传统腮腺浅叶部分切除术的比较研究[J].中华整形外科杂志,2009,25(4)：241-244.
[16]陈小平,林洁,杨甑宇,等.内镜辅助面部轮廓改形术[J].中国微创外科杂志,2008,8(11)：1000-1001.
[17]王江宁,王寿宇,张晨,等.内窥镜下微创下颌角肥大矫正术的临床研究[J].中国实用美容整形外科杂志,2006,17(1)：39-40.
[18]陈小平,宋建良,林洁,等.内镜辅助方型脸改型术[J].中华医学美学美容杂志,2006,12(6)：328-330.
[19]Iwai T, Matsui Y, Hirota M, et al. Endoscopically-assisted intraoral vertical ramus osteotomy:Secure technique to prevent complications[J]. Int J Oral Maxillofac Surg,2009,38(5):558.
[20]Rohner D, Yeow V K L. Endoscopic approaches to maxillary orthognathic surgery[J]. Facial Plastic Surgery Clinics of North America,2006,14(1):51-55.
[21]Yamaguchi Y, Okano T, Nishimura K, et al. Intraoral vertical ramus osteotomy for correction of mandibular prognathism-the surgical technique and complications [J]. Int J Oral Maxillofac Surg,2005,34(Supplement 1):35.
[22]Troulis M J, Nahlieli O, Castano F, et al. Minimally invasive orthognathic surgery:Endoscopic vertical ramus osteotomy[J]. Int J Oral Maxillofac Surg, 2000,29(4):239-242.
[23]金尚训,李勇,金奇龙,等.局麻下不同术式矫正下颌角肥大的体会[J].中国美容医学,2009,18(7)：954-955.
[24]项昌峰,顾飚.口内入路手术矫正下颌角肥大畸形[J].中华医学美学美容杂志,2007,13(5)：302-303.
[25]徐士亮,罗锦辉,惠俐,等.单纯下颌骨磨削法矫治下颌角肥大[J].中国美容整形外科杂志,2006,17(4)：250-252.
[26]陶宏炜,宣庆元.口外切口下颌角肥大整形术[J].中国美容医学,2003, 12(3)：291-293.
[27]刘立刚,陈刚,刘晓涛,等.口内切口辅以微小口外切口下颌角缩小整形术[J].中国美容医学,2003,12(3)：282-284.
[28]张菊芳,张如鸿,王毅敏,等.口内外联合入路小切口下颌角肥大弧形截骨术[J].中华医学美学美容杂志,2002,8(3)：133-136.
[29]归来,侯全志,张智勇,等.口内入路下颌角肥大弧形截骨术[J].中华整形外科杂志,1999,15(5)：336-338.
[30]穆雄铮,王炜,杭榆,等.口内外联合进路下颌角肥大截骨整形术[J].中华整形烧伤外科杂志,1996,12(2)：104-106.
[31]张金,白晋,宋建星.耳后小切口矫正下颌角重度肥大的临床价值[J].临床军医杂志,2009,37(2)：212-214.
[32]曹景敏,王慧,王标,等.耳后微创切口行下颌角肥大矫正术[J].中华整形外科杂志,2004,20(2)：156-157.
[33]王侠,李健宁,马勇光,等.下颌角测量与下颌角半盲视下改良截骨术[J].中华整形外科杂志,1998(3)：166-168.
[34]周智,柳大烈,刘志刚,等.汉族人下颌角相关测量与下颌角肥大诊断标准分析[J].第三军医大学学报,2006,28(7)：936-939.
[35]胡静,王大章,邹淑娟.经口内途径方颌畸形的外科矫治[J].临床口腔医学杂志,1999,15(1)：25-26.
[36]谢卫国,刘立刚,李淑良.三种入路下颌角肥大截骨术的比较[J].实用美容整形外科杂志,2003,14(5)：260-261.
[37]赵启明,第4届中国美容与整形医师大会论文集.下颌角肥大整形术及并发症的防治,2007.
[38]林卫,李世荣,毋巨龙等.口内外联合小切口下颌角肥大整形术[J].中国美容医学,2006,15(1)：50-52.
[39]Adams W M. Bilateral hypertrophy of the masseter muscle-an operation for correction-case report[J]. Br J Plast Surg,1949,2(2):78-81.
[40]Yang D B, Park C G. Mandibular contouring surgery for purely aesthetic reasons[J]. Aesthetic Plast Surg,1991,15(1):53-60.
[41]Baek S M, Kim S S, Bindiger A. The prominent mandibular angle-preoperative management, operative technique, and results in 42 patients[J]. Plast Reconstr Surg,1989,83(2):272-278.
[42]Jin H, Kim B G. Mandibular angle reduction versus mandible reduction[J]. Plast Reconstr Surg,2004,114(5):1263-1269.
[43]王竞鹏,柳大烈,罗奇.面下部轮廓整形术的术式选择[J].中国美容医学,2009,18(9)：1235-1237.
[44]Han K, Kim J. Reduction mandibuloplasty:Ostectomy of the lateral cortex around the mandibular angle [J]. J Craniofac Surg,2001,12(4):314-325.
[45]赵珍珍,宋建星.下颌角区域解剖结构特征与颅耳沟微创切口[J].中国组织工程研究与临床康复,2009,13(7)：1301-1304.
[46]De Miranda S L, Abrah M. Intraoral vertical ramus osteotomy endoscopic surgery [J]. J Oral Maxillofac Surg,2007,65(4):805-808.
[47]孙坚,孙弘.外耳后进路手术治疗下颌角与咬肌肥大[J].中国美容医学杂志,2001,10(1)：29-32.
[48]廖进民,陈海芳,李忠华,等.下颌支截骨术手术入路的应用解剖学研究[J].解剖与临床,2007,12(3)：152-156.
[49]雷涛,徐达传,高建华.除皱术中防止面神经下颌缘支损伤的解剖学研究[J].中华医学美学美容杂志,2004,10(1)：18-20.
[50]洪丽,安高,彭田红.面神经下颌缘支主干的定位解剖学研究[J].南华大学学报：医学版,2005,33(4)：485-488.
[51]Song H S, Park C G. Masseter muscle atrophy after ostectomy of the mandibular angle in rabbits[J]. Plast Reconstr Surg,1997,99(1):51-60.
[52]杜本军,柳大烈,梁莉,等.下颌角磨削去骨术前后咬肌变化[J].第三军医大学学报,2005,27(23)：2376-2378.
[53]付国友,柳大烈,单磊,等.下颌角整形术中去咬肌和不去咬肌两种术式对下颌运动功能的影响[J].中国临床康复,2006,10(25)：134-135.
[54]赵弘宇,罗永萍,林华.局部浸润麻醉口内切口下面部整形术[J].中华医学美学美容杂志,2005,11(5)：273-276.
[55]Katsumata A, Fujishita M, Ariji Y, et al.3d ct evaluation of masseter muscle morphology after setback osteotomy for mandibular prognathism[J]. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology,2004,98(4): 461-470.
[56]Ueki K, Okabe K, Mukozawa A, et al. Assessment of ramus, condyle, masseter muscle, and occlusal force before and after sagittal split ramus osteotomy in patients with mandibular prognathism[J]. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology,2009,108(5):679-686.
[57]陈小平,林洁,沈剑,等.下颌骨角全层截骨加下颌骨外板劈除行方形脸改型术[J].中华医学美学美容杂志,2008,14(4)：249-251.
[58]李自力,王兴,张熙恩,等.下颌角嚼肌肥大畸形的口内入路手术矫治[J].中华医学美学美容杂志,2005,11(2)：65-68.
[59]许龙顺,张灵芝,何佑成,等.口内入路弧形截骨治疗下颌角肥大[J].中国美容医学,2004,13(4)：446-447.
[60]Hwang K, Kim Y J, Park H, et al. Selective neurectomy of the masseteric nerve in masseter hypertrophy [J]. J Craniofac Surg,2004,15(5):780-784.
[61]Hwang K, Kim Y J, Chung I H, et al. Deep middle masseteric artery (dmma) attributed to hemorrhage in resection of masseter muscle and mandibular angle[J]. J Craniofac Surg,2001,12(4):381-385; discussion 386.
[62]冯传波,李学雷,高建华.下颌后静脉的形态学特点及其临床意义[J].中国临 床解剖学杂志,2006,24(4)：390-392.
[63]宋立为,李晓亮,苏庆.超声切割止血刀与高强度聚焦超声刀的比较[J].医疗设备信息,2007,22(10)：32-34.
[64]苏华,王永来.几种医疗止血器械在腹腔镜手术中的应用[J].中国内镜杂志,2004,10(8)：108-110.
[65]黄韶成,张玲玲,夏艳,等.妇科腹腔镜手术几种止血方法的临床评价[J].现代医学,2003,31(4)：233-235.
[66]马娅芬.3种止血方法在妇科腹腔镜手术中的临床评价[J].广西医科大学学报,2008,25(4)：598-599.
[67]程宁新,高尔青,王原路,等.内窥镜辅助隆乳术[J].中华整形外科杂志,2001,17(1)：40-42.
[68]余力,杨川,范志宏,等.内窥镜乳房整形的进展[J].实用美容整形外科杂志,2002,13(3)：143-145.
[69]栾杰,穆大力,刘晨,等.经腋窝入路内镜辅助双平面法解剖型假体隆乳术[J].中华整形外科杂志,2009,25(3)：175-177.
[70]余力,张波,王健,等.内窥镜腹壁整形术[J].组织工程与重建外科杂志,2005,1(1)：39-41.
[71]董立鹏,薛春玲,李荣强,等.内窥镜技术在脂肪抽吸手术中的应用[J].中国美容医学杂志,2002,11(3)：238-240.
[72]张颖涛.内窥镜脂肪抽吸的临床应用发展[J].川北医学院学报,2003,18(4)：169-171.
[73]卢彬,张树青,张澜成,等.内镜下超声脂肪抽吸术[J].中国美容医学,2003,12(1)：45-46.
[74]董立鹏,薛春玲,李荣强,等.内窥镜辅助脂肪抽吸36例[J].中华整形外科杂志,2002,18(6)：345.
[75]顾斌,李青峰,刘凯,等.胸部瘢痕治疗中应用内窥镜辅助扩张器置入的疗 效观察[J].中国临床康复,2004,8(32)：7339-7340.
[76]王志刚,杜红亚,熊立红,等.内窥镜在额颞部除皱术中的应用[J].中国美容医学,2009,18(12)：1739-1741.
[77]丁世凯,刘正茂.内窥镜下面部除皱术[J].重庆医学,2008,37(15)：1672.
[78]叶秀娣,乐淑君,虞渝生.内窥镜骨膜下额部除皱骨固定19例[J].中华整形外科杂志,2005,21(5)：342-344.
[79]Troulis M J, Ramirez J L, Kaban L B. Endoscopic approach for mandibular orthognathic surgery [J]. Facial Plast Surg Clin North Am,2006,14(1):45-50.
[80]Iwai T, Matsui Y, Tohnai I, et al. Endoscopic-assisted medial osteotomy during sagittal split ramus osteotomy[J]. J Plast Reconstr Aesthet Surg,2008,61(12): 1547-1548.
[81]Troulis M J, Kaban L B. Endoscopic vertical ramus osteotomy:Early clinical results[J]. J Oral Maxillofac Surg,2004,62(7):824-828.
[1]Bartlett SP, Wornom I 3rd, Whitaker LA. Evaluation of facial skeletal aesthetics and surgical planning[J]. Clin Plast Surg,1991,18(1):1-9.
[2]陈小平,林洁,杨甄宇,等.下面部轮廓过宽改型的新概念[J].中华整形外科杂志,2007,23(6)：540-541.
[3]Satoh K. Mandibular contouring surgery by angular contouring combined with genioplasty in orientals[J]. Plast Reconstr Surg,1998,101(2):461-472.
[4]Yang D B, Park C G. Mandibular contouring surgery for purely aesthetic reasons[J]. Aesthetic Plast Surg,1991,15(1):53-60.
[5]归来,侯全志,张智勇,等.口内入路下颌角肥大弧形截骨术[J].中华整形外科杂志,1999,15(5)：336-338.
[6]Morris D E, Moaveni Z, Lo L J. Aesthetic facial skeletal contouring in the asian patient[J]. Clin Plast Surg,2007,34(3):547-549.
[7]Whitaker L A. Aesthetic contouring of the facial support system[J]. Clin Plast Surg,1989,16(4):815-823.
[8]Han K, Kim J. Reduction mandibuloplasty:Ostectomy of the lateral cortex around the mandibular angle[J]. J Craniofac Surg,2001,12(4):314-325.
[9]Newton J P, Cowpe J G, Mcclure I J, et al. Masseteric hypertrophy?:Preliminary report[J]. Br J Oral Maxillofac Surg,1999,37(5):405-408.
[10]陈小平,宋建良,陈晓燕,等.方型脸改型术[J].中华整形外科杂志,1998(3)：169-172.
[11]徐永成,原林,李建辉.咬肌、翼内肌与下颌角肥大的相关性研究[J].中华医学美学美容杂志,2002,8(5)：250-253.
[12]Karasz I, Korondi L, Szabo G. Photoelastic stress-analysis on mandibular osteosynthesis[J]. Int J Oral Maxillofac Surg,1986,15(3):259-262.
[13]李慧超,李冬梅,归来,等.下颌角截骨整形手术前后下颌骨生物力学的三维有限元分析[J].中华整形外科杂志,2008,24(6)：416-420.
[14]王侠,李健宁,马勇光,等.下颌角测量与下颌角半盲视下改良截骨术[J].中华整形外科杂志,1998(3)：166-168.
[15]周智,柳大烈,刘志刚,等.汉族人下颌角相关测量与下颌角肥大诊断标准分析[11].第三军医大学学报,2006,28(7)：936-939.
[16]胡静,王大章,邹淑娟.经口内途径方颌畸形的外科矫治[J].临床口腔医学杂志,1999,15(1)：25-26.
[17]赵峰,高勃,刘震侠,等.Dicom标准和mimics软件辅助建立下颌骨三维有 限元模型[J].西南国防医药,2005,15(5)：479-481.
[18]赵延峰,郝云飞,陆平,等.基于三维CT配准技术的下颌矢状劈开去骨术的临床研究[J].华西口腔医学杂志,2009,27(5)：516-520.
[19]孔亮,胡开进,赵海涛,等.利用薄层CT技术和matlab软件辅助建立下颌骨三维有限元模型[J].实用口腔医学杂志,2004,20(2)：175-177.
[20]李月明,高月明,张万林.利用三维CT重建术研究面型与下颌骨内部结构的关系[J].哈尔滨医科大学学报,2005,39(4)：340-343.
[21]王吉昌,归来,张智勇,等.下颌神经管三维CT定位在下颌角截骨整形术中的应用[J].中华整形外科杂志,2008,24(5)：360-362.
[22]陈育哲,王侠,秦荣生,等.下颌截骨整体塑形术[J].中华整形外科杂志,2004,20(1)：45-47.
[23]王竞鹏,柳大烈,罗奇.面下部轮廓整形术的术式选择[J].中国美容医学,2009,18(9)：1235-1237.
[24]Kim S K, Han J J, Kim J T. Classification and treatment of prominent mandibular angle[J]. Aesthetic Plast Surg,2001,25(5):382-387.
[25]李自力,王兴,张熙恩,等.下颌角嚼肌肥大畸形的口内入路手术矫治[J].中华医学美学美容杂志,2005,11(2)：65-68.
[26]谢卫国,刘立刚,李淑良.三种入路下颌角肥大截骨术的比较[J].实用美容整形外科杂志,2003,14(5)：260-261.
[27]吴国平,何小川,蒋晓丽,等.口内入路下颌角弧形截骨联合下颌角外板矢状劈除矫治下颌角肥大[J].中华医学美学美容杂志,2009,15(4)：244-246.
[28]刘丽萍,高卓平,李素景.耳后切口下颌角肥大矫正术12例报告[J].陕西医学杂志,2004,33(8)：761-762.
[29]孙坚,孙弘.外耳后进路手术治疗下颌角与咬肌肥大[J].中国美容医学杂志,2001,10(1)：29-32.
[30]曹景敏,王慧,王标,等.耳后微创切口行下颌角肥大矫正术[J].中华整形外科 杂志,2004,20(2)：156-157.
[31]赵启明,第4届中国美容与整形医师大会论文集.下颌角肥大整形术及并发症的防治,2007.
[32]林卫,李世荣,毋巨龙等.口内外联合小切口下颌角肥大整形术[J].中国美容医学,2006,15(1)：50-52.
[33]张菊芳,张如鸿,王毅敏,等.口内外联合入路小切口下颌角肥大弧形截骨术[J].中华医学美学美容杂志,2002,8(3)：133-136.
[34]穆雄铮,王炜,杭榆,等.口内外联合进路下颌角肥大截骨整形术[J].中华整形烧伤外科杂志,1996,12(2)：104-106.
[35]陈小平,宋建良.下颌角肥大的治疗现状及进展[J].中华医学美学美容杂志,2007,13(2)：125-128.
[36]Adams W M. Bilateral hypertrophy of the masseter muscle-an operation for correction-case report[J]. Br J Plast Surg,1949,2(2):78-81.
[37]Baek S M, Kim S S, Bindiger A. The prominent mandibular angle-preoperative management, operative technique, and results in 42 patients[J]. Plast Reconstr Surg,1989,83(2):272-278.
[38]Jin H, Kim B G. Mandibular angle reduction versus mandible reduction[J]. Plast Reconstr Surg,2004,114(5):1263-1269.
[39]Hwang K, Lee D K, Lee W J, et al. A split ostectomy of mandibular body and angle reduction[J]. J Craniofac Surg,2004,15(2):341-346.
[40]Pu Z N, Zhang Y G, Yang J, et al. Mandibular angle ostectomy for chinese women:Approaches and extent determined by cephalometric analysis[J]. J Craniofac Surg,2009,20(1):105-110.
[41]Nagase T, Yoshimura K, Aiba E, et al. Angle-splitting ostectomy followed by face lift for elderly patients with prominent mandibular angles[J]. Plast Reconstr Surg,2005,115(2):633-640.
[42]Deguchi M, Iio Y, Kobayashi K, et al. Angle-splitting ostectomy for reducing the width of the lower face[J]. Plast Reconstr Surg,1997,99(7):1831-1839.
[43]Cui J, Zhu S, Hu J, et al. The effect of different reduction mandibuloplasty types on lower face width and morphology[J]. Aesthetic Plast Surg,2008,32(4): 593-598.
[44]Yang J Y, Wang L, Xu H S, et al. Mandibular oblique ostectomy:An alternative procedure to reduce the width of the lower face[J]. J Craniofac Surg,2009,20: 1822-1826.
[45]De Miranda S L, Abrah 鉶 M. Intraoral vertical ramus osteotomy endoscopic surgery[J]. J Oral Maxillofac Surg,2007,65(4):805-808.
[46]赵珍珍,宋建星.下颌角区域解剖结构特征与颅耳沟微创切口[J].中国组织工程研究与临床康复,2009,13(7)：1301-1304.
[47]范海东,王兴,张熙恩,等.改良下颌角矢状劈开去骨术在矫治中轻度下颌角嚼肌良性肥大畸形中的应用[J].现代口腔医学杂志,2001,15(1)：18-20.
[48]Song H S, Park C G. Masseter muscle atrophy after ostectomy of the mandibular angle in rabbits[J]. Plast Reconstr Surg,1997,99(1):51-60.
[49]杜本军,柳大烈,梁莉,等.下颌角磨削去骨术前后咬肌变化[J].第三军医大学学报,2005,27(23)：2376-2378.
[50]付国友,柳大烈,单磊,等.下颌角整形术中去咬肌和不去咬肌两种术式对下颌运动功能的影响[J].中国临床康复,2006,10(25)：134-135.
[51]赵弘宇,罗永萍,林华.局部浸润麻醉口内切口下面部整形术[J].中华医学美学美容杂志,2005,11(5)：273-276.
[52]Katsumata A, Fujishita M, Ariji Y, et al.3d ct evaluation of masseter muscle morphology after setback osteotomy for mandibular prognathism[J]. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology,2004,98(4): 461-470.
[53]Ueki K, Okabe K, Mukozawa A, et al. Assessment of ramus, condyle, masseter muscle, and occlusal force before and after sagittal split ramus osteotomy in patients with mandibular prognathism[J]. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology,2009,108(5):679-686.
[54]陈小平,林洁,沈剑,等.下颌骨角全层截骨加下颌骨外板劈除行方形脸改型术[J].中华医学美学美容杂志,2008,14(4)：249-251.
[55]许龙顺,张灵芝,何佑成,等.口内入路弧形截骨治疗下颌角肥大[J].中国美容医学,2004,13(4)：446-447.
[56]Hwang K, Kim Y J, Park H, et al. Selective neurectomy of the masseteric nerve in masseter hypertrophy [J]. J Craniofac Surg,2004,15(5):780-784.
[57]Von Lindern J J, Niederhagen B, Appel T, et al. Type a botulinum toxin for the treatment of hypertrophy of the masseter and temporal muscles:An alternative treatment[J]. Plast Reconstr Surg,2001,107(2):327-332.
[58]Al-Ahmad H T, Al-Qudah M A. The treatment of masseter hypertrophy with botulinum toxin type a[J]. Saudi Medical Journal,2006,27(3):397-400.
[59]Park M Y, Ahn K Y, Jung D S. Botulinum toxin type a treatment for contouring of the lower face[J]. Dermatol Surg,2003,29(5):477-483.
[60]冯传波,高建华,刘红梅.肉毒杆菌毒素A注射治疗良性咬肌肥大[J].中国临床康复,2006,10(36)：45-47.
[61]刘玉生,柳大烈,杜本军,等.肌注肉毒毒素A和糖皮质激素治疗咬肌肥大[J].中国美容医学,2006,15(3)：265-267.
[62]Dubin B, Jackson I T, Halim A, et al. Anatomy of the buccal fat pad and its clinical significance [J]. Plast Reconstr Surg,1989,83(2):257-264.
[63]Jackson I T. Anatomy of the buccal fat pad and its clinical significance[J]. Plast Reconstr Surg,1999,103(7):2059-60; discussion 2061-2063.
[64]Stuzin J M, Wagstrom L, Kawamoto H K, et al. The anatomy and clinical applications of the buccal fat pad[J]. Plast Reconstr Surg,1990,85(1):29-37.
[65]Zhang H M, Yan Y P, Qi K M, et al. Anatomical structure of the buccal fat pad and its clinical adaptations[J]. Plast Reconstr Surg,2002,109(7):2509-2518; discussion 2519-2520.
[66]黄海龙,韦嫚,周挺.颊脂垫的解剖及其在面颊部整形美容外科中的应用[J].解剖学研究,2008,30(5)：375-377.
[67]黄鲜,曹阳,黄伟光.颊脂肪垫的应用解剖及切除术[J].重庆医学,2006,35(24)：2280-2281.
[68]邱涛.面中部纤维脂肪垫的解剖和临床应用研究[D].2009.
[69]张树民.带蒂颊脂垫瓣在口腔内软组织缺损修复中的应用[J].口腔颌面外科杂志,2009,19(1)：47-48.
[70]胡克苏,蒋平,王磊,等.颊脂垫部分摘除术的临床体会[J].中国美容医学,2009,18(10)：1458-1459.
[71]李俊,黄金龙,沈干,等.颊脂垫摘除术26例总结[J].中国美容整形外科杂志,2008,19(1)：58.
[72]邵宏,彭晓云.颊脂垫吸除联合A型肉毒毒素咬肌多点注射瘦脸术[J].中国美容医学,2004,13(5)：562-564.
[73]田立粮,刘志刚.颊脂垫切除术38例分析[J].齐齐哈尔医学院学报,2008,29(9)：1073.
[74]严义坪,张海明.颊脂肪垫的解剖结构及其在面颊部整形手术中的意义[J].中国美容医学杂志,2001,10(4)：272-276.
[75]Hwang K, Kim Y J, Chung I H, et al. Deep middle masseteric artery (dmma) attributed to hemorrhage in resection of masseter muscle and mandibular angle[J]. J Craniofac Surg,2001,12(4):381-385; discussion 386.
[76]冯传波,李学雷,高建华.下颌后静脉的形态学特点及其临床意义[J].中国临床解剖学杂志,2006,24(4)：390-392.
[77]阎晓辉.去除肥大下颌角手术时对面动脉出血的处理[J].海军总医院学报,2005,18(1)：53-54.
[78]廖进民,陈海芳,李忠华,等.下颌支截骨术手术入路的应用解剖学研究[J].解剖与临床,2007,12(3)：152-156.
[79]雷涛,徐达传,高建华.除皱术中防止面神经下颌缘支损伤的解剖学研究[J].中华医学美学美容杂志,2004,10(1)：18-20.
[80]洪丽,安高,彭田红.面神经下颌缘支主干的定位解剖学研究[J].南华大学学报：医学版,2005,33(4)：485-488.
[81]黄绿萍,归来,张智勇,等.下颌角肥大矫治术及其常见并发症的处理[J].中华整形外科杂志,2003,19(5)：364-366.
[82]Hwang K, Han J Y, Kil M S, et al. Treatment of condyle fracture caused by mandibular angle ostectomy[J]. J Craniofac Surg,2002,13(5):709-712.
[83]Han K, Kim J. Reduction mandibuloplasty:Ostectomy of the lateral cortex around the mandibular angle[J]. J Craniofac Surg,2001,12(4):314-325.
[84]Haibo Liu,Zihai Ding Endoscopically assisted prominent mandibular angle contouring surgery with postauricular incision[J]. During modify
[2]Kim H J, Lee H Y, Chung I H, et al. Mandibular anatomy related to sagittal split ramus osteotomy in koreans[J]. Yonsei Med J,1997,38(1):19-25.
[3]Nason R W, Binahmed A, Torchia M G, et al. Clinical observations of the anatomy and function of the marginal mandibular nerve[J]. Int J Oral Maxillofac Surg,2007,36(8):712-715.
[4]Smith B R, Rajchel J L, Waite D E, et al. Mandibular ramus anatomy as it relates to the medial osteotomy of the sagittal split ramus osteotomy [J]. J Oral Maxillofac Surg,1991,49(2):112-116.
[5]Tom W K, Martone C H, Mintz S M. A study of mandibular ramus anatomy and its significance to sagittal split osteotomy [J]. Int J Oral Maxillofac Surg,1997, 26(3):176-178.
[6]Yu I H, Wong Y K. Evaluation of mandibular anatomy related to sagittal split ramus osteotomy using 3-dimensional computed tomography scan images [J]. Int J Oral Maxillofac Surg,2008,37(6):521-528.
[7]董博,王学东.面神经下颌缘支的应用解剖[J].局解手术学杂志,2008,17(03)：177-178.
[8]华泽权,邹明宇,李树华.下颌升支截骨手术相关下颌管解剖标志的多层ct测量研究[J].临床口腔医学杂志,2006,22(01)：3-4.
[9]廖进民,陈海芳,李忠华,等.下颌支截骨术手术入路的应用解剖学研究[J].解剖与临床,2007,12(03)：152-156.
[10]皮昕.下颌骨矢状劈开截骨术中下颌管的应用解剖[J].临床口腔医学杂志,1986(01)：16-17.
[11]王伦安,刘卫华,李鑫,等.下颌角肥大弧形截骨术中在下颌骨颊侧骨板表面定位截骨线的临床应用解剖[J].华西医学,2006,26(01)：9-10.
[12]徐永成,汪立川,原林.下颌角截骨术的应用解剖研究进展[J].中华医学美学美容杂志,2003,9(04)：55-56.
[13]孙坚,孙弘.外耳后进路手术治疗下颌角与咬肌肥大[J].中国美容医学,2001,10(01)：29-32.
[14]曹景敏,王慧,王标,等.耳后微创切口行下颌角肥大矫正术[J].中华整形外科杂志,2004,20(02)：73-74.
[15]张金,白晋,宋建星.耳后小切口矫正下颌角重度肥大的临床价值[J].临床军医杂志,2009,37(02)：212-214.
[16]Jost G, Levet Y. Parotid fascia and face lifting-a critical-evaluation of the smas concept[J]. Plast Reconstr Surg,1984,74(1):42-51.
[17]Thaller S R, Kim S, Patterson H, et al. The submuscular aponeurotic system (smas)-a histologic and comparative anatomy evaluation[J]. Plast Reconstr Surg, 1990,86(4):690-696.
[18]Ghassemi A, Prescher A, Riediger D, et al. Anatomy of the smas revisited[J]. Aesthetic Plast Surg,2003,27(4):258-264.
[19]姜平,钟世镇,徐达传.面部表浅肌肉腱膜系统(smas)的解剖学研究[J].中国临床解剖学杂志,1999,17(04)：320-322.
[20]廖进民,陈海芳,李忠华,等.下颌支截骨术手术入路的应用解剖学研究[J]. 解剖与临床,2007,12(3)：152-156.
[21]雷涛,徐达传,高建华.除皱术中防止面神经下颌缘支损伤的解剖学研究[J].中华医学美学美容杂志,2004,10(1)：18-20.
[22]洪丽,安高,彭田红.面神经下颌缘支主干的定位解剖学研究[J].南华大学学报：医学版,2005,33(4)：485-488.
[1]蒋常文,陆明深,邵正仁.耳大神经移植治疗面神经麻痹的应用解剖学研究[J].解剖学杂志,1995,18(06)：502-503.
[2]姚向阳,王林,冯梅,等.耳大神经移植修复面神经缺损[J].山西医科大学学报,1999,30(03)：275.
[3]陈海芳,廖进民,李忠华,等.枕小和耳大神经移植修复面神经缺损的应用解剖[J].四川解剖学杂志,2009,17(02)：15-17.
[4]张引成,胡永升,党汝霖.耳大神经的应用解剖[J].实用口腔医学杂志,1987(03)：145-146.
[5]涂心明,李伟.耳大神经的体表定位[J].河南科技大学学报(医学版),2003,21(01)：40-41.
[6]瞿佐发,汤桂成,徐锐,等.耳大及腓浅神经移植的应用解剖[J].解剖科学进展,2001,7(02).100-102.
[7]殷之平,徐贤寅,杨代茂,等.远端蒂耳大神经营养血管筋膜皮瓣的应用解剖与临床应用[J].中国临床解剖学杂志,2006,24(05)：573-576.
[8]郑天中,李伟.耳大神经的表面投影[J].临床应用解剖学杂志,1985(01)：58-59.
[9]刘大庸,胡耀民,董敬朋.耳大神经移植体的应用解剖学[J].临床应用解剖学杂志,1985(02)：95-97.
[10]Ryan W R, Fee W E. Long-term great auricular nerve morbidity after sacrifice during parotidectomy[J]. The Laryngoscope,2009,119(6):1140-1146.
[11]王磊,吕改玲,刘平平.改良切口保留耳大神经在腮腺手术中的应用[J].实用诊断与治疗杂志,2008,22(04)：313-314.
[12]汪立鑫,黄瀛,党瑞山,等.耳大神经的应用解剖[J].解剖学杂志,1995,18(06)：499-501.
[13]盛瑶环,曾祥福,刘仰斌.耳大神经的形态学观测及其临床意义[J].赣南医学院学报,2002,22(04)：335-336.
[14]余崇仙,刘业海,陶冶.颈部ⅱ～ⅳ区副神经和耳大神经及颈横神经临床解剖学研究[J].中国耳鼻咽喉头颈外科,2008,15(06)：339-342.
[15]Aboudib J J H C, Cardoso De Castro C. Anatomical variations analysis of the external jugular vein, great auricular nerve, and posterosuperior border of the platysma muscle[J]. Aesthetic Plast Surg,1997,21(2):75-78.
[16]牙祖蒙,张纲,王建华,等.耳大神经及腮腺筋膜解剖的再认识与腮腺切除手术的改良[J].中国临床解剖学杂志,2006,24(02)：212-214.
[17]Zohar Y, Siegal A, Siegal G, et al. The great auricular nerve; does it penetrate the parotid gland? An anatomical and microscopical study[J]. J Craniomaxillofac Surg,2002,30(5):318-321.
[18]Brown J S, Ord R A. Preserving the great auricular nerve in parotid surgery[J]. Br J Oral Maxillofac Surg,1989,27(6):459-466.
[19]Silvester K C. Preserving the great auricular nerve in parotid surgery[J]. J Oral Maxillofac Surg,1990,48(9):1015.
[20]Porter M J, Wood S J. Preservation of the great auricular nerve during parotidectomy[J]. Clin Otolaryngol Allied Sci.1997,22(3):251-253.
[21]Biglioli F, D'orto O, Bozzetti A, et al. Function of the great auricular nerve following surgery for benign parotid disorders[J]. J Craniomaxillofac Surg,2002, 30(5):308-317.
[22]Hui Y, Wong D S Y, Wong L-Y, et al. A prospective controlled double-blind trial of great auricular nerve preservation at parotidectomy[J]. Amer J Surg,2003, 185(6):574-579.
[23]王涛.腮腺良性肿瘤切除术中保留耳大神经耳后、耳垂支的应用[J].实用医学杂志,2009,25(20)：3435-3436.
[24]李雅冬,杨凯,张劲松,等.保留颈外静脉,耳大神经和颈神经丛深支的根治性颈清扫术疗效评价[J].口腔医学研究,2009,25(03)：322-324.
[25]李明月,张伟,刘宁,等.腮腺筋膜和耳大神经保留的改良方法[J].中国口腔颌面外科杂志,2009,7(04)：366-369.
[26]李军,王建功,韩晓晨,等.腮腺肿瘤术中保留耳大神经后支的临床价值[J].山东医药,2008,48(06)：95.
[27]李彬,李春华,江剑桥,等.保留耳大神经颈淋巴结清扫术临床分析[J].中国耳鼻咽喉头颈外科,2008,15(08)：437-439.
[28]李建虎,孙沫逸,陈伟,等.腮腺良性肿瘤手术中耳大神经的解剖与保留[J].现代肿瘤医学,2007,15(03)：322-325.
[29]Min H J, Lee H S, Lee Y S, et al. Is it necessary to preserve the posterior branch of the great auricular nerve in parotidectomy?[J]. Otolaryngol Head Neck Surg, 2007,137(4):636-641.
[30]温玉明,王昌美,李龙江,等.保留颈外静脉、颈神经丛深支和耳大神经的根治性颈淋巴清扫术疗效评价[J].中国口腔颌面外科杂志,2006,4(01)：8-13.
[31]赵科,罗洪,黄光磊.腮腺良性肿瘤切除术中保留耳大神经后支减少术后并发症的疗效观察[J].贵州医药,2003,27(10)：899-900.
[32]陈杰,田勇泉,肖健云,等.保留耳大神经及枕小神经的功能性颈廓清术[J].中国耳鼻咽喉颅底外科杂志,2003,9(05)：19-21.
[1]Brosi N, Deckardt R. Endoscopic surgery in patients with borderline tumor of the ovary:A follow-up study of thirty-five patients[J]. J Minim Invasive Gynecol, 2007,14(5):606-609.
[2]Bonatz G, Lehmann-Willenbrock E, Mettler L, et al. Ten-year experience with endoscopic surgery on the ovary [J]. J Am Assoc Gynecol Laparosc,1995,2(4, Supplement 1):S5.
[3]Takahata S, Tsutsumi K, Yasui T, et al. Preserved gallbladder prevents recurrent common bile duct stones after endoscopic sphincterotomy[J]. Gastrointest Endosc, 2009,69(5):158.
[4]Ghazal a H, Sorour M A, El-Riwini M, et al. Single-step treatment of gall bladder and bile duct stones:A combined endoscopic-laparoscopic technique [J]. Int J Surg, 2009,7(4):338-346.
[5]Dhiman R K, Phanish M K, Chawla Y K, et al. Gallbladder motility and lithogenicity of bile in patients with choledocholithiasis after endoscopic sphincterotomy[J]. J Hepatol,1997,26(6):1300-1305.
[6]Dill JE, Dill B, Palmer ST. Diagnosing gallbladder carcinoma:Percutaneous cholecystoscopy or endoscopic ultrasound?[J]. Gastrointest Endosc,1997,46(3): 288.
[7]Sakamoto T, Kato H, Okabe T, et al. A large inflammatory fibroid polyp of the colon treated by endoclip-assisted endoscopic polypectomy:A case report[J]. Dig Liver Dis,2005,37(12):968-972.
[8]Conio M, Caroli-Bosc F X, Filiberti R, et al. Endoscopic nd:Yag laser therapy for villous adenomas of the right colon[J]. Gastrointest Endosc,1999,49(4): 504-508.
[9]Romagnuolo J, Morris J O, Palesch S, et al. Natural orifice transluminal endoscopic surgery versus laparoscopic surgery for inadvertent colon injury repair: Feasibility, risk of abdominal adhesions, and peritoneal contamination in a porcine survival model[J]. Gastrointest Endosc,2010,71(4):817-823.
[10]Chang E H, Wright S K. Open vs. Total endoscopic approach to the thyroid[J]. Otolaryngol Head Neck Surg,2008,139(2, Supplement 1):42.
[11]Pritchyk K M, Thompson L D R, Malekzadeh S. Endoscopic management of intratracheal ectopic thyroid[J]. Otolaryngol Head Neck Surg,2004,130(5): 630-632.
[12]Kitagawa W, Shimizu K, Akasu H, et al. Endoscopic neck surgery with lymph node dissection for papillary carcinoma of the thyroid using a totally gasless anterior neck skin lifting method[J]. J Am Coll Surg,2003,196(6):990-994.
[13]Shimizu K, Akira S, Jasmi a Y, et al. Video-assisted neck surgery:Endoscopic resection of thyroid tumors with a very minimal neck wound [J]. J Am Coll Surg, 1999,188(6):697-703.
[14]Ma S, Fang R H. Endoscopic mandibular angle surgery:A swine model[J]. Ann Plast Surg,1994,33(5):473-475.
[15]孙伟,黄晓明,郑亿庆,等.内镜辅助下腮腺浅叶部分切除术与传统腮腺浅叶部分切除术的比较研究[J].中华整形外科杂志,2009,25(4)：241-244.
[16]陈小平,林洁,杨甑宇,等.内镜辅助面部轮廓改形术[J].中国微创外科杂志,2008,8(11)：1000-1001.
[17]王江宁,王寿宇,张晨,等.内窥镜下微创下颌角肥大矫正术的临床研究[J].中国实用美容整形外科杂志,2006,17(1)：39-40.
[18]陈小平,宋建良,林洁,等.内镜辅助方型脸改型术[J].中华医学美学美容杂志,2006,12(6)：328-330.
[19]Iwai T, Matsui Y, Hirota M, et al. Endoscopically-assisted intraoral vertical ramus osteotomy:Secure technique to prevent complications[J]. Int J Oral Maxillofac Surg,2009,38(5):558.
[20]Rohner D, Yeow V K L. Endoscopic approaches to maxillary orthognathic surgery[J]. Facial Plastic Surgery Clinics of North America,2006,14(1):51-55.
[21]Yamaguchi Y, Okano T, Nishimura K, et al. Intraoral vertical ramus osteotomy for correction of mandibular prognathism-the surgical technique and complications [J]. Int J Oral Maxillofac Surg,2005,34(Supplement 1):35.
[22]Troulis M J, Nahlieli O, Castano F, et al. Minimally invasive orthognathic surgery:Endoscopic vertical ramus osteotomy[J]. Int J Oral Maxillofac Surg, 2000,29(4):239-242.
[23]金尚训,李勇,金奇龙,等.局麻下不同术式矫正下颌角肥大的体会[J].中国美容医学,2009,18(7)：954-955.
[24]项昌峰,顾飚.口内入路手术矫正下颌角肥大畸形[J].中华医学美学美容杂志,2007,13(5)：302-303.
[25]徐士亮,罗锦辉,惠俐,等.单纯下颌骨磨削法矫治下颌角肥大[J].中国美容整形外科杂志,2006,17(4)：250-252.
[26]陶宏炜,宣庆元.口外切口下颌角肥大整形术[J].中国美容医学,2003, 12(3)：291-293.
[27]刘立刚,陈刚,刘晓涛,等.口内切口辅以微小口外切口下颌角缩小整形术[J].中国美容医学,2003,12(3)：282-284.
[28]张菊芳,张如鸿,王毅敏,等.口内外联合入路小切口下颌角肥大弧形截骨术[J].中华医学美学美容杂志,2002,8(3)：133-136.
[29]归来,侯全志,张智勇,等.口内入路下颌角肥大弧形截骨术[J].中华整形外科杂志,1999,15(5)：336-338.
[30]穆雄铮,王炜,杭榆,等.口内外联合进路下颌角肥大截骨整形术[J].中华整形烧伤外科杂志,1996,12(2)：104-106.
[31]张金,白晋,宋建星.耳后小切口矫正下颌角重度肥大的临床价值[J].临床军医杂志,2009,37(2)：212-214.
[32]曹景敏,王慧,王标,等.耳后微创切口行下颌角肥大矫正术[J].中华整形外科杂志,2004,20(2)：156-157.
[33]王侠,李健宁,马勇光,等.下颌角测量与下颌角半盲视下改良截骨术[J].中华整形外科杂志,1998(3)：166-168.
[34]周智,柳大烈,刘志刚,等.汉族人下颌角相关测量与下颌角肥大诊断标准分析[J].第三军医大学学报,2006,28(7)：936-939.
[35]胡静,王大章,邹淑娟.经口内途径方颌畸形的外科矫治[J].临床口腔医学杂志,1999,15(1)：25-26.
[36]谢卫国,刘立刚,李淑良.三种入路下颌角肥大截骨术的比较[J].实用美容整形外科杂志,2003,14(5)：260-261.
[37]赵启明,第4届中国美容与整形医师大会论文集.下颌角肥大整形术及并发症的防治,2007.
[38]林卫,李世荣,毋巨龙等.口内外联合小切口下颌角肥大整形术[J].中国美容医学,2006,15(1)：50-52.
[39]Adams W M. Bilateral hypertrophy of the masseter muscle-an operation for correction-case report[J]. Br J Plast Surg,1949,2(2):78-81.
[40]Yang D B, Park C G. Mandibular contouring surgery for purely aesthetic reasons[J]. Aesthetic Plast Surg,1991,15(1):53-60.
[41]Baek S M, Kim S S, Bindiger A. The prominent mandibular angle-preoperative management, operative technique, and results in 42 patients[J]. Plast Reconstr Surg,1989,83(2):272-278.
[42]Jin H, Kim B G. Mandibular angle reduction versus mandible reduction[J]. Plast Reconstr Surg,2004,114(5):1263-1269.
[43]王竞鹏,柳大烈,罗奇.面下部轮廓整形术的术式选择[J].中国美容医学,2009,18(9)：1235-1237.
[44]Han K, Kim J. Reduction mandibuloplasty:Ostectomy of the lateral cortex around the mandibular angle [J]. J Craniofac Surg,2001,12(4):314-325.
[45]赵珍珍,宋建星.下颌角区域解剖结构特征与颅耳沟微创切口[J].中国组织工程研究与临床康复,2009,13(7)：1301-1304.
[46]De Miranda S L, Abrah M. Intraoral vertical ramus osteotomy endoscopic surgery [J]. J Oral Maxillofac Surg,2007,65(4):805-808.
[47]孙坚,孙弘.外耳后进路手术治疗下颌角与咬肌肥大[J].中国美容医学杂志,2001,10(1)：29-32.
[48]廖进民,陈海芳,李忠华,等.下颌支截骨术手术入路的应用解剖学研究[J].解剖与临床,2007,12(3)：152-156.
[49]雷涛,徐达传,高建华.除皱术中防止面神经下颌缘支损伤的解剖学研究[J].中华医学美学美容杂志,2004,10(1)：18-20.
[50]洪丽,安高,彭田红.面神经下颌缘支主干的定位解剖学研究[J].南华大学学报：医学版,2005,33(4)：485-488.
[51]Song H S, Park C G. Masseter muscle atrophy after ostectomy of the mandibular angle in rabbits[J]. Plast Reconstr Surg,1997,99(1):51-60.
[52]杜本军,柳大烈,梁莉,等.下颌角磨削去骨术前后咬肌变化[J].第三军医大学学报,2005,27(23)：2376-2378.
[53]付国友,柳大烈,单磊,等.下颌角整形术中去咬肌和不去咬肌两种术式对下颌运动功能的影响[J].中国临床康复,2006,10(25)：134-135.
[54]赵弘宇,罗永萍,林华.局部浸润麻醉口内切口下面部整形术[J].中华医学美学美容杂志,2005,11(5)：273-276.
[55]Katsumata A, Fujishita M, Ariji Y, et al.3d ct evaluation of masseter muscle morphology after setback osteotomy for mandibular prognathism[J]. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology,2004,98(4): 461-470.
[56]Ueki K, Okabe K, Mukozawa A, et al. Assessment of ramus, condyle, masseter muscle, and occlusal force before and after sagittal split ramus osteotomy in patients with mandibular prognathism[J]. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology,2009,108(5):679-686.
[57]陈小平,林洁,沈剑,等.下颌骨角全层截骨加下颌骨外板劈除行方形脸改型术[J].中华医学美学美容杂志,2008,14(4)：249-251.
[58]李自力,王兴,张熙恩,等.下颌角嚼肌肥大畸形的口内入路手术矫治[J].中华医学美学美容杂志,2005,11(2)：65-68.
[59]许龙顺,张灵芝,何佑成,等.口内入路弧形截骨治疗下颌角肥大[J].中国美容医学,2004,13(4)：446-447.
[60]Hwang K, Kim Y J, Park H, et al. Selective neurectomy of the masseteric nerve in masseter hypertrophy [J]. J Craniofac Surg,2004,15(5):780-784.
[61]Hwang K, Kim Y J, Chung I H, et al. Deep middle masseteric artery (dmma) attributed to hemorrhage in resection of masseter muscle and mandibular angle[J]. J Craniofac Surg,2001,12(4):381-385; discussion 386.
[62]冯传波,李学雷,高建华.下颌后静脉的形态学特点及其临床意义[J].中国临 床解剖学杂志,2006,24(4)：390-392.
[63]宋立为,李晓亮,苏庆.超声切割止血刀与高强度聚焦超声刀的比较[J].医疗设备信息,2007,22(10)：32-34.
[64]苏华,王永来.几种医疗止血器械在腹腔镜手术中的应用[J].中国内镜杂志,2004,10(8)：108-110.
[65]黄韶成,张玲玲,夏艳,等.妇科腹腔镜手术几种止血方法的临床评价[J].现代医学,2003,31(4)：233-235.
[66]马娅芬.3种止血方法在妇科腹腔镜手术中的临床评价[J].广西医科大学学报,2008,25(4)：598-599.
[67]程宁新,高尔青,王原路,等.内窥镜辅助隆乳术[J].中华整形外科杂志,2001,17(1)：40-42.
[68]余力,杨川,范志宏,等.内窥镜乳房整形的进展[J].实用美容整形外科杂志,2002,13(3)：143-145.
[69]栾杰,穆大力,刘晨,等.经腋窝入路内镜辅助双平面法解剖型假体隆乳术[J].中华整形外科杂志,2009,25(3)：175-177.
[70]余力,张波,王健,等.内窥镜腹壁整形术[J].组织工程与重建外科杂志,2005,1(1)：39-41.
[71]董立鹏,薛春玲,李荣强,等.内窥镜技术在脂肪抽吸手术中的应用[J].中国美容医学杂志,2002,11(3)：238-240.
[72]张颖涛.内窥镜脂肪抽吸的临床应用发展[J].川北医学院学报,2003,18(4)：169-171.
[73]卢彬,张树青,张澜成,等.内镜下超声脂肪抽吸术[J].中国美容医学,2003,12(1)：45-46.
[74]董立鹏,薛春玲,李荣强,等.内窥镜辅助脂肪抽吸36例[J].中华整形外科杂志,2002,18(6)：345.
[75]顾斌,李青峰,刘凯,等.胸部瘢痕治疗中应用内窥镜辅助扩张器置入的疗 效观察[J].中国临床康复,2004,8(32)：7339-7340.
[76]王志刚,杜红亚,熊立红,等.内窥镜在额颞部除皱术中的应用[J].中国美容医学,2009,18(12)：1739-1741.
[77]丁世凯,刘正茂.内窥镜下面部除皱术[J].重庆医学,2008,37(15)：1672.
[78]叶秀娣,乐淑君,虞渝生.内窥镜骨膜下额部除皱骨固定19例[J].中华整形外科杂志,2005,21(5)：342-344.
[79]Troulis M J, Ramirez J L, Kaban L B. Endoscopic approach for mandibular orthognathic surgery [J]. Facial Plast Surg Clin North Am,2006,14(1):45-50.
[80]Iwai T, Matsui Y, Tohnai I, et al. Endoscopic-assisted medial osteotomy during sagittal split ramus osteotomy[J]. J Plast Reconstr Aesthet Surg,2008,61(12): 1547-1548.
[81]Troulis M J, Kaban L B. Endoscopic vertical ramus osteotomy:Early clinical results[J]. J Oral Maxillofac Surg,2004,62(7):824-828.
[1]Bartlett SP, Wornom I 3rd, Whitaker LA. Evaluation of facial skeletal aesthetics and surgical planning[J]. Clin Plast Surg,1991,18(1):1-9.
[2]陈小平,林洁,杨甄宇,等.下面部轮廓过宽改型的新概念[J].中华整形外科杂志,2007,23(6)：540-541.
[3]Satoh K. Mandibular contouring surgery by angular contouring combined with genioplasty in orientals[J]. Plast Reconstr Surg,1998,101(2):461-472.
[4]Yang D B, Park C G. Mandibular contouring surgery for purely aesthetic reasons[J]. Aesthetic Plast Surg,1991,15(1):53-60.
[5]归来,侯全志,张智勇,等.口内入路下颌角肥大弧形截骨术[J].中华整形外科杂志,1999,15(5)：336-338.
[6]Morris D E, Moaveni Z, Lo L J. Aesthetic facial skeletal contouring in the asian patient[J]. Clin Plast Surg,2007,34(3):547-549.
[7]Whitaker L A. Aesthetic contouring of the facial support system[J]. Clin Plast Surg,1989,16(4):815-823.
[8]Han K, Kim J. Reduction mandibuloplasty:Ostectomy of the lateral cortex around the mandibular angle[J]. J Craniofac Surg,2001,12(4):314-325.
[9]Newton J P, Cowpe J G, Mcclure I J, et al. Masseteric hypertrophy?:Preliminary report[J]. Br J Oral Maxillofac Surg,1999,37(5):405-408.
[10]陈小平,宋建良,陈晓燕,等.方型脸改型术[J].中华整形外科杂志,1998(3)：169-172.
[11]徐永成,原林,李建辉.咬肌、翼内肌与下颌角肥大的相关性研究[J].中华医学美学美容杂志,2002,8(5)：250-253.
[12]Karasz I, Korondi L, Szabo G. Photoelastic stress-analysis on mandibular osteosynthesis[J]. Int J Oral Maxillofac Surg,1986,15(3):259-262.
[13]李慧超,李冬梅,归来,等.下颌角截骨整形手术前后下颌骨生物力学的三维有限元分析[J].中华整形外科杂志,2008,24(6)：416-420.
[14]王侠,李健宁,马勇光,等.下颌角测量与下颌角半盲视下改良截骨术[J].中华整形外科杂志,1998(3)：166-168.
[15]周智,柳大烈,刘志刚,等.汉族人下颌角相关测量与下颌角肥大诊断标准分析[11].第三军医大学学报,2006,28(7)：936-939.
[16]胡静,王大章,邹淑娟.经口内途径方颌畸形的外科矫治[J].临床口腔医学杂志,1999,15(1)：25-26.
[17]赵峰,高勃,刘震侠,等.Dicom标准和mimics软件辅助建立下颌骨三维有 限元模型[J].西南国防医药,2005,15(5)：479-481.
[18]赵延峰,郝云飞,陆平,等.基于三维CT配准技术的下颌矢状劈开去骨术的临床研究[J].华西口腔医学杂志,2009,27(5)：516-520.
[19]孔亮,胡开进,赵海涛,等.利用薄层CT技术和matlab软件辅助建立下颌骨三维有限元模型[J].实用口腔医学杂志,2004,20(2)：175-177.
[20]李月明,高月明,张万林.利用三维CT重建术研究面型与下颌骨内部结构的关系[J].哈尔滨医科大学学报,2005,39(4)：340-343.
[21]王吉昌,归来,张智勇,等.下颌神经管三维CT定位在下颌角截骨整形术中的应用[J].中华整形外科杂志,2008,24(5)：360-362.
[22]陈育哲,王侠,秦荣生,等.下颌截骨整体塑形术[J].中华整形外科杂志,2004,20(1)：45-47.
[23]王竞鹏,柳大烈,罗奇.面下部轮廓整形术的术式选择[J].中国美容医学,2009,18(9)：1235-1237.
[24]Kim S K, Han J J, Kim J T. Classification and treatment of prominent mandibular angle[J]. Aesthetic Plast Surg,2001,25(5):382-387.
[25]李自力,王兴,张熙恩,等.下颌角嚼肌肥大畸形的口内入路手术矫治[J].中华医学美学美容杂志,2005,11(2)：65-68.
[26]谢卫国,刘立刚,李淑良.三种入路下颌角肥大截骨术的比较[J].实用美容整形外科杂志,2003,14(5)：260-261.
[27]吴国平,何小川,蒋晓丽,等.口内入路下颌角弧形截骨联合下颌角外板矢状劈除矫治下颌角肥大[J].中华医学美学美容杂志,2009,15(4)：244-246.
[28]刘丽萍,高卓平,李素景.耳后切口下颌角肥大矫正术12例报告[J].陕西医学杂志,2004,33(8)：761-762.
[29]孙坚,孙弘.外耳后进路手术治疗下颌角与咬肌肥大[J].中国美容医学杂志,2001,10(1)：29-32.
[30]曹景敏,王慧,王标,等.耳后微创切口行下颌角肥大矫正术[J].中华整形外科 杂志,2004,20(2)：156-157.
[31]赵启明,第4届中国美容与整形医师大会论文集.下颌角肥大整形术及并发症的防治,2007.
[32]林卫,李世荣,毋巨龙等.口内外联合小切口下颌角肥大整形术[J].中国美容医学,2006,15(1)：50-52.
[33]张菊芳,张如鸿,王毅敏,等.口内外联合入路小切口下颌角肥大弧形截骨术[J].中华医学美学美容杂志,2002,8(3)：133-136.
[34]穆雄铮,王炜,杭榆,等.口内外联合进路下颌角肥大截骨整形术[J].中华整形烧伤外科杂志,1996,12(2)：104-106.
[35]陈小平,宋建良.下颌角肥大的治疗现状及进展[J].中华医学美学美容杂志,2007,13(2)：125-128.
[36]Adams W M. Bilateral hypertrophy of the masseter muscle-an operation for correction-case report[J]. Br J Plast Surg,1949,2(2):78-81.
[37]Baek S M, Kim S S, Bindiger A. The prominent mandibular angle-preoperative management, operative technique, and results in 42 patients[J]. Plast Reconstr Surg,1989,83(2):272-278.
[38]Jin H, Kim B G. Mandibular angle reduction versus mandible reduction[J]. Plast Reconstr Surg,2004,114(5):1263-1269.
[39]Hwang K, Lee D K, Lee W J, et al. A split ostectomy of mandibular body and angle reduction[J]. J Craniofac Surg,2004,15(2):341-346.
[40]Pu Z N, Zhang Y G, Yang J, et al. Mandibular angle ostectomy for chinese women:Approaches and extent determined by cephalometric analysis[J]. J Craniofac Surg,2009,20(1):105-110.
[41]Nagase T, Yoshimura K, Aiba E, et al. Angle-splitting ostectomy followed by face lift for elderly patients with prominent mandibular angles[J]. Plast Reconstr Surg,2005,115(2):633-640.
[42]Deguchi M, Iio Y, Kobayashi K, et al. Angle-splitting ostectomy for reducing the width of the lower face[J]. Plast Reconstr Surg,1997,99(7):1831-1839.
[43]Cui J, Zhu S, Hu J, et al. The effect of different reduction mandibuloplasty types on lower face width and morphology[J]. Aesthetic Plast Surg,2008,32(4): 593-598.
[44]Yang J Y, Wang L, Xu H S, et al. Mandibular oblique ostectomy:An alternative procedure to reduce the width of the lower face[J]. J Craniofac Surg,2009,20: 1822-1826.
[45]De Miranda S L, Abrah 鉶 M. Intraoral vertical ramus osteotomy endoscopic surgery[J]. J Oral Maxillofac Surg,2007,65(4):805-808.
[46]赵珍珍,宋建星.下颌角区域解剖结构特征与颅耳沟微创切口[J].中国组织工程研究与临床康复,2009,13(7)：1301-1304.
[47]范海东,王兴,张熙恩,等.改良下颌角矢状劈开去骨术在矫治中轻度下颌角嚼肌良性肥大畸形中的应用[J].现代口腔医学杂志,2001,15(1)：18-20.
[48]Song H S, Park C G. Masseter muscle atrophy after ostectomy of the mandibular angle in rabbits[J]. Plast Reconstr Surg,1997,99(1):51-60.
[49]杜本军,柳大烈,梁莉,等.下颌角磨削去骨术前后咬肌变化[J].第三军医大学学报,2005,27(23)：2376-2378.
[50]付国友,柳大烈,单磊,等.下颌角整形术中去咬肌和不去咬肌两种术式对下颌运动功能的影响[J].中国临床康复,2006,10(25)：134-135.
[51]赵弘宇,罗永萍,林华.局部浸润麻醉口内切口下面部整形术[J].中华医学美学美容杂志,2005,11(5)：273-276.
[52]Katsumata A, Fujishita M, Ariji Y, et al.3d ct evaluation of masseter muscle morphology after setback osteotomy for mandibular prognathism[J]. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology,2004,98(4): 461-470.
[53]Ueki K, Okabe K, Mukozawa A, et al. Assessment of ramus, condyle, masseter muscle, and occlusal force before and after sagittal split ramus osteotomy in patients with mandibular prognathism[J]. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology,2009,108(5):679-686.
[54]陈小平,林洁,沈剑,等.下颌骨角全层截骨加下颌骨外板劈除行方形脸改型术[J].中华医学美学美容杂志,2008,14(4)：249-251.
[55]许龙顺,张灵芝,何佑成,等.口内入路弧形截骨治疗下颌角肥大[J].中国美容医学,2004,13(4)：446-447.
[56]Hwang K, Kim Y J, Park H, et al. Selective neurectomy of the masseteric nerve in masseter hypertrophy [J]. J Craniofac Surg,2004,15(5):780-784.
[57]Von Lindern J J, Niederhagen B, Appel T, et al. Type a botulinum toxin for the treatment of hypertrophy of the masseter and temporal muscles:An alternative treatment[J]. Plast Reconstr Surg,2001,107(2):327-332.
[58]Al-Ahmad H T, Al-Qudah M A. The treatment of masseter hypertrophy with botulinum toxin type a[J]. Saudi Medical Journal,2006,27(3):397-400.
[59]Park M Y, Ahn K Y, Jung D S. Botulinum toxin type a treatment for contouring of the lower face[J]. Dermatol Surg,2003,29(5):477-483.
[60]冯传波,高建华,刘红梅.肉毒杆菌毒素A注射治疗良性咬肌肥大[J].中国临床康复,2006,10(36)：45-47.
[61]刘玉生,柳大烈,杜本军,等.肌注肉毒毒素A和糖皮质激素治疗咬肌肥大[J].中国美容医学,2006,15(3)：265-267.
[62]Dubin B, Jackson I T, Halim A, et al. Anatomy of the buccal fat pad and its clinical significance [J]. Plast Reconstr Surg,1989,83(2):257-264.
[63]Jackson I T. Anatomy of the buccal fat pad and its clinical significance[J]. Plast Reconstr Surg,1999,103(7):2059-60; discussion 2061-2063.
[64]Stuzin J M, Wagstrom L, Kawamoto H K, et al. The anatomy and clinical applications of the buccal fat pad[J]. Plast Reconstr Surg,1990,85(1):29-37.
[65]Zhang H M, Yan Y P, Qi K M, et al. Anatomical structure of the buccal fat pad and its clinical adaptations[J]. Plast Reconstr Surg,2002,109(7):2509-2518; discussion 2519-2520.
[66]黄海龙,韦嫚,周挺.颊脂垫的解剖及其在面颊部整形美容外科中的应用[J].解剖学研究,2008,30(5)：375-377.
[67]黄鲜,曹阳,黄伟光.颊脂肪垫的应用解剖及切除术[J].重庆医学,2006,35(24)：2280-2281.
[68]邱涛.面中部纤维脂肪垫的解剖和临床应用研究[D].2009.
[69]张树民.带蒂颊脂垫瓣在口腔内软组织缺损修复中的应用[J].口腔颌面外科杂志,2009,19(1)：47-48.
[70]胡克苏,蒋平,王磊,等.颊脂垫部分摘除术的临床体会[J].中国美容医学,2009,18(10)：1458-1459.
[71]李俊,黄金龙,沈干,等.颊脂垫摘除术26例总结[J].中国美容整形外科杂志,2008,19(1)：58.
[72]邵宏,彭晓云.颊脂垫吸除联合A型肉毒毒素咬肌多点注射瘦脸术[J].中国美容医学,2004,13(5)：562-564.
[73]田立粮,刘志刚.颊脂垫切除术38例分析[J].齐齐哈尔医学院学报,2008,29(9)：1073.
[74]严义坪,张海明.颊脂肪垫的解剖结构及其在面颊部整形手术中的意义[J].中国美容医学杂志,2001,10(4)：272-276.
[75]Hwang K, Kim Y J, Chung I H, et al. Deep middle masseteric artery (dmma) attributed to hemorrhage in resection of masseter muscle and mandibular angle[J]. J Craniofac Surg,2001,12(4):381-385; discussion 386.
[76]冯传波,李学雷,高建华.下颌后静脉的形态学特点及其临床意义[J].中国临床解剖学杂志,2006,24(4)：390-392.
[77]阎晓辉.去除肥大下颌角手术时对面动脉出血的处理[J].海军总医院学报,2005,18(1)：53-54.
[78]廖进民,陈海芳,李忠华,等.下颌支截骨术手术入路的应用解剖学研究[J].解剖与临床,2007,12(3)：152-156.
[79]雷涛,徐达传,高建华.除皱术中防止面神经下颌缘支损伤的解剖学研究[J].中华医学美学美容杂志,2004,10(1)：18-20.
[80]洪丽,安高,彭田红.面神经下颌缘支主干的定位解剖学研究[J].南华大学学报：医学版,2005,33(4)：485-488.
[81]黄绿萍,归来,张智勇,等.下颌角肥大矫治术及其常见并发症的处理[J].中华整形外科杂志,2003,19(5)：364-366.
[82]Hwang K, Han J Y, Kil M S, et al. Treatment of condyle fracture caused by mandibular angle ostectomy[J]. J Craniofac Surg,2002,13(5):709-712.
[83]Han K, Kim J. Reduction mandibuloplasty:Ostectomy of the lateral cortex around the mandibular angle[J]. J Craniofac Surg,2001,12(4):314-325.
[84]Haibo Liu,Zihai Ding Endoscopically assisted prominent mandibular angle contouring surgery with postauricular incision[J]. During modify