颧部修复重建的临床应用解剖研究
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摘要
目的：
①对颧部进行专题解剖研究，以期为颧部修复重建手术的开展提供
应用基础理论；
②研究颧骨整形的立体可视化和手术仿真模拟；
③探讨颧骨缩小术和颅骨、锁骨、肋骨、髂骨等骨皮瓣颧骨修复再
造术的方法和解剖要点。
材料与方法：
①解剖15例30侧防腐成人头部标本和9例18侧新鲜成人头部标本；
②观察头面部血管铸型标本10例18侧；
③解剖2具成人尸体标本；
④复习有关解剖资料；
⑤应用3DCMFCAS操作系统。
结果：
①颧骨是面部较突出的部位，影响容貌的特征之一，由菱形的骨体
与4个骨突组成，有3个面和5个缘。
②除颧大肌起自颧骨体与颧弓的交界处，咬肌起于颧弓下缘、颧弓颧
骨的内侧面外，其余部位无肌肉附着，颧骨呈“游离”状。
③颞深筋膜起自颞肌附着缘，由单层逐渐分为深浅两层向下分别附着
于颧弓上缘的内侧面和外侧面，两者之间含有脂肪垫，并在其上部有颞中
静脉走行。经颞深筋膜的深、浅两层之间的间隙直接达颧弓上缘是安全的
手术入路。
④面神经的颞支和颧支在颧弓下缘出腮腺，出腮腺后由腮腺筋膜分
隔包裹走行于SMAS和深筋膜之间的SMAS下层内，斜向前上方行走并
逐渐分支，于肌肉的深面进入并支配之。
⑤3DCMFCAS可进行颧骨缩小术等手术的仿真模拟，可用于手术前的
讨论和制定手术方案和临床教学等。但目前只能进行硬组织的切割和移
位，不能预测手术后面部软组织和外观的变化，不能用于颧骨切削缩小术
和双侧颧骨扩增术的模拟，不能与精细的电脑加工机械连接在体外复制出
模型和加工制作植入体，有待于进一步开发研究。
⑤颧骨有丰富的血供，滋养动脉从颧骨的后内侧缘进入骨内经颧面
孔穿出成为颧面动脉。面横动脉、颗饯动脉、眶下动脉。面动脉及上颌动
脉均有分支达颧骨周围组织，井有细小血管经骨膜供养颧骨。
①在颧弓平面下颌骨冠突与颧骨间的距离为（1．3士3．6）nun及该处
颧骨的厚度为（8．8士2．3）mm，冠突与颧弓间的距离为（6．5土 1．2）mm
及该处颧弓的厚度为Q．3土0．4）M。
③颅骨、锁骨、肋骨和骼骨具有一定的弧度适合于颧骨的修复重建，
根据颅骨、锁骨、肋骨和骼骨等部位的解剖和血供特点可设计额部扩张皮
瓣复合额顶颅骨瓣转移、颈部扩张皮瓣带锁骨转移、胸背动脉蒂第11、12
肋骨皮瓣游离移植或带蒂转移、双蒂骼骨皮瓣游离移植修复颧骨部位的骨
及软组织缺损，各有其优缺点。
结论：
①观察了颧部的组织层次及颧骨的形态、颧骨与肌肉的关系、颧骨
与颗浅、深筋膜的关系、颧骨与面神经的关系。颧骨的血液供应、颧骨与
下颌骨冠突的关系（颧骨后间隙）井于颧弓平面测量颧骨颧弓的厚度等。
②3DCMFCAS具有三维重建达到立体可视化效果，可手术仿真模拟。
可用于手术前的讨论和制定手术方案和临床教学等优点。但仍有许多不足
有待于进一步开发研究。
③分析总结了颧骨手术入路的解剖要点。颧部理想手术层次是在骨
膜下，可减少面神经的损伤。
④颧骨磨削术适合于颧骨骨质较厚者，最大磨削厚度为颧骨厚度的
一半。颧骨截骨缩小术适合于颧骨颧弓向前向外隆凸颧骨后间隙增宽者，
提出了解剖安全线和临床实用截骨线。
⑤额部皮肤扩张复合颅骨瓣、颈胸部预扩张皮瓣带半片锁骨转移。
胸背动脉蒂第 11。12肋骨皮瓣、双蒂骼骨皮瓣游离移植在修复颧部方面
有良好的血供基础和意义，各有其优、缺点。
Object:
o provide anatomic basis for the reconstruction of the zygomatic region , the special topic research of zygomatic region was taken.
(2)To study the operation mimesis of the zygomatic plastic.
(3)To research the technique and anatomic key points of the zygomatic reduction and the zygomatic reconstaiction with bone flaps of the calvarial bone, clavicle, rib, iliac.
Methods:
?0 sides of 15 antisepsis adult head specimens and 18 sides of 9 fresh adult head specimens were studied.
(2)18 sides of 10 blood vessel cast head specimens were observed.
(3)2 adult cadavers were anatomized.
(4)The related anatomic materials were reviewed. ㏕he 3DCMFCAS was applied.
Results:
㎝alar is the prominent part and appearance feature of face, consists of a rhombic bone body and 4 processuses.
(2)M. zygomatic major origins from the boundary point between zygomatic body and arch, M. masseter origins from the margo inferior of the zygomatic arch and the medial aspect of zygomatic bone; except the two muscles, there are no muscles attaching to zygomatic bone, which is "dissociated".
(3)The deep temporal fascia origins from the attachment edge of M. temporal and divides into two lamellas(the deep and superficial lamellas), which attach to the lateral and medial sides of the zygomatic arch respectively. There is a fat pad between the two lamellas. V. temporalis media travels in the upside of the fat pad. The secure operation pathway is passing through the
-3-
interspace between the deep and superficial lamellas to the superior edge of the zygomatic arch.
(4)R. temporales and R. zygomatici come out of the parotid gland at the margo inferior of the zygomatic arch(segregated and bundled by the parotid fascia), run forward and up, ramify gradually in the lamella under the SMAS, and go into the depth of muscle and innervate it.
(?3DCMFCAS can be used to simulate the zygomatic reduction, the sclerous tissues can be cut and displaced, but the change of the appearance and the soft tissue of face cannot be predicted. 3DCMFCAS cannot be used to simulate the zygomatic cutting reduction and the zygomatic augmentation. 3DCMFCAS cannot be used to link with a meticulous machine to reproduce a model or form an implant.
㏕here have rich blood supply in zygomatic bone. The nutrient artery goes into the zygomatic bone from the posterior margo medialis, becomes the zygomaticofaciale artery out of the zygomaticofaciale foramen. The periosteum arteries origin from the A. transversa faciei, the A. temporalis superficialis, the A. infraoribitalis, the A. facialis, the A. maxillaris and so on.
㏕he distance between the processus coronoideus and the malar is 12.3 + 3.6m and the thickness of malar in this point is 9.8?.3mm; The distance between the processus coronoideus and the malar arch is 5.2+ 1.2mm and the thickness of malar arch in this point is 3.3 ?.4mm<>
㏕he calvarial bone, clavicle, rib and iliac have a radian and are suited to the zygomatic reconstruction. The expanded forehead flap with scapular bone, the expanded cervix flap with clavicle, the eleventh or twelfth rib flap with the arteriae thoracodorsalis pedicle and the iliac flap with double pedicles are designed by the characteristic of the anatomy and blood supply. Those flaps are suited for the zygomatic reconstruction with different advantages and disadvantages.
Conclusion:
㏕he tissue structure of the zygomatic region and the shape of the zygomatic bone were observed. The relation between zygomatic bone and muscle, the relation between zygomatic bone and the deep and superficial temporal fascia, the relation between zygomatic bone and the face nerve, the blood supply of zygomatic bone, the relation between zygomatic bone and the coronoid process were researched.
(2)3DCMFCAS can be used for simulating the operations, discussing and making an operation plan preoperation, teaching, and so on; but it has a lot of disadvantages, should be developed.
(3)Anatomic key points of the zygomatic operation were summarized. To decrease the dam
①对颧部进行专题解剖研究，以期为颧部修复重建手术的开展提供
应用基础理论；
②研究颧骨整形的立体可视化和手术仿真模拟；
③探讨颧骨缩小术和颅骨、锁骨、肋骨、髂骨等骨皮瓣颧骨修复再
造术的方法和解剖要点。
材料与方法：
①解剖15例30侧防腐成人头部标本和9例18侧新鲜成人头部标本；
②观察头面部血管铸型标本10例18侧；
③解剖2具成人尸体标本；
④复习有关解剖资料；
⑤应用3DCMFCAS操作系统。
结果：
①颧骨是面部较突出的部位，影响容貌的特征之一，由菱形的骨体
与4个骨突组成，有3个面和5个缘。
②除颧大肌起自颧骨体与颧弓的交界处，咬肌起于颧弓下缘、颧弓颧
骨的内侧面外，其余部位无肌肉附着，颧骨呈“游离”状。
③颞深筋膜起自颞肌附着缘，由单层逐渐分为深浅两层向下分别附着
于颧弓上缘的内侧面和外侧面，两者之间含有脂肪垫，并在其上部有颞中
静脉走行。经颞深筋膜的深、浅两层之间的间隙直接达颧弓上缘是安全的
手术入路。
④面神经的颞支和颧支在颧弓下缘出腮腺，出腮腺后由腮腺筋膜分
隔包裹走行于SMAS和深筋膜之间的SMAS下层内，斜向前上方行走并
逐渐分支，于肌肉的深面进入并支配之。
⑤3DCMFCAS可进行颧骨缩小术等手术的仿真模拟，可用于手术前的
讨论和制定手术方案和临床教学等。但目前只能进行硬组织的切割和移
位，不能预测手术后面部软组织和外观的变化，不能用于颧骨切削缩小术
和双侧颧骨扩增术的模拟，不能与精细的电脑加工机械连接在体外复制出
模型和加工制作植入体，有待于进一步开发研究。
⑤颧骨有丰富的血供，滋养动脉从颧骨的后内侧缘进入骨内经颧面
孔穿出成为颧面动脉。面横动脉、颗饯动脉、眶下动脉。面动脉及上颌动
脉均有分支达颧骨周围组织，井有细小血管经骨膜供养颧骨。
①在颧弓平面下颌骨冠突与颧骨间的距离为（1．3士3．6）nun及该处
颧骨的厚度为（8．8士2．3）mm，冠突与颧弓间的距离为（6．5土 1．2）mm
及该处颧弓的厚度为Q．3土0．4）M。
③颅骨、锁骨、肋骨和骼骨具有一定的弧度适合于颧骨的修复重建，
根据颅骨、锁骨、肋骨和骼骨等部位的解剖和血供特点可设计额部扩张皮
瓣复合额顶颅骨瓣转移、颈部扩张皮瓣带锁骨转移、胸背动脉蒂第11、12
肋骨皮瓣游离移植或带蒂转移、双蒂骼骨皮瓣游离移植修复颧骨部位的骨
及软组织缺损，各有其优缺点。
结论：
①观察了颧部的组织层次及颧骨的形态、颧骨与肌肉的关系、颧骨
与颗浅、深筋膜的关系、颧骨与面神经的关系。颧骨的血液供应、颧骨与
下颌骨冠突的关系（颧骨后间隙）井于颧弓平面测量颧骨颧弓的厚度等。
②3DCMFCAS具有三维重建达到立体可视化效果，可手术仿真模拟。
可用于手术前的讨论和制定手术方案和临床教学等优点。但仍有许多不足
有待于进一步开发研究。
③分析总结了颧骨手术入路的解剖要点。颧部理想手术层次是在骨
膜下，可减少面神经的损伤。
④颧骨磨削术适合于颧骨骨质较厚者，最大磨削厚度为颧骨厚度的
一半。颧骨截骨缩小术适合于颧骨颧弓向前向外隆凸颧骨后间隙增宽者，
提出了解剖安全线和临床实用截骨线。
⑤额部皮肤扩张复合颅骨瓣、颈胸部预扩张皮瓣带半片锁骨转移。
胸背动脉蒂第 11。12肋骨皮瓣、双蒂骼骨皮瓣游离移植在修复颧部方面
有良好的血供基础和意义，各有其优、缺点。
Object:
o provide anatomic basis for the reconstruction of the zygomatic region , the special topic research of zygomatic region was taken.
(2)To study the operation mimesis of the zygomatic plastic.
(3)To research the technique and anatomic key points of the zygomatic reduction and the zygomatic reconstaiction with bone flaps of the calvarial bone, clavicle, rib, iliac.
Methods:
?0 sides of 15 antisepsis adult head specimens and 18 sides of 9 fresh adult head specimens were studied.
(2)18 sides of 10 blood vessel cast head specimens were observed.
(3)2 adult cadavers were anatomized.
(4)The related anatomic materials were reviewed. ㏕he 3DCMFCAS was applied.
Results:
㎝alar is the prominent part and appearance feature of face, consists of a rhombic bone body and 4 processuses.
(2)M. zygomatic major origins from the boundary point between zygomatic body and arch, M. masseter origins from the margo inferior of the zygomatic arch and the medial aspect of zygomatic bone; except the two muscles, there are no muscles attaching to zygomatic bone, which is "dissociated".
(3)The deep temporal fascia origins from the attachment edge of M. temporal and divides into two lamellas(the deep and superficial lamellas), which attach to the lateral and medial sides of the zygomatic arch respectively. There is a fat pad between the two lamellas. V. temporalis media travels in the upside of the fat pad. The secure operation pathway is passing through the
-3-
interspace between the deep and superficial lamellas to the superior edge of the zygomatic arch.
(4)R. temporales and R. zygomatici come out of the parotid gland at the margo inferior of the zygomatic arch(segregated and bundled by the parotid fascia), run forward and up, ramify gradually in the lamella under the SMAS, and go into the depth of muscle and innervate it.
(?3DCMFCAS can be used to simulate the zygomatic reduction, the sclerous tissues can be cut and displaced, but the change of the appearance and the soft tissue of face cannot be predicted. 3DCMFCAS cannot be used to simulate the zygomatic cutting reduction and the zygomatic augmentation. 3DCMFCAS cannot be used to link with a meticulous machine to reproduce a model or form an implant.
㏕here have rich blood supply in zygomatic bone. The nutrient artery goes into the zygomatic bone from the posterior margo medialis, becomes the zygomaticofaciale artery out of the zygomaticofaciale foramen. The periosteum arteries origin from the A. transversa faciei, the A. temporalis superficialis, the A. infraoribitalis, the A. facialis, the A. maxillaris and so on.
㏕he distance between the processus coronoideus and the malar is 12.3 + 3.6m and the thickness of malar in this point is 9.8?.3mm; The distance between the processus coronoideus and the malar arch is 5.2+ 1.2mm and the thickness of malar arch in this point is 3.3 ?.4mm<>
㏕he calvarial bone, clavicle, rib and iliac have a radian and are suited to the zygomatic reconstruction. The expanded forehead flap with scapular bone, the expanded cervix flap with clavicle, the eleventh or twelfth rib flap with the arteriae thoracodorsalis pedicle and the iliac flap with double pedicles are designed by the characteristic of the anatomy and blood supply. Those flaps are suited for the zygomatic reconstruction with different advantages and disadvantages.
Conclusion:
㏕he tissue structure of the zygomatic region and the shape of the zygomatic bone were observed. The relation between zygomatic bone and muscle, the relation between zygomatic bone and the deep and superficial temporal fascia, the relation between zygomatic bone and the face nerve, the blood supply of zygomatic bone, the relation between zygomatic bone and the coronoid process were researched.
(2)3DCMFCAS can be used for simulating the operations, discussing and making an operation plan preoperation, teaching, and so on; but it has a lot of disadvantages, should be developed.
(3)Anatomic key points of the zygomatic operation were summarized. To decrease the dam
引文
1 Sumiya N, Kondo S, Ito Y, et al. Reduction malarplasty. Plast Reconstr Surg, 1997, 100(2) : 461-467
2 Hwang YJ, Jeon JY, Lee MS. A simple method of reduction malarplasty. Plast Reconstr Surg, 1997, 99(2) : 348-355
3 Satoh K, Ohkubo F, Tsukagoshi T. Consideration of operative procedures for zygomatic reduction in Orientals: based on a consecutive series of 28 clinical cases. Plast-Reconstr-Surg, 1995, 96(6) : 1298-1306
4 Yang DB, Park CG. Infracture technique for the zygomatic body and arch reduction. Aesthetic Plast Surg.1992, 16(4) : 355-363
5 Cho BC, Lee JH, Baik BS. Reduction malarplasty using sliding setback osteotomy. J Craniofac Surg. 1998, 9(3) : 275-279
6 Kim JW. Laser-assisted endoscopic reduction malarplasty in Asians: quick combined surgery. Aesthetic Plast Surg. 1998 , 22(4) : 289-297
7 Logani SC, Conn H, Logani S, et al. Paralytic ectropion: a complication of malar implant surgery. Ophthal Plast Reconstr Surg. 1998, 14(2) : 89-93
8 Hirano S, Shoji K, Kojima H, et al. Use of hydroxyapatite for reconstruction after surgical removal of intraosseous hemangioma in the zygomatic bone. Plast Reconstr Surg. 1997, 100(1) : 86-90
9 Ivy EJ, Lorenc ZP, Aston SJ. Malar augmentation with silicone implants. Plast Reconstr Surg. 1995, 96(1) : 63-68
10 Mommaerts MY, Abeloos JV, De-Clercq CA, et al. The 'sandwich' zygomatic osteotomy: technique, indications and clinical results. J Craniomaxillofac Surg. 1995, 23(1) : 12-191
11 Adams JR, Kawamoto HK. Late infection following aesthetic malar augmentation with proplast implants. Plast Reconstr Surg. 1995, 95(2) : 382-384
12 Lane AG, Johnson CS, Costantino PD. Pedicled osseous flaps. Otolaryngol Clin North Am. 1994, 27(5) : 927-54
13． Kamiji T, Fujikawa M, Honda T, et al. Restoration of the mandible by full-thickness calvaria bone flap. Ann Plast Surg, 1992,29(5) : 438-443
14 De-Ponte FS, Becelli R, Rinna C, et al. Aesthetic and functional reconstruction in intraosseus hemangiomas of the zygoma. J Craniofac Surg. 1995,6(6) : 506-509
15 Kyutoku S, Tsuji H, Inoue T, ct al. Plast Reconstr Surg. 1999 , 103(2) : 395-402
16 Jensen J, Reiche FO, Sihdet PS. Autogenous mandibular bone grafts for malar augmentation. J Oral Maxillofac Surg. 1995, 53(1) : 88-90
17 Tideman H, Samman N, Cheung LK. Immediate reconstruction following maxillectomy: a new method. Int J Oral Maxillofac Surg. 1993, 22(4): 221-225
18 Fukuta K, Jackson IT, Topf JS. Facial lawn mower injury treated by a vascularized costochondral graft. J Oral Maxillofac Surg. 1992, 50(2): 194-198
19 Wittkampf AR, Zonneveld FW. [The use of 3-dimensional models in craniofacial surgery]. Ned Tijdschr Geneeskd. 1996, 140(26): 1353-1358
20 Arvier JF, Barker TM, Yau YY, et al. Maxillofacial biomodelling. Br J Oral Maxillofac Surg, 1994, 32(5): 276-283
21 Arvier J. Malar recontouring using 3D bio-modelling. Ann R Australas Coll Dent Stag, 1996, 13:137-140
22 Yau YY, Arvier JF, Barker TM. Technical note: maxillofacial biomodelling—preliminary result. Br J Radiol, 1995, 68(809): 519-523
23 杨月如．国人颧骨的观察．昆明医学院学报，1987，8(2)：33-39
24 Baek SM, Chung YD, Kim SS. Reduction malarplasty. Plast Recostr Surg, 1991,88:53-58
25 孙弘，孙坚．高颧骨畸形矫正术．实用美容整形外科杂志,1997,8(3)：136-138
26 Salas E, Ziyal IM, Bejjani GK, et al. Anatomy of the frontotemporal branch of the facial nerve and indications for interfascial dissection. Neurosurgery, 1998, 43(3): 563-568;
27 郑国焱．计算机辅助外科手术系统技术进展和应用．国外医学生物医学工程分册，1995，18(4)：202-209
28 Thomas A, Mustoc Hongshik Han. The effect of new technologes on plastic surgery. Arch Surg, 1999,134(11): 1178
29 宋志巍，余咏梅，胡碧芳，等．三维 CT 在颌面部整形修复中的应用．中华整形外科杂志，2000，16(5)：315-317
30 Marden E, Alder D, Thomas D, et al. Clinical usefulness of two-dimensional reformatted and three-dimensionally rendered computerized tomographic images. J Oral Maxillofac Surg, 1995, 53:375-386
31 Marsh L J, Vannier MW. The "third" dimension in craniofacial surgery. Plast Reconstr Sueg, 1983,71:759-767
32 张辉，鲁开化，郭树忠．计算机图像处理技术在整形美容外科的应用．中国美容医学杂志，2000,9(5)：386-388
33 Altobelli DE, Kikinis R, Mulliken JB et al. Computer-assisted three-dimensional planning in cranionfacial surgery. Plast Reconstr Surg, 1993, 92(4):576-579
34 Eufinger H, Wehmoller M, Harders A et al. Prefabricated prostheses for the reconstruction of skull defects. Int J Oral Maxillofac Surg, 1995,24(1): 104-108
35 Voigt M, Schaefer DJ, Andree C. Three-dimensional reconstruction of a defect of the frontozygomatic area by custom made Proplast Ⅱ implant. Eur J Plast Surg,2000,23:391-394
36 刘基光．颅骨瓣在颌面外科的应用．国外医学·口腔医学分册，1988,15(1)：4-8
37 Antonyshyn O, Colcleugh RG, Hurst LN, et al. The temporalis myo-osseous flap: an experimental study. Plast Reconstr Surg, 1986, 77(3): 406-415
38 Fasano D, Menoni V, Riberti C, et al. The temporalis osteomuscular flap versus the free calvarial bone graft. An experimental study in the growing rabbit. J Craniomaxillofac Surg. 1987, 15(6): 332-341
39 Antonyshyn O, Colcleugh RG, Anderson C. Growth potential in suture bone inlay grafts: a comparison of vascularized and free calvarial bone grafts. Plast Reconstr Surg. 1987, 79(1): 1-11
40 Grotting JC, Psillakis JM, Casanova R, et al. Craniofacial reconstruction after tumor resections using vascularized outer table calvarial bone flaps. Am J Surg, 1986, 152:438- 440
41 Psillakis JM, Grotting JC, Casanova R, et al. Vasculariazed outer-table calvarial bone flaps. Plast Reconstr Surg, 1986,78:309-321
42 高学宏，宁金龙，李晓静，等．带颞浅血管筋膜蒂的颅骨外板复合瓣移位修复额面部缺损．安徽医科大学学报，1996，31(6)：492-493
43 王佳琦，戚可名，吕唯，等．蒂颞浅动脉蒂颅骨外板移植修复面部凹陷畸形．中华整形烧伤外科杂志，1994，10(3)：190-2
44 陈乃俊，林李嵩，施斌，等．带蒂颅骨外板在颌面整复中的应用．口腔颌面外科杂志，1998，8(4)：245-247
45 李正斌，王琪影，王剑，等．应用前额岛状皮瓣快速扩张法性鼻再造术．实用美容整形外科杂志，1999，10(1)：10-11
46 彭田红，徐达传，许本柯．带颞浅血管颅骨瓣修复颌面骨缺损的应用解剖．中国临床解剖学杂志，2001，19(1)：38-40
47 Court BC, Josegh GM, Alejandro B. Bblood supply of the upper craniofacial skeleton: the search for composite calvarial bone flaps. Plast Reconstr Surg, 1984,74:603-610
48 Rafael C, David C, James C, et al. Anatomic basis for vascularized outer-table calvarial bone flaps. Plast Reconstr Surg, 1986,78:300-308
49 Jorge MP, James CC, Rafael C, et al. Vascularized outer-table calvarial bone flaps. Plast Reconstr Surg, 1986,78:309-317
50 鲁开化，艾玉峰，郭树忠．扩张后皮瓣在修复重建外科的应用．中国修复重建外科杂志,1996,10(2)：65-66
51 Hell B, Tischer A, Heissler E, et al. A method for the bony and dental reconstruction of the maxilla in dentate patients. Int J Oral Maxillofac Surg. 1997, 26(5): 369-373
52 Gratz KW, Sailer HF, Haers PE, et al. Mandibular reconstruction with full thickness calvarial bone and temporal muscle flap. Br J Oral Maxillofac Surg. 1996, 34(5): 379-385
53 Kamiji T, Fujikawa M, Honda T, et al. Restoration of the mandible by full-thickness calvarial bone flap. Ann PIast Surg, 1992, 29(5): 438-443
54 李光武，高杰，吴仁秀．颅骨移植的显微外科解剖学观测．安徽医科大学学报，1998，33(4)：262-264
55 李曦光，赵连岐，张亚洲，等．带胸锁乳突肌蒂的半片锁骨瓣修复下颌骨缺损．中华口腔医学杂志，1986，21(2)：105-106
56 叶延荣，张添炳，蔡铭奇，胸锁乳突肌蒂带复合半片锁骨瓣重建下颌骨节段性缺损．中华口腔医学杂志，1985，20(5)：293
57 孙弘，王勇，张付初。双侧胸锁乳突肌蒂半片锁骨一期修复下颌骨小颌畸形．中国修复重建外科学杂志，1994，8(1)：21-22
58 林毅，欧子民．胸锁乳突肌皮瓣带锁骨修复下颌骨缺损16例报告．广西医学，1997，19(2)：297-298
59 蔡建通，许卫红，郑和平．胸锁乳突肌锁骨头蒂半片锁骨瓣修复锁骨肩峰端的应用解剖学．福建医科大学学报，1998，32(3)：243-245
60 马继任，苑正太．双侧颈胸皮瓣在颌颈部瘢痕挛缩整复中的应用．中国修复重建外科杂志，1994；8(4)：230-231
61 张仲，李彤，邹鸣岚，等．颈肩胸区真皮下血管网薄皮瓣在面颈部整复中的应用．中华整形烧伤外科杂志,1995,11(2)：93-95
62 孟庆延，贾军，陈勉增，等．颈胸部真皮下血管网皮瓣的血供特点及临床应用，实用美容整形外科杂志，1999，10(1)：15-17
63 李谆，原林，高岚，等．颈胸前筋膜皮瓣修复颈前瘢痕的解剖学研究．中国美容医学杂志，9(5)：331-333
64 Deslaugiers B, Vaysse P, Combes JM, et al. Contribution to the study of the tributaries and the termination of the external jugular vein. Surg Radiol Anat. 1994; 16(2): 173-177
65 贺忠文，袁志芳，闫国富，等．皮肤扩张术机理探讨，中华整形外科杂志，2000，16(2)：84-86
66 王佳琦，陈建，刘珍君，等．颈胸联合皮瓣扩张修复面颊部瘢痕．中华整形烧伤外科杂志，1997，13(4)：311
67 Hurwitz DJ, Babson JA, Futrell JW. The anantomic basis for the platysma skin flap. Plast reconstr surg, 1983,72(3):302-312
68 Ozcelik T, Aksoy S, Gokler A. Platysma myocutaneous flap: use for intraoral reconstruction. Otolaryngol Head Neck Surg. 1997, 116(4): 493-496
69 马显杰，鲁开化，艾玉峰．应用多个扩张器修复面颈部瘢痕．中国修复重建外科杂志，2000，14(1)：33-34
70 Bhathena HM, Kavarana NM. Primary reconstruction of head and neck cancer with anterior rib, osteomyocutaneous composite flap. Head Neck. 1992, 14(3): 183-187
71 Ohsumi N, Shimamoto R, Tsukagoshi T. Free composite latissimus dorsi muscle-rib flap not containing the intercostal artery and vein for reconstruction of bone and soft-tissue defects. Plast Reconstr Surg. 1994,94(2): 372-378
72 Hui KC, Zhang F, Lineaweaver WC, et al. Serratus anterior-rib composite flap: anatomic studies and clinical application to hand reconstruction. Ann Plast Surg. 1999, 42(2): 132-136
73 de-Azevedo JF. Pectoralis minor flaps: an experimental study and clinical applications of osteomuscular, osteomyocutaneous, and myocutaneous models. Head Neck Surg. 1987, 9(4): 211-222
74 Bhathena H, Kavarana NM. One-stage total mandibular reconstruction with rib, pectoralis major osteomyocutaneous flap. Head Neck Surg. 1986,8(3): 211-213
75 Yamamoto Y, Sugihara T, Kuwahara H, et al. An anatomic study for the rectus abdominis myocutaneous flap combined with a vascularized rib. Plast Reconstr Surg. 1995, 96(6): 1336-1340
76 Gucer T, Oge K, Ozgur F. Is it necessary to use the angular artery to feed the scapular tip when preparing a latissimus dorsi osteomyocutaneous flap?: case report. J Reconstr Microsurg. 2000, 16(3): 197-200
77 Yamamoto Y, Sugihara T, Kawashima K, et al. An anatomic study of the latissimus dorsi-rib flap: an extension of the subscapular combined flap. Plast Reconstr Surg. 1996, 98(5): 811-816
78 Maruyama Y, Onishi K, Iwahira Y, et al. Free compound rib-latissimus dorsi osteomusculocutaneous flap in reconstruction of the leg. J Reconstr Microsurg. 1986, 3(1): 13-18
79 Hayashi A, Maruyama Y. Subclavicular approach in head and neck reconstruction with the latissimus dorsi musculocutaneous flap. Br J Plast Surg. 1991, 44(1): 71-74
80 Horng SY, Chen MT. Reversed cephalic vein: a lifeboat in head and neck free-flap reconstruction [see comments]. Plast Reconstr Surg. 1993, 92(4): 752-753
81 苗华，尹正银，黄恭康．髂嵴前部的血液供应．解剖学报，1981，12(4)：376-377
82 王拴科，张凤岗，张祥生，等．旋髂深血管髂骨瓣的临床应用．中华显微外科杂志，1996，19(4)：267-269
83 Thein T, Kreidler J, Stocker E, et al. Morphology and blood supply of the iliac crest applied to jaw reconstruction. Surg Radiol Anat. 1997; 19(4): 217-225
84 Kuzbari R, Worseg A, Burggasser G, et al. The external oblique muscle free flap. Plast Reconstr Surg. 1997 Apr; 99(5): 1338-45
85 Minami A, Ogino T, Itoga H. Vascularized iliac osteocutaneous flap based on the deep circumflex iliac vessels: experience in 13 cases. Microsurgery. 1989; 10(2): 99-102
86 David DJ, Tan E, Katsaros J, et al. Mandibular reconstruction with vascularized iliac crest: a 10-year experience. Plast Reconstr Surg. 1988, 82(5): 792-803
87 Quillen CG, Wiener B, Mendoza L, et al. Experiences in the use of eight cutaneous and osteocutaneous superficial and deep circumflex iliac free flaps. J Reconstr Microsurg. 1985, 1(4): 269-281
88 Winters HA, Smeele LE, Leemans CR. The bipedicled iliac crest flap. J Reconstr Microsurg. 1996,12(4): 257-259
89 Koshima I, Fukuda H, Soeda S. Free combined anterolateral thigh flap and vascularized iliac bone graft with double vascular pedicle. J Reconstr Microsurg. 1989,5(1): 55-61
90 Koshima I, Soeda S, Nakayama Y, et al. A combined rectus abdominis musculocutaneous flap and vascularized iliac bone graft with double vascular pedicles. Plast Reconstr Surg. 1991, 88(3): 492-496;discussion 497-498
91 刘亚国，徐达传，钟世镇，等．以旋髂深血管为蒂的髂骨瓣和血管束联合移植的应用解剖学．中国临床解剖学杂志，1988，6(4)：194-196
92 徐达传，钟世镇，孙博，等．吻合旋股外侧血管升支髂骨瓣移植的应用解剖学．显微医学杂志，1985，8(2)：96-98
93 徐达传．臀大肌上部肌皮瓣移位有关的解剖学．临床应用解剖学杂志，1985，3(2)：82-84
94 王庭家，徐达传，陈荣生，等．以髂腰血管为蒂髂骨(膜)瓣移植的应用解剖．中国临床解剖学杂志，1998，16(4)：294-296
2 Hwang YJ, Jeon JY, Lee MS. A simple method of reduction malarplasty. Plast Reconstr Surg, 1997, 99(2) : 348-355
3 Satoh K, Ohkubo F, Tsukagoshi T. Consideration of operative procedures for zygomatic reduction in Orientals: based on a consecutive series of 28 clinical cases. Plast-Reconstr-Surg, 1995, 96(6) : 1298-1306
4 Yang DB, Park CG. Infracture technique for the zygomatic body and arch reduction. Aesthetic Plast Surg.1992, 16(4) : 355-363
5 Cho BC, Lee JH, Baik BS. Reduction malarplasty using sliding setback osteotomy. J Craniofac Surg. 1998, 9(3) : 275-279
6 Kim JW. Laser-assisted endoscopic reduction malarplasty in Asians: quick combined surgery. Aesthetic Plast Surg. 1998 , 22(4) : 289-297
7 Logani SC, Conn H, Logani S, et al. Paralytic ectropion: a complication of malar implant surgery. Ophthal Plast Reconstr Surg. 1998, 14(2) : 89-93
8 Hirano S, Shoji K, Kojima H, et al. Use of hydroxyapatite for reconstruction after surgical removal of intraosseous hemangioma in the zygomatic bone. Plast Reconstr Surg. 1997, 100(1) : 86-90
9 Ivy EJ, Lorenc ZP, Aston SJ. Malar augmentation with silicone implants. Plast Reconstr Surg. 1995, 96(1) : 63-68
10 Mommaerts MY, Abeloos JV, De-Clercq CA, et al. The 'sandwich' zygomatic osteotomy: technique, indications and clinical results. J Craniomaxillofac Surg. 1995, 23(1) : 12-191
11 Adams JR, Kawamoto HK. Late infection following aesthetic malar augmentation with proplast implants. Plast Reconstr Surg. 1995, 95(2) : 382-384
12 Lane AG, Johnson CS, Costantino PD. Pedicled osseous flaps. Otolaryngol Clin North Am. 1994, 27(5) : 927-54
13． Kamiji T, Fujikawa M, Honda T, et al. Restoration of the mandible by full-thickness calvaria bone flap. Ann Plast Surg, 1992,29(5) : 438-443
14 De-Ponte FS, Becelli R, Rinna C, et al. Aesthetic and functional reconstruction in intraosseus hemangiomas of the zygoma. J Craniofac Surg. 1995,6(6) : 506-509
15 Kyutoku S, Tsuji H, Inoue T, ct al. Plast Reconstr Surg. 1999 , 103(2) : 395-402
16 Jensen J, Reiche FO, Sihdet PS. Autogenous mandibular bone grafts for malar augmentation. J Oral Maxillofac Surg. 1995, 53(1) : 88-90
17 Tideman H, Samman N, Cheung LK. Immediate reconstruction following maxillectomy: a new method. Int J Oral Maxillofac Surg. 1993, 22(4): 221-225
18 Fukuta K, Jackson IT, Topf JS. Facial lawn mower injury treated by a vascularized costochondral graft. J Oral Maxillofac Surg. 1992, 50(2): 194-198
19 Wittkampf AR, Zonneveld FW. [The use of 3-dimensional models in craniofacial surgery]. Ned Tijdschr Geneeskd. 1996, 140(26): 1353-1358
20 Arvier JF, Barker TM, Yau YY, et al. Maxillofacial biomodelling. Br J Oral Maxillofac Surg, 1994, 32(5): 276-283
21 Arvier J. Malar recontouring using 3D bio-modelling. Ann R Australas Coll Dent Stag, 1996, 13:137-140
22 Yau YY, Arvier JF, Barker TM. Technical note: maxillofacial biomodelling—preliminary result. Br J Radiol, 1995, 68(809): 519-523
23 杨月如．国人颧骨的观察．昆明医学院学报，1987，8(2)：33-39
24 Baek SM, Chung YD, Kim SS. Reduction malarplasty. Plast Recostr Surg, 1991,88:53-58
25 孙弘，孙坚．高颧骨畸形矫正术．实用美容整形外科杂志,1997,8(3)：136-138
26 Salas E, Ziyal IM, Bejjani GK, et al. Anatomy of the frontotemporal branch of the facial nerve and indications for interfascial dissection. Neurosurgery, 1998, 43(3): 563-568;
27 郑国焱．计算机辅助外科手术系统技术进展和应用．国外医学生物医学工程分册，1995，18(4)：202-209
28 Thomas A, Mustoc Hongshik Han. The effect of new technologes on plastic surgery. Arch Surg, 1999,134(11): 1178
29 宋志巍，余咏梅，胡碧芳，等．三维 CT 在颌面部整形修复中的应用．中华整形外科杂志，2000，16(5)：315-317
30 Marden E, Alder D, Thomas D, et al. Clinical usefulness of two-dimensional reformatted and three-dimensionally rendered computerized tomographic images. J Oral Maxillofac Surg, 1995, 53:375-386
31 Marsh L J, Vannier MW. The "third" dimension in craniofacial surgery. Plast Reconstr Sueg, 1983,71:759-767
32 张辉，鲁开化，郭树忠．计算机图像处理技术在整形美容外科的应用．中国美容医学杂志，2000,9(5)：386-388
33 Altobelli DE, Kikinis R, Mulliken JB et al. Computer-assisted three-dimensional planning in cranionfacial surgery. Plast Reconstr Surg, 1993, 92(4):576-579
34 Eufinger H, Wehmoller M, Harders A et al. Prefabricated prostheses for the reconstruction of skull defects. Int J Oral Maxillofac Surg, 1995,24(1): 104-108
35 Voigt M, Schaefer DJ, Andree C. Three-dimensional reconstruction of a defect of the frontozygomatic area by custom made Proplast Ⅱ implant. Eur J Plast Surg,2000,23:391-394
36 刘基光．颅骨瓣在颌面外科的应用．国外医学·口腔医学分册，1988,15(1)：4-8
37 Antonyshyn O, Colcleugh RG, Hurst LN, et al. The temporalis myo-osseous flap: an experimental study. Plast Reconstr Surg, 1986, 77(3): 406-415
38 Fasano D, Menoni V, Riberti C, et al. The temporalis osteomuscular flap versus the free calvarial bone graft. An experimental study in the growing rabbit. J Craniomaxillofac Surg. 1987, 15(6): 332-341
39 Antonyshyn O, Colcleugh RG, Anderson C. Growth potential in suture bone inlay grafts: a comparison of vascularized and free calvarial bone grafts. Plast Reconstr Surg. 1987, 79(1): 1-11
40 Grotting JC, Psillakis JM, Casanova R, et al. Craniofacial reconstruction after tumor resections using vascularized outer table calvarial bone flaps. Am J Surg, 1986, 152:438- 440
41 Psillakis JM, Grotting JC, Casanova R, et al. Vasculariazed outer-table calvarial bone flaps. Plast Reconstr Surg, 1986,78:309-321
42 高学宏，宁金龙，李晓静，等．带颞浅血管筋膜蒂的颅骨外板复合瓣移位修复额面部缺损．安徽医科大学学报，1996，31(6)：492-493
43 王佳琦，戚可名，吕唯，等．蒂颞浅动脉蒂颅骨外板移植修复面部凹陷畸形．中华整形烧伤外科杂志，1994，10(3)：190-2
44 陈乃俊，林李嵩，施斌，等．带蒂颅骨外板在颌面整复中的应用．口腔颌面外科杂志，1998，8(4)：245-247
45 李正斌，王琪影，王剑，等．应用前额岛状皮瓣快速扩张法性鼻再造术．实用美容整形外科杂志，1999，10(1)：10-11
46 彭田红，徐达传，许本柯．带颞浅血管颅骨瓣修复颌面骨缺损的应用解剖．中国临床解剖学杂志，2001，19(1)：38-40
47 Court BC, Josegh GM, Alejandro B. Bblood supply of the upper craniofacial skeleton: the search for composite calvarial bone flaps. Plast Reconstr Surg, 1984,74:603-610
48 Rafael C, David C, James C, et al. Anatomic basis for vascularized outer-table calvarial bone flaps. Plast Reconstr Surg, 1986,78:300-308
49 Jorge MP, James CC, Rafael C, et al. Vascularized outer-table calvarial bone flaps. Plast Reconstr Surg, 1986,78:309-317
50 鲁开化，艾玉峰，郭树忠．扩张后皮瓣在修复重建外科的应用．中国修复重建外科杂志,1996,10(2)：65-66
51 Hell B, Tischer A, Heissler E, et al. A method for the bony and dental reconstruction of the maxilla in dentate patients. Int J Oral Maxillofac Surg. 1997, 26(5): 369-373
52 Gratz KW, Sailer HF, Haers PE, et al. Mandibular reconstruction with full thickness calvarial bone and temporal muscle flap. Br J Oral Maxillofac Surg. 1996, 34(5): 379-385
53 Kamiji T, Fujikawa M, Honda T, et al. Restoration of the mandible by full-thickness calvarial bone flap. Ann PIast Surg, 1992, 29(5): 438-443
54 李光武，高杰，吴仁秀．颅骨移植的显微外科解剖学观测．安徽医科大学学报，1998，33(4)：262-264
55 李曦光，赵连岐，张亚洲，等．带胸锁乳突肌蒂的半片锁骨瓣修复下颌骨缺损．中华口腔医学杂志，1986，21(2)：105-106
56 叶延荣，张添炳，蔡铭奇，胸锁乳突肌蒂带复合半片锁骨瓣重建下颌骨节段性缺损．中华口腔医学杂志，1985，20(5)：293
57 孙弘，王勇，张付初。双侧胸锁乳突肌蒂半片锁骨一期修复下颌骨小颌畸形．中国修复重建外科学杂志，1994，8(1)：21-22
58 林毅，欧子民．胸锁乳突肌皮瓣带锁骨修复下颌骨缺损16例报告．广西医学，1997，19(2)：297-298
59 蔡建通，许卫红，郑和平．胸锁乳突肌锁骨头蒂半片锁骨瓣修复锁骨肩峰端的应用解剖学．福建医科大学学报，1998，32(3)：243-245
60 马继任，苑正太．双侧颈胸皮瓣在颌颈部瘢痕挛缩整复中的应用．中国修复重建外科杂志，1994；8(4)：230-231
61 张仲，李彤，邹鸣岚，等．颈肩胸区真皮下血管网薄皮瓣在面颈部整复中的应用．中华整形烧伤外科杂志,1995,11(2)：93-95
62 孟庆延，贾军，陈勉增，等．颈胸部真皮下血管网皮瓣的血供特点及临床应用，实用美容整形外科杂志，1999，10(1)：15-17
63 李谆，原林，高岚，等．颈胸前筋膜皮瓣修复颈前瘢痕的解剖学研究．中国美容医学杂志，9(5)：331-333
64 Deslaugiers B, Vaysse P, Combes JM, et al. Contribution to the study of the tributaries and the termination of the external jugular vein. Surg Radiol Anat. 1994; 16(2): 173-177
65 贺忠文，袁志芳，闫国富，等．皮肤扩张术机理探讨，中华整形外科杂志，2000，16(2)：84-86
66 王佳琦，陈建，刘珍君，等．颈胸联合皮瓣扩张修复面颊部瘢痕．中华整形烧伤外科杂志，1997，13(4)：311
67 Hurwitz DJ, Babson JA, Futrell JW. The anantomic basis for the platysma skin flap. Plast reconstr surg, 1983,72(3):302-312
68 Ozcelik T, Aksoy S, Gokler A. Platysma myocutaneous flap: use for intraoral reconstruction. Otolaryngol Head Neck Surg. 1997, 116(4): 493-496
69 马显杰，鲁开化，艾玉峰．应用多个扩张器修复面颈部瘢痕．中国修复重建外科杂志，2000，14(1)：33-34
70 Bhathena HM, Kavarana NM. Primary reconstruction of head and neck cancer with anterior rib, osteomyocutaneous composite flap. Head Neck. 1992, 14(3): 183-187
71 Ohsumi N, Shimamoto R, Tsukagoshi T. Free composite latissimus dorsi muscle-rib flap not containing the intercostal artery and vein for reconstruction of bone and soft-tissue defects. Plast Reconstr Surg. 1994,94(2): 372-378
72 Hui KC, Zhang F, Lineaweaver WC, et al. Serratus anterior-rib composite flap: anatomic studies and clinical application to hand reconstruction. Ann Plast Surg. 1999, 42(2): 132-136
73 de-Azevedo JF. Pectoralis minor flaps: an experimental study and clinical applications of osteomuscular, osteomyocutaneous, and myocutaneous models. Head Neck Surg. 1987, 9(4): 211-222
74 Bhathena H, Kavarana NM. One-stage total mandibular reconstruction with rib, pectoralis major osteomyocutaneous flap. Head Neck Surg. 1986,8(3): 211-213
75 Yamamoto Y, Sugihara T, Kuwahara H, et al. An anatomic study for the rectus abdominis myocutaneous flap combined with a vascularized rib. Plast Reconstr Surg. 1995, 96(6): 1336-1340
76 Gucer T, Oge K, Ozgur F. Is it necessary to use the angular artery to feed the scapular tip when preparing a latissimus dorsi osteomyocutaneous flap?: case report. J Reconstr Microsurg. 2000, 16(3): 197-200
77 Yamamoto Y, Sugihara T, Kawashima K, et al. An anatomic study of the latissimus dorsi-rib flap: an extension of the subscapular combined flap. Plast Reconstr Surg. 1996, 98(5): 811-816
78 Maruyama Y, Onishi K, Iwahira Y, et al. Free compound rib-latissimus dorsi osteomusculocutaneous flap in reconstruction of the leg. J Reconstr Microsurg. 1986, 3(1): 13-18
79 Hayashi A, Maruyama Y. Subclavicular approach in head and neck reconstruction with the latissimus dorsi musculocutaneous flap. Br J Plast Surg. 1991, 44(1): 71-74
80 Horng SY, Chen MT. Reversed cephalic vein: a lifeboat in head and neck free-flap reconstruction [see comments]. Plast Reconstr Surg. 1993, 92(4): 752-753
81 苗华，尹正银，黄恭康．髂嵴前部的血液供应．解剖学报，1981，12(4)：376-377
82 王拴科，张凤岗，张祥生，等．旋髂深血管髂骨瓣的临床应用．中华显微外科杂志，1996，19(4)：267-269
83 Thein T, Kreidler J, Stocker E, et al. Morphology and blood supply of the iliac crest applied to jaw reconstruction. Surg Radiol Anat. 1997; 19(4): 217-225
84 Kuzbari R, Worseg A, Burggasser G, et al. The external oblique muscle free flap. Plast Reconstr Surg. 1997 Apr; 99(5): 1338-45
85 Minami A, Ogino T, Itoga H. Vascularized iliac osteocutaneous flap based on the deep circumflex iliac vessels: experience in 13 cases. Microsurgery. 1989; 10(2): 99-102
86 David DJ, Tan E, Katsaros J, et al. Mandibular reconstruction with vascularized iliac crest: a 10-year experience. Plast Reconstr Surg. 1988, 82(5): 792-803
87 Quillen CG, Wiener B, Mendoza L, et al. Experiences in the use of eight cutaneous and osteocutaneous superficial and deep circumflex iliac free flaps. J Reconstr Microsurg. 1985, 1(4): 269-281
88 Winters HA, Smeele LE, Leemans CR. The bipedicled iliac crest flap. J Reconstr Microsurg. 1996,12(4): 257-259
89 Koshima I, Fukuda H, Soeda S. Free combined anterolateral thigh flap and vascularized iliac bone graft with double vascular pedicle. J Reconstr Microsurg. 1989,5(1): 55-61
90 Koshima I, Soeda S, Nakayama Y, et al. A combined rectus abdominis musculocutaneous flap and vascularized iliac bone graft with double vascular pedicles. Plast Reconstr Surg. 1991, 88(3): 492-496;discussion 497-498
91 刘亚国，徐达传，钟世镇，等．以旋髂深血管为蒂的髂骨瓣和血管束联合移植的应用解剖学．中国临床解剖学杂志，1988，6(4)：194-196
92 徐达传，钟世镇，孙博，等．吻合旋股外侧血管升支髂骨瓣移植的应用解剖学．显微医学杂志，1985，8(2)：96-98
93 徐达传．臀大肌上部肌皮瓣移位有关的解剖学．临床应用解剖学杂志，1985，3(2)：82-84
94 王庭家，徐达传，陈荣生，等．以髂腰血管为蒂髂骨(膜)瓣移植的应用解剖．中国临床解剖学杂志，1998，16(4)：294-296