面部美容外科[英文](可编辑)
面部美容外科[英文]
Contents
Section I General Principles for Approaches to the Facial Skeleton 1
1 General Principles for Approaches to the Facial Skeleton 3
Section II Periorbita Approaches 7
2 Lower Eyelid Approach 9
3 Transconjunctival Approach 38
4 Supraorbital Eyebrow Approach 51
5 Upper Eyelid Approach 55
Section III Coronal Approach 63
6 Coronal Approach 65
Section IV Transoral Approachs to the Facial Skeleton 95
7 illary Vestibular Approach 97
8 Mandibular Vestibular Approach 109
Section V Transfacial Approaches to the Mandible 121
9 Submandibular Approach 123
10 Retromandibular Approach 139
11 Rhytidectomy Approach 154
Section VI Approaches to the Temporomandibular Joint 161
12 Preauricular Approach 163
Section VII Surgical Approaches to the Nasal Skeleton 187
13 External (Open) Approach 189
14 Endonasal Approach 204
Index 217
xiii S E C T I O N
I GENERAL
PRINCIPLES FOR
APPROACHES TO THE
FACIAL SKELETON
1 General Principles For
Approaches To The
Facial Skeleton
aximum success in skeletal surgery depends on adequate access to and exposure of the
skeleton. Skeletal surgery is simplified and expedited when the involved parts are sufficiently
exposed. In orthopedic surgery, especially of the appendicular skeleton, a basic rule is to
select the most direct approach possible to the underlying bone. Thus, incisions are usually placed
very near the area of interest while major nerves and blood vessels are retracted. This involves little
regard for aesthetics, allowing the orthopedics surgeon greater leeway in the location, direction, and
length of the incision.
M
Surgery of the facial skeleton, however, differs from general orthopedics surgery in several
important ways. First, the primary factor in incision placement is not surgical convenience but facial
esthetics. The face is plainly visible to everyone, and a conspicuous scar may create a cosmetic
deformity that can be as troubling to the individual as the reason for which the surgery was
performed. Cosmetic considerations are critical in light of the emphasis that Western society places
on facial appearance. Thus, as we will see in this text, all of the incisions used on the face must be
placed in inconspicuous areas, sometimes very distant from the underlying osseous skeleton on
which the surgery is being performed. For instance, placement of incisions in the oral cavity allows
superb exposure of much of the facial skeleton with a completely hidden scar.
A second factor that differentiates incision placement on the face from that anywhere else
on the body is the presence of the muscles and nerve (cranial nerve VII) of facial expression. The
muscles are subcutaneous structures, and the facial nerve branches that supply them can be
traumatized if incisions are placed in their path. This can result in a “paralyzed”face, which is not
only a severe cosmetic deformity but can have great functional ramifications as well. For instance,
if the ability to close the eye is lost, corneal damage can ensue, affecting sight. Thus, placement of
incisions and dissections that expose the facial skeleton must ensure that damage to the facial nerve
is unlikely. Many dissections to expose the skeleton require care and electrical nerve stimulation to
identify and protect the nerve. Approaches using incisions in the facial skin must take into
consideration the muscles of facial expression. This is especially important for approaches to the
orbit, where the orbicularis oculi muscle must be traversed. Closure of some incisions also affects
the muscle of facial expression. For instance, if a illary vestibular incision is closed without