上颌面中颌面骨折解剖形态综述uppermidface

Craniomaxillofacial
Craniomaxillofacial (CMF) Trauma 颅颌面（CFM）外伤
• Direct exposure and fixation of these buttresses provides anatomical restoration. 直接暴露并固定这些支柱有助于解剖结构的恢复。
Craniomaxillofacial
Upper/MidFace Surgical Approaches 上面部/面中部手术入路
Exposure of the maxilla:
Zygoma:颧骨：
暴露上颌骨
• Gillies Gillies入路
• Intraoral: vestibular incision/
• Inferior border of mandible下颌骨下缘
Horizontal 水平的
Craniomaxillofacial
Vertical 垂直的
Craniomaxillofacial
Frontal Bone额骨 Nasal Bones鼻骨 Ethmoid筛骨 Lacrimal Bone泪骨 Zygoma颧骨 Maxilla上颌骨 Alveolar Process牙槽突
• Coronal冠状
Sublabial/Gingivobuccal sulcus • Lateral brow眉弓外侧
口内入路：前庭切口/唇下/牙槽沟 • Blepharoplasty眼睑成形术
• Periorbital:眶周入路
• Subciliary 睫下
Naso-orbital-ethmoidal:鼻-眶-筛
Craniomaxillofacial
Upper Lid Blepharoplasty 上眼睑成形术入路
Craniomaxillofacial
Upper Face/ Mid Face 上面部/面中部
Midface面中部
Craniomaxillofacial
The Midface is comprised primarily by Two Bones: 面中部主要包括两块骨骼： The Maxilla & the Zygoma上颌骨和颧骨
• Zygomatico-maxillary (lateral)颧骨上颌 （侧面）
• Nasomaxillary (medial) 鼻上颌（中间）
Horizontal水平的
• Nasofrontal (supraorbital rims)鼻骨额骨 （眼眶上缘）
• Nasomaxillary (inferior orbital rims)鼻上 颌（眼眶下壁）
• Transconjunctival经结膜
• bicoronal incision 双侧冠状切
• Subtarsal 跗骨下
口
• Infraorbital眶下
• Lateral brow眉弓外侧
• Coronal冠状
• Upper Eyelid/Blephoroplasty
上睑/内眼角wenku.baidu.com
Craniomaxillofacial
▪ Sensory nerves and cranial nerves感觉神经及颅神经 ▪ Also consider unique anatomy of patient ▪ 还要考虑到患者解剖结构的特殊性。 ▪ Utilize open wounds for exposure to fracture site • 利用开放的伤口暴露出骨折的位置。
• Maxillary fractures account for approximately 10% to 20% of all facial fractures 在所有面部骨折中上颌骨骨折的发生率约为10%-20%。
Buttresses支柱效应
• Support pillars of the face and they transmit forces to the base of the skull.
• 像柱子一样支撑面部并将压力传导到头 盖骨底部。
• Reconstruction of these buttresses is the key to maxillary/midfacial repair (and the general principle of plate osteosynthesis)
Craniomaxillofacial
Coronal Approach 冠状入路
Pericranium颅骨膜
Craniomaxillofacial
Coronal Approach 冠状入路
Craniomaxillofacial
Gillies Approach Gillies 入路
For Closed Reduction of a Zygoma Fracture 用于颧骨骨折的闭合性复位
• 在上颌骨/面中部骨折的修复中重建这些 支柱非常关键（这也是颌面修复接骨板 应用的普遍原则）。
Craniomaxillofacial
Craniomaxillofacial
Buttresses支柱效应
Vertical垂直的
• Pterygomaxillary (posterior)翼突上颌（ 后面）
Coronal Approach冠状入路
To access: Zygomatic arch, Superior, medial & lateral orbital rims, Naso ethmoidal Region, and Frontal Sinus
•可进入：颧弓、眼眶前部、中间及后部、鼻筛区及额陡
• Main goal is to restore:修复的主要目标： • Height高度 • Width宽度 • Projection 投影
Craniomaxillofacial
Surgical Exposure Selection 术野选择
▪ Cosmetic appearance, inconspicuous area ▪ 对外表影响较小的不明显的区域。 ▪ Avoid when possible muscles and nerves尽量避开肌肉及神经。