上颌面中颌面骨折解剖形态综述upper mid face

• Gillies: Reposition of the zygoma temporally • Gillies入路：可用于颧骨的临时复位。
• Transbuccal (sharp hook or bone repositioning pin) • 经颊的（可应用锐钩或骨复位针）
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Zygomaticomaxillary Complex Fracture (ZMC) 颧颌复合体骨折（ZMC）
Most common midface fracture! 是最常见的中面骨折
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Zygoma Fracture: Surgical Approaches 颧骨骨折：外科手术入路
Horizontal 水平的
Vertical 垂直的
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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
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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) • 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）。
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Buttresses支柱效应
Vertical垂直的 • Pterygomaxillary (posterior)翼突上颌（ 后面）
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Zygomatico-maxillary (lateral)颧骨上颌 （侧面） Nasomaxillary (medial) 鼻上颌（中间）
• Functionally stable plate
osteosynthesis 功能性稳定的接骨术
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ZMC Fracture: Repositioning Pin 颧颌复合体骨折：复位针
Transbuccal Stab Incision 经颊针刺切口
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Upper Lid Blepharoplasty 上眼睑成形术入路
Zygoma Fractures, Frontozygomatic Suture Line, and Orbital Roof Fractures, Lateral brow 颧骨骨折、额颧缝及眶顶骨折、眉弓外侧
Naso-orbital-ethmoidal:鼻-眶-筛 • bicoronal incision 双侧冠状切 口
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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
Inferior Orbital Rim, Orbital Floor, ZMC fractures and Lateral Rim 眶下缘、眶底、颧颌骨折、眶外侧
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Subtarsal Approach 跗骨下入路
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Subtarsal Approach 跗骨下入路
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Vestibular/Sublabial/ Gingivobuccal Sulcus Incision 前庭/唇下/牙槽沟切口
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Universal Upperface/Midface 通用上面部/面中部
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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。 • Main goal is to restore:修复的主要目标： • Height高度 • Width宽度 • Projection 投影
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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。 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。
Horizontal水平的
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• •
Nasofrontal (supraorbital rims)鼻骨额骨 （眼眶上缘）
Nasomaxillary (inferior orbital rims)鼻上 颌（眼眶下壁） Inferior border of mandible下颌骨下缘
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Upper/MidFace Surgical Approaches 上面部/面中部手术入路
Exposure of the maxilla: 暴露上颌骨 • Intraoral: vestibular incision/ Sublabial/Gingivobuccal sulcus 口内入路：前庭切口/唇下/牙槽沟 • Periorbital:眶周入路 • Subciliary 睫下 • Transconjunctival经结膜 • Subtarsal 跗骨下 • Infraorbital眶下 • Lateral brow眉弓外侧 • Coronal冠状 • Upper Eyelid/Blephoroplasty 上睑/内眼角 Zygoma:颧骨： • Gillies Gillies入路 • Coronal冠状 • Lateral brow眉弓外侧 • Blepharoplasty眼睑成形术
Tarsal Plate 睑板
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Periorbital Incisions 眶周切口
源自文库
Lateral Brow眉弓外侧
Upper Eyelid/Blepharplasty上睑/睑成形术 Transconjunctival经结膜 Subciliary睫下 Subtarsal跗骨下
ZMC Fracture Types 颧颌复合体骨折类型
第1 类
第2类
第3 类
第4类
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Type 1 & 2 ZMC Treatment 第1类及第2类颧颌复合体骨折的治疗
Reduction修复 Two point fixation with rigid miniplates (1.2/1.7mm): 用微型硬接骨板（1.2/1.7mm）进行 两点固定 ZF suture & Inferior orbital rim 颧颌缝及眶下缘
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Lateral Brow Incision 眉弓外侧切口
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Transconjunctival Approach 经结膜入路
Inferior Orbital Rim, Orbital Floor, ZMC fractures, Lateral Rim, and Medial Wall 前眶部、眶底、颧颌骨折、眶外侧壁及内侧壁
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Subcilliary Approach 睫下入路
Inferior Orbital Rim, Orbital Floor, ZMC fractures and Lateral Rim 眶下缘、眶底、颧颌骨折、眶外侧
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Infraorbital Incision 眶下切口
ZMC Fracture: Treatment 颧颌复合体骨折：治疗
• Exposure of the fracture sites
暴露骨折位点。
• Reduction of the fractured bone
with a sharp hook or repositioning pin 用锐钩或复位针将断骨复位。
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Upper Face/ Mid Face 上面部/面中部
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Midface面中部
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
• 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%。
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Buttresses支柱效应
• Support pillars of the face and they
• Lateral brow incision (in or below the eyebrow) for access to the ZF suture • 眉弓外侧切口（在眉毛里或在眉毛下）达到颧骨骨折线。 • Vestibular incision for access to the zygomaticomaxillary buttress • 前庭切口可以暴露颧颌支。 • Subciliary, transconjunctival, subtarsal, or infraorbital for the inferior orbital rim and orbital floor • 睫下、经结膜、跗骨下或眶下入路用于暴露眶下部及眶底。
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Coronal Approach 冠状入路
Pericranium颅骨膜
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Coronal Approach 冠状入路
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Gillies Approach Gillies 入路
For Closed Reduction of a Zygoma Fracture 用于颧骨骨折的闭合性复位
Infraorbital眶下
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Vestibular/Sublabial/ Gingivobuccal Sulcus Incision 前庭/唇下/牙龈槽切口
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Vestibular/Sublabial/ Gingivobuccal Sulcus Incision 前庭/唇下/牙槽沟切口
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Lateral Brow Incision 眉弓外侧切口
Zygoma Fractures, Frontozygomatic Suture Line, and Orbital Roof Fractures, Lateral brow 颧骨骨折、额颧缝及眶顶骨折、眉弓外侧