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ศัลยกรรมตัดมุมกราม : Angle mandible resection

เป็นการแก้ไขใบหน้าใหญ่เนื่องจากกระดูกกรามกว้าง

ขั้นตอนการผ่าตัด

1. ดมยาสลบ

2. กรีดเปิดแผลบริเวณซอกเหงือกด้านหลังฟันซี่สุดท้ายในปากเลาะแยกกระดูกขากรรไกรกับเนื้อเยื่อข้างเคียงจนถึงมุมกระดูกขากรรไกร และตัดแต่งตามต้องการ

3. ใส่ท่อระบายและเย็บปิดแผล

ระยะเวลาในการผ่าตัดและพักฟื้นเวลาในการผ่าตัดมุมกรามประมาณ 2 ชั่วโมงนอนพักฟื้นในโรงพยาบาลประมาณ 2 วัน   อาการบวมบริเวณกรามจะยุบลงใน 3-4 สัปดาห์

วิธีการดูแลหลังการผ่าตัด

1. ประคบเย็น 48 ชั่วโมง

2. นำท่อระบายออก 24-48 ชั่วโมง

3. นอนศีรษะสูง 1 สัปดาห์

 

 

Mandibular Angle Resection

    The concept of surgery is to contour the mandibular angle to be small, smooth and sloping. 
    The cause of prominence of the mandibular angle comes mainly from the bony part rather than from the cheek muscle. 

    Pre-Operative Care

    Prominence of the mandibular (lower jaw) angle, which makes the face square with masculine look, is considered to be unattractive for females as well as transsexuals. The shape of lower jaw in female tends to have a more gradual curve

    The Operation

    Surgical technique by intra-oral approach
  1 The procedure is done under general anesthesia. 
  2 The incisions are made along the sulcus between gum and cheek mucosa to access the prominent areas of jaw bone 
  3 The marked area of prominent bone is cut with surgical drill and micro-saw, curving down from back to front, to achieve the best rounded contour without stepping. 
  4 A small surgical tube is placed inside the wound and comes out through the skin at the level of your previous jaw line and will leave some mini-scar (0.5cm), which will be nearly invisible soon. This is very important to prevent any potential blood collection and shorten the period of postoperative swelling. 
  5  Sintra oral Mandibular wand  will liclose logcther

    Asymmetry or over-resection:
    A careful preoperative assessment, x-ray template and a complete set of fine surgical instruments can help prevent such problems.

    Post-Operative Care

    It is important to use cold compress to avoid swelling and bruising for the first 24 hours. However, make sure not get the bandages or stitched areas wet. This could cause infection.
The tubes used for draining are usually removed after the first 24 hours.
    It is important to keep your head elevated and try not to move. The stitches at your ears hold all the weight of your skin. Too much pressure or stretching from activity can result in a less than desirable appearance. Extra pillows will not only help to elevate your head but will also cradle your head. This also reduces swelling.
    Often there is a general discomfort and bruising .There should be no major pain or swelling. However, there will be varying degrees of pain and discomfort. Bruising varies but usually fades after a few days. 
    Many patients experience a sensation of tightness or numbness. The face will be numb in some areas. This is from slight damage to the nerve fibers. After 6 to 12 weeks the nerve fibers will all grow back .In some rare cases, numbness can last up to nine mouths. Use mild pain medication as necessary such as Tylenol or prescribed Hydrocodone.
    Be sure to have someone around the house who can help you. This person should help to rotate the cold compress, answer the phone and prepare your meals. For a speedy recovery and best results you must limit your physical activity. This means no sex or heavy exercising. Sex and exercising increase your blood pressure. An increase in blood pressure can result in bleeding or stretching of stitches. Even talking or removing the jaw should be avoided right after the surgery since this can dislodge the stitches. All vigorous activity should be avoided for one full month after surgery.
    Your diet should be liquid soft for the first 48 hours. Chewing promotes swelling and bruising. In addition to liquids, your diet should be high protein and contain vitamins. Avoid preservatives because preservatives promote swelling.