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วันอังคาร 24 เมษายน 2018
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เสริมคาง

    ศัลยกรรม เสริมคาง 
ช่วยเติมเต็มรูปร่างของคางให้สมบูรณ์ ทำให้ใบหน้าดูยาวเรียว รูปหน้าได้สัดส่วนที่ดีขึ้น

    เหมาะสำหรับ
ผู้ที่มีคางเล็ก คางสั้น หรือ ไม่มีปลายคาง ทำให้ใบหน้าดูสั้นกลม และ หน้าส่วนกลาง ดูกว้างใหญ่และบานออก หรือ ยื่นล้ำกว่า เมื่อเทียบกับใบหน้าส่วนล่าง

    ปัญหาที่ต้องแก้ไข

คาง เป็นส่วน ต่ำที่สุด และ ยื่นที่สุด ของกระดูกกราม ที่เป็นขอบล่างใบหน้า ความยาวของคางจึงมีผลต่อ ความยาวและสัดส่วน ของใบหน้า และ ความยื่นนูนของคาง มีผลต่อ มิติส่วนล่าง ของใบหน้า เพื่อรับกับมิติส่วนบน มิติส่วนกลางใบหน้า เช่น หน้าผาก โหนกแก้ม จมูก

กระดูกคาง จะเป็นส่วนสำคัญ ที่มีผลต่อรูปทรงของคาง ที่สั้นยาว หรือ ยื่นนูน โดยมีส่วนที่เป็นผิวหนัง ไขมัน กล้ามเนื้อที่ไม่หนา ดังนั้น รูปร่างของคางที่เล็ก สั้น ส่วนใหญ่จะเป็นปัญหาจาก การเจริญเติบโตของส่วนกระดูกคาง การเสริมปรับรูปทรงรูปร่างของคาง จึงต้องใช้วัสดุมาขัดเกลาเพื่อเสริมแทนกระดูก เพิ่มให้รูปทรงคางมีความ ยาว นูน ตามความเหมาะสม สวยงาม ได้สัดส่วนรับกับส่วนอื่นของใบหน้า

   ลักษณะปัญหาของคาง
 – คางสั้น (ขาดในแนวบนล่าง) จะทำให้ใบหน้าดูสั้น และ สัดส่วนของใบหน้า ส่วนล่างสั้นกว่า ใบหน้าที่มีสัดส่วนสวยงาม
 – คางที่ไม่มีความยื่นนูน (ขาดในแนวหน้าหลัง) หรือ คางลาดถอยมาด้านหลัง จะทำให้ใบหน้าส่วนล่าง ยุบ ถอยกว่าใบหน้าโดยรวม ทำให้ขาดมิติของส่วนล่างใบหน้า ปาก และ จมูก จะดูอูมยื่น                                          – ส่วนรูปร่างของคางบางลักษณะ เช่น คางที่เป็นเหลี่ยม ในบางรายสามารถปรับโดยการเสริมคาง ในรูปแบบที่ดูมนขึ้นได้
เมื่อแก้ไขปัญหาได้เหมาะสม ตามสัดส่วน จะทำให้หน้าโดยรวมดูยาว และเรียวขึ้นได้

   หยุดพัก
สามารถทำงานได้ทันที หากจะพักเพราะเรื่องบวม ประมาณ 4-5 วัน

   วิธีการผ่าตัด                                                                     
ก่อนทำผ่าตัด แพทย์จะวัดส่วนสัดของคางเดิม และ ใบหน้าทั้งหมด แล้วทำการพิจารณาเปรียบเทียบกับ สัดส่วนใบหน้าที่สวยงาม ทีละตำแหน่งของคาง ว่าที่จะเสริม จุดใดบ้าง และเพิ่มเท่าไร ถึงจะเหมาะสม แล้วจึง นำค่าที่ได้มาใช้ในการเหลา ซิลิโคน และ ต้องให้เข้ารูปพอดีกับฐานคางเดิม เมื่อได้ ซิลิโคนที่เหมาะสมแล้ว จึงนำไปผ่านการฆ่าเชื้อ ใช้เวลาเตรียมซิลิโคน 30-45 นาที

หลังจากนั้น เป็นขั้นตอนการเตรียมทำความสะอาดบนใบหน้าและช่องปาก ก่อนจะทำการเสริมคาง แพทย์จะวาดเส้นแนวกึ่งกลางคาง และ ทำเครื่องหมาย ตำแหน่ง ขอบเขต คางที่จะแก้ไข เพื่อให้ได้ตำแหน่งที่ชัดเจนแน่นอน หลังจากนั้นให้ยาชา บริเวณคางทั้งหมดจะรู้สึกชา แพทย์จะทำความสะอาดด้านในปากเพิ่มเติม สำหรับใช้เป็นแผลทางเข้าของซิลิโคน ยาวประมาณ 1.5-3 เซนติเมตร หลังจากทำให้เกิดช่องว่างใต้กล้ามเนื้อ และ อยู่ชิดบนกระดูกคาง ตามแนวขอบเขตที่วางแผนไว้ ก็จะนำซิลิโคนที่ผ่านการฆ่าเชื้อแล้ว เสริมเข้าทางแผลในปากไปอยู่ในเนื้อที่ว่างดังกล่าว ซิลิโคนจะวางอยู่บนกระดูกคางเดิม ตรงตำแหน่งที่ต้องการ ภายในช่องที่จำกัดพอดี ทำให้ไม่สามารถขยับไปมาหรือเคลื่อนที่ได้ หลังจากปรับแต่งรูปทรงซิลิโคนและตรวจสอบจน คางได้รูปทรงที่สวยงามแล้ว ก็จะทำการเย็บแผลปิดด้วยไหมละลาย ให้สนิทแน่น ไม่ให้น้ำลายเข้าแผลได้

   แผลผ่าตัด
แผลจะซ่อนอยู่ ด้านในร่องซอกริมฝีปากล่าง ยาว 1.5 – 3 เซนติเมตร มองจะไม่เห็นแผลจากภายนอก ไหมจะละลายเองภายใน 10 วัน ไม่ต้องตัดไหม

   เตรียมตัวก่อนทำ
-ไม่ต้องอดอาหาร ควรรับประทานอาหารให้ไม่อิ่มเกินไป                                                                 – แปรงฟันให้สะอาด ก่อนมาทำผ่าตัด

   การดูแลหลังทำ
เนื่องจากการ เสริมคาง มีแผลในปากเล็กขนาด 1-2.5 เซนติเมตร และ ใช้วิธีเย็บแบบแน่นหนา ไม่ให้น้ำเข้า จึงไม่ต้องมีการดูแลแผลใดๆ

1. นอนศีรษะสูง 2 วัน สามารถนอนตะแคงศีรษะได้ (ช่วยให้บวมน้อยและยุบบวมได้เร็ว)

2. ประคบเย็นตรง คางให้บ่อยที่สุด นาน 2 วัน หรือ จนกว่าจะยุบบวม (ช่วยให้บวมน้อยและยุบบวมได้เร็ว)

3. อย่ารับประทานอาหารเผ็ดจัด หรือดื่มแอลกอฮอล์ งดสูบบุหรี่ (ป้องกันไม่ให้เลือดสูบฉีดขึ้นใบหน้ามาก ทำให้บวมมากขึ้น)

4. ทำกิจวัตรประจำวันที่ไม่หนักได้ตามปกติ งดออกกำลังกายหนัก 

5. สามารถ แปรงฟันได้ แต่ระวัง ไม่ให้กระแทกบริเวณแผล

6. ระวังการกระแทกบริเวณคาง หรือ นั่งค้ำดันคาง งดรับประทานอาหารที่ต้องเคี้ยว มีการขยับกรามมาก โดยเฉพาะในช่วง 3 สัปดาห์แรก (ป้องกันไม่ให้มีแรงมากระทบให้ซิลิโคนมากเกินไป จนอาจจะขยับ ก่อนที่จะติดแน่น) ถ้าเผลอถูกกระแทก ให้โทรติดต่อแพทย์

   วัสดุที่ใช้

ซิลิโคน คุณภาพสูงได้มาตรฐานระดับใช้ทางการแพทย์ (Medical grade)

   ข้อจำกัด
คางที่ลักษณะสั้นมาก ควรจะต้องใช้ วิธี ศัลยกรรมเลื่อนกระดูกคาง (sliding chin surgery) ไม่เหมาะที่จะ เสริมด้วยซิลิโคน เพราะจะต้องใช้ซิลิโคนขนาดที่ใหญ่มาก

คางที่บิดเบี้ยวไม่เท่ากัน จากโครงกระดูกคาง เมื่อเสริมซิลิโคนจะทำให้บิดเบี้ยวได้ง่าย ในกรณีนี้ต้อง วินิจฉัยโรคที่เป็น และ แก้ไขสาเหตุก่อน

คางสั้น หรือ ถอยไปด้านหลัง ที่มีความผิดปกติเรื่องการสบฟัน กรณีต้องให้แพทย์วินิจฉัยว่า ควรใช้วิธีศัลยกรรมชนิดใดจึงจะเหมาะสม เช่น การทำ ศัลยกรรม เลื่อนกรามพร้อมคาง ( bilateral sagital split osteotomy surgery ) หรือ ศัลยกรรม ตัดเลื่อนกระดูกคาง (sliding chin surgery)

คางที่เคยฉีด ซิลิโคนเหลว หรือ สารอื่น มาก่อน รูปทรงของคางจะควบคุมได้ยาก จาก ซิลิโคนเหลวที่แทรกที่ผิว หรือ สารที่ตกค้างในเนื้อ

 

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