经耳屏小切口入路手术治疗髁状突矢状骨折  

Small incision through the tragus for the treatment of sagittal condylar fracture

作　　者：刘彦杰[1] 黎钢[1] 王俊林[1] 宋勇[1] 陈裕聪 覃沅华[1] LIU Yanjie;LI Gang;WANG Junlin;SONG Yong;CHEN Yucong;QIN Yuanhua(The Department of Stomatology of Liuzhou General Hospital,Liuzhou 545006,China)

机构地区：[1]柳州市人民医院口腔科,广西柳州545006

出　　处：《口腔疾病防治》2018年第7期460-463,共4页Journal of Prevention and Treatment for Stomatological Diseases

基　　金：广西壮族自治区卫生和计划生育委员会科研课题(Z2015126)

摘　　要：目的探讨下颌骨髁状突矢状骨折手术经耳屏小切口入路的方法及疗效。方法 15例19侧下颌骨髁状突矢状骨折患者,采用经耳屏约4 cm长隐蔽小切口入路,解剖颞浅动静脉并向前拨开,切开颞深筋膜浅层并沿筋膜深面解剖暴露颧弓及颞下颌关节关节囊,切开关节囊,在直视下进行下颌骨髁状突骨折坚固内固定术,术后通过临床及影像学检查随访6个月。结果全部患者术后1周拆线,其中2例出现轻度面瘫,分别为患侧颞支Ⅱ级面瘫及患侧颞支Ⅲ级面瘫、颧支Ⅱ级面瘫,给予营养神经治疗后,3个月内恢复正常。所有患者没有出现术后涎瘘感染及其他严重并发症,咬合关系恢复良好,术后复查CT提示骨折断端复位良好,髁状突形态良好。术后3个月咬合关系正常,张口度大于30 mm,关节无弹响,开口型无偏斜,术后6个月复查,疤痕不明显。结论经耳屏小切口入路手术创伤小,解剖层次清晰,避免损伤面神经,可为髁状突矢状骨折手术提供较好的手术视野,安全便捷。Objective The purpose of this study was to a new operative approach for sagittal condylar fractures via a preauricular small incision-based technique and to examine the effectiveness of this approach. Methods Fifteen patients（19 sides） with sagittal condylar fractures were included in the study. The incision length was approximately 4 cm through the tragus, exposing the superficial temporal vessels, which was then pulled forward. Next, the deep temporal superficial fascia was cut, and the surface of the zygomatic arch and the articular capsule of the temporomandibular joint were exposed. Joint capsule incision was performed, with mandibular condylar fracture fixation under direct vision. We followed up with the patients postoperatively for 6 months with clinical and radiographic examinations. Results All patients had 1 week postoperation before being discharged, during which 2 cases of mild facial paralysis（with lateral temporal level Ⅱ facial paralysis, with lateral temporal branch level Ⅲ facial paralysis and level Ⅱ zygomatic branch of facial nerve paralysis after treatment） were observed, after given nerve nutrition agents, 2 cases returned to normal within3 months. No patient exhibited a postoperative delayed fistula infection or other serious complications. Intraoperative occlusion relationships recovered well, and postoperative CTs suggested that the fracture ends and condyles were in good condition. The occlusion relationship was normal for 3 months after surgery, with a degree of opening greater than 30 mm, no play in the joints and no oblique openings being observed, and reexamination 6 months after the surgery revealed no obvious scars. Conclusion This surgical method involves a small incision and clear anatomic structures and avoids damage to the facial nerve. This method provides better surgical vision for treatment of sagittal condylar fractures, is safe and convenient, and deserves clinical recommendation.

关 键 词：髁状突矢状骨折 耳屏小切口 手术入路 颞中静脉 解剖结构 

分 类 号：R782.4[医药卫生—口腔医学]