摘要
目的为避免面颈部留下手术瘢痕,探讨从口腔入路复位固定髁突颈及下颌骨支骨折的方法。方法采用口腔内下颌骨矢状截骨手术切口入路,用摆动锯将下颌支后缘垂直截骨,取出升支后缘骨块,髁突游离取出,体外直视下与升支后缘骨块固定后再从口腔原切口回植入,钛板固定。15例17侧采用本方法治疗,其中2例为外地医院行下颌角截骨整形术中意外将下颌骨髁突颈部劈裂骨折,其余13例为闭合性骨折。结果术后1年复查全部患者的开口范围25～40mm,平均为35.8mm,1例有患侧后牙早接触,下切牙中线偏斜1mm。另1例张口约25mm,轻度受限,其余患者咬合关系良好,无主诉关节疼痛与弹响症状。全部患者无面神经、耳大神经损伤,无涎瘘,面颈皮肤无手术瘢痕。结论在目前美容要求越来越高的趋势下,口腔入路具有无外部瘢痕优势,且不会损伤面神经。缺点是操作范围较小,增加了下颌支后缘垂直截骨。
Objective To discuss the way of open reduction and internal fixation for fractured condylar neck and mandible ramus via intraoral approach aiming to avoid the facial incision. Methods Fifteen cases （ 17 sides） with mandibular condyle fractures underwent open reduction and osteosynthesis with plates and screws. After the mandibular ramus was under vertical osteotomy with an oscillating saw, the posterior border bone block of mandibular ramus as well as the free condyle neck were taken out. The fractured condyle neck and the posterior border bone block of mandibular ramus were fixated with a titanium miniplate in vitro. The reunion bone was implanted and reposited in the mouth incision. Of all, two cases suffered fracture of the condyle neck in the other hospital when they received esthetic surgery and resection of prominent mandible angle （PMA）. Results Anatomic reduction was achieved in all cases, without damage to facial nerve and major auricular nerve or salivary fistula. There were slight bony resorption and good temporomandibular joint function one year ＇after surgery, with range of mouth opening for 25-40 mm（ mean 35.8 mm）. Two cases regained their occlusion before their PMA operation. One case had premature contact of the buecal teeth,with 1 mm diverging to medline of the incisor teeth. Intraoral approach not only could avoid large facial scars and facial nerve injury, but also allow visualization of the occlusion during the procedure. Conclusions As more and more consideration is taken to cosmetology, the transoral approach is a reliable surgical alternative for fractures of the condyle neck, without leaving extensive visible scars or damaging facial nerve. The disadvantage is vertical osteotomy of the posterior border of the mandibular ramus.
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2005年第9期641-645,共5页
Chinese Journal of Trauma
基金
国家自然科学基金资助项目(30471902)
首都医学发展科研基金资助项目(20023091)
