经颌后腮腺前缘入路治疗髁突低位骨折的临床体会

目的探讨下颌骨髁突低位骨折、下颌升支骨折内固定新入路的方法及治疗效果。方法对15例单侧髁突低位骨折及下颌升支骨折患者沿耳垂下后作3 cm小切口,翻开皮肤,在腮腺咬肌筋膜浅面向前方分离,在腮腺前缘将腮腺组织向后方掀起,咬肌内钝性分离暴露骨折线后,直视下对髁突骨折、升支骨折断端进行复位固定。结果所有患者解剖复位,咬合关系良好,术后关节三维活动正常,瘢痕隐蔽。结论颌后腮腺前缘入路是治疗髁突低位骨折、升支骨折的较好方法,值得在临床推广。     

腮腺前缘咬肌入路固定髁突中低位骨折对面神经的影响

目的　探讨腮腺前缘咬肌入路手术复位固定髁状突中低位骨折对面神经的影响。方法　对2009—2017年安康市中医院口腔科收治的46例（53侧）髁颈下及髁突基部骨折患者,采用腮腺前缘咬肌入路手术复位固定,分2种方法处理面神经,一种［16例（19侧）］是在咬肌表面解剖显露面神经后自面神经间横断咬肌手术;另一种 ［30例（34侧）］是不刻意寻找面神经,在腮腺前缘咬肌表面直接打开咬肌筋膜,显露咬肌后横断咬肌,直达升支骨面手术。统计两组患者术后面神经损伤结果。结果　两组患者全麻清醒后及术后第1天、第7天检查,无一例发生面神经功能障碍,组间差异无统计学意义。结论　腮腺前缘咬肌入路手术治疗髁突中低位骨折,无论显露面神经与否,均可降低面神经损伤风险,在面神经解剖方法上及防止面神经损伤方面有所改进和创新,使手术更加安全可靠、快速简便。     

腮腺前缘咬肌入路固定髁状突中低位骨折

目的：探讨腮腺前缘咬肌表面面神经间入路复位固定下颌骨髁突中低位骨折的方法。方法：37例43侧髁突中低位骨折患者随机分为两组,A组：16例19侧耳前切口穿腮腺入路复位固定骨折;B组：21例24侧髁状突中低位骨折患者采用绕下颌角皮肤切口,腮腺前缘、咬肌表面面神经间入路,直视下复位固定骨折。对两组的临床疗效进行比较。结果：B组术后第2d咬合关系恢复情况,涎瘘发生情况及术后1月下颌运动时关节局部牵拉不适感等方面均优于A组,差异有统计学意义（P＜0．05）;面神经功能障碍、术后CT三维重建骨折断端对位及术后1月患者主观满意度等方面差异无统计学意义（P＞0．05）。结论：腮腺前缘、咬肌表面面神经间入路可获得较为理想的术野,直视下保护面神经、复位固定骨折,不需分离腮腺,发生涎瘘和面神经损伤的危险性大大降低,并能用于下颌支粉碎性骨折等较为复杂的骨折的治疗,是安全有效的手术路径之一。     

绕耳轮脚切口行翼外肌-髁突解剖复位内固定治疗髁突颈骨折

目的探讨下颌骨髁突颈骨折翼外肌-髁突解剖复位内固定新入路的方法及疗效。方法对60例（73侧）髁突颈骨折行耳屏前绕耳轮脚切口,向前下沿外耳道前缘颞下颌韧带关节囊表面将覆盖在关节表面的腮腺上极翻起,向前牵拉腮腺组织,不用显露耳颞神经、颞浅血管及面神经,显露颞下颌韧带和关节囊;在直视下寻找移位的髁突,将翼外肌-髁突解剖复位坚固内固定。术后1、3、6月复诊。结果术后3月,所有局部伤口耳轮脚上切口隐蔽仅见耳屏前愈合线、面型对称、开口度≥3.5cm、开口型无偏斜、关系好、骨折一期愈合、髁突表面未见骨质吸收、面神经瘫痪症状恢复、双侧咬合力对称、伤口愈合线隐蔽。结论髁突颈骨折经耳屏前后上绕耳轮脚切口,切口隐蔽,能较好的保护颞下颌关节区相关血管神经;对髁突颈部骨折行翼外肌-髁突解剖结构开放性复位内固定,是一种恢复解剖形态和关节功能的有效方法,在术后3月内可判定其效果。     

经咬肌颌后入路治疗髁突中低位骨折

目的 探讨下颌骨髁突中低位骨折内固定术新入路的方法 及治疗效果.方法 对16例单侧髁突中低位骨折患者沿下颌后作2 cm小切口,顺表浅肌肉腱膜系统(SMAS)表面向前方分离,确认骨折线后钝性分离SMAS,避开腮腺,于咬肌内平行咬肌肌束钝性分离暴露骨折线后,直视下对髁突骨折端进行复位固定.结果 所有患者复位满意,咬合关系良...     

经腮腺边缘穿咬肌入路行髁突骨折坚固内固定的临床总结

目的:探讨经腮腺边缘穿咬肌入路行髁突骨折坚固内固定的临床效果。方法:回顾分析2014-05—2017-01收治的30例36侧髁突骨折患者的诊治经验。其中21侧髁突中低位骨折,通过颌后切口经腮腺前缘穿咬肌入路行坚固内固定术。15侧髁突高位骨折通过改良耳屏切口,经腮腺前、上缘穿咬肌入路行坚固内固定术,术后随访6个月,从患者的咬合关系、开口度、涎瘘及面神经功能等方面进行评估。结果:30例患者术后咬合关系和开口度均恢复良好,无涎瘘的病例出现,有4例出现暂时性面瘫,2月后内恢复。结论:经腮腺边缘穿咬肌入路手术治疗髁突骨折,视野暴露充分,切口隐蔽,利于保护面神经,并发症少,是安全有效的手术入路之一。     

两种颌后入路治疗下颌骨髁突骨折方法的研究

目的:探讨两种颌后入路治疗下颌骨髁突颈骨折的治疗方法及效果。方法:64例成人下颌骨中低位髁突颈骨折患者,随机分为A、B两组,经颌后入路,分别采用腮腺前缘入路及横断腮腺入路,解剖复位髁突骨折行坚强内固定术。结果:64例患者均取得良好解剖复位,咬合关系恢复良好,无关节强直出现。A组2例出现面神经麻痹。B组2例出现涎瘘,4例出现面神经麻痹症状。结论:颌后入路可有效治疗髁突骨折,且腮腺前缘入路较横断腮腺入路减少了手术并发症的发生。     

经腮腺前缘进路行下颌髁状突骨折内固定术

我们对下颌骨髁状突骨折内固定耳前切口后改为经腮腺前缘入路,取得较好效果,现报告如下。1资料与方法1.1一般资料31例患者均为单侧下颌骨髁状突中高位骨折,移位21例,脱位10例。其中男23例,女8例,年龄21～70岁,平均30岁。22例伴有颏部骨折。1.2手术方法局麻或全麻下采用耳前角形切口,在腮腺嚼肌筋膜表面翻皮瓣,显露腮腺上极。在腮腺前缘咬肌表面,寻找出面神经颧支和上颊支,稍游离后给予保护。在两支神经之间,从腮腺前缘沿咬肌表面腺体深面向后钝性分离至咬肌后缘,将咬肌向前牵拉,即可寻找深面的骨折片。再将腮腺前缘向后牵拉,在腮腺和关节囊…     

耳下切口经腮腺入路治疗髁突低位骨折 21 例临床报道

目的：探讨耳下切口穿腮腺入路行髁突低位骨折坚固内固定术的临床效果。方法：通过耳下切13经腮腺入路,对21例22侧髁突低位骨折病例施行开放复位坚强内固定术。术后对患者开口度,咬合关系,面神经功能等进行临床疗效分析。结果：21例患者术后咬合关系均恢复良好,开口度最大4．7cm,最小3．3cm,无张13偏斜病例。有2例出现暂时陛面瘫,经过治疗后2月内恢复。手术3月后复查CT,显示所有病例髁突骨折均解剖复位。结论：耳下切口经过腮腺入路手术治疗髁突低位骨折,伤口隐蔽,术后瘢痕小,且能达到解剖复位和坚强内固定的求。     

经颌后切口入路治疗髁突骨折

目的:探讨经颌后切口入路治疗髁突中低位骨折的临床效果。方法 :对18例经颌后入路行髁突中低位骨折切开复位内固定术进行回顾分析,评价患者张口度、开口型、咬合关系、面部表情肌功能、涎瘘等临床指标。结果:18例患者术后咬合关系、张口度、开口型均可恢复正常,无面瘫、涎瘘病例出现。术后3个月复查CT片显示髁突解剖复位,骨折断端无成角或裂开。结论:经颌后切口入路治疗髁突中低位骨折,能充分保护面神经分支,最大程度减轻对腮腺腺体创伤,且能达到髁突解剖复位和坚固内固定的治疗效果。     

内镜辅助髁突下骨折的复位与内固定

目的：为减少明显的瘢痕和面神经损伤的机会,采用内镜辅助经口内入路进行成年人髁突下骨折的复位与固定。方法：从2003年4月—2005年12月就诊的11例髁突下骨折病例,全麻下口内切开,内镜辅助下进行髁突下骨折的复位与内固定,同期行其他部位骨折的复位与固定。结果：11例患者中有9例获得了良好的解剖复位,另2例因存在骨质缺损未能达到精确的解剖复位。手术后恢复较快,均无面神经损伤症状。随访期为1.5～3.8a,平均2.2a。术后6个月内关节功能正常,瘢痕不明显;随访期末,平均开口度为3.6cm,2例患者出现关节弹响,但不影响生活。结论：经口内入路内镜辅助的下颌骨髁突下骨折复位与固定可达到开放性手术类似的疗效,并可减少瘢痕的形成和面神经损伤的发生。     

Retromandibular approach to condyle fractures: two case reports

Retromandibular approach was first described in 1967 for vertical subcondylar osteotomy and later became popular for surgical treatment of temporomandibular joint dysfunction and low condyle fractures. The trajectory of the incision, parallel to the posterior border of the mandibular ramus, allows a good approach with easy separation of the buccal and marginal mandibular branches of the facial nerve, when they are present in the surgical field. When open reduction and internal rigid fixation with plates and screws are indicated for condylar fractures, retromandibular approach offers an excellent esthetic result with low morbidity. Two clinical cases are presented, in which the surgical treatment was carried out for condylar fractures, and clearly illustrate the proposed approach.     

Treatment of low subcondylar fractures—a 5-year retrospective study

The aim of the present study was to retrospectively review the treatment outcome of low subcondylar temporomandibular joint fractures. The retrospective analysis was performed on all patients treated for low subcondylar fractures (below the sigmoid notch) between 2006 and 2011. Patients were divided into two groups: the closed reduction group (maxillomandibular fixation, MMF) and the open reduction group (anteroparotid transmasseteric (APTM) approach). Out of 129 condylar fractures, a total of 37 patients met the inclusion criterion of a fracture below the sigmoid notch (low subcondylar). Ten patients (seven males and three females) were treated using the APTM approach, and 27 patients were treated conservatively by MMF. In the open reduction group, two patients (20%) had limited mouth opening that resolved following physiotherapy; the closed reduction group had a similar percentage (18.5%) of mouth opening limitation (below 35 mm). No facial nerve damage was noted. Adult patients suffering from low subcondylar fractures can be treated by open reduction and internal fixation using the APTM approach, which was found to be a safe and reproducible procedure with no facial nerve damage; however this is a surgical procedure with a shallow learning curve.     

Endoscopic-assisted repair of subcondylar fractures

OBJECTIVE: To evaluate outcomes of a series of mandibular subcondylar fractures repaired with endoscopic reduction and fixation.Study design Six consecutive subcondylar fractures were treated endoscopically. Intermaxillary fixation was used intraoperatively to aid in fracture reduction. A modified Risdon incision was used to gain access to the lateral ramus, and a modified retractor and endoscope were used for retraction and visualization. Fracture fixation was achieved with a 2-mm titanium plate and screws. Patients were evaluated clinically and radiographically for 6 months and functional, radiographic, and esthetic parameters were assessed at each time period (1, 2, 4, 12, and 24 weeks). RESULTS: All patients demonstrated a stable occlusion in the postoperative period and anatomic alignment of the condyle radiographically. By 1 month, maximum interincisal opening was 42.2 +/- 5.7 mm. There was no joint noise or temporomandibular joint (TMJ) pain postoperatively. Radiographs at each follow-up visit indicated the ramus height was maintained in most cases. There was minimal transient facial nerve paresis following surgery. Scar perception was considered acceptable by all patients. Operative times were acceptable as well. CONCLUSION: Endoscopic-assisted repair of subcondylar fractures is an additional tool for management of subcondylar fractures, however there is a steep learning curve based on this study. The technique allows good visualization of the fracture site for reduction through an incision with an acceptable cosmetic result.     

A transparotid transcutaneous approach for internal rigid fixation in condylar fractures

Closed versus open reduction in condyle fractures is a dilemma that may torment the plastic surgeon. Although at present it is accepted that there are fractures that must be open reduced as when the middle cranial fossa or temporal fossa are involucrated, foreign body are in the joint capsule, lateral extracapsular deviation of condylar deviation, and open fractures. Risdon or retromandibular approaches are used for the treatment of fractures in the condyle neck and superior third of the lower ramus.When both approaches are used the correct placement of screws is very difficult for the following reasons: 1. Both drill and screwdrivers must be placed in an oblique direction to the bone surface; as a result, screws do not press the plate toward the bone and therefore a deficient stabilization results; 2. A distraction of too much soft tissue entrapped between the skin and mandibular bone is necessary for a good visual to surgical field and 3. The parotid tissue, the masseter muscle, and the facial nerve must be strongly distracted facilitating the nerve injury.A transcutaneous transparotid approach is the most appropriate for screws placement. By means of transbuccal set it is possible to reach the mandibular bone going through both the parotid tissue and the masseter muscle avoiding the injury the branches of the facial nerve.A case report illustrates the practical application of the above technique and it shows that as the lesion of branches of the facial nerve can be avoided.     

髁突骨折手术治疗的临床研究

目的：探讨手术治疗髁突骨折的适应证、技术要点和并发症的发生因素。方法：回顾分析5年来采用手术治疗的116例髁突骨折病例的临床资料,分别采取切开复位内固定术和髁突摘除术,随访3个月至3年,复查内容包括患者咬合关系、开口度、开口型、神经损伤、颞下颌关节症状、面型和X线检查。结果：外形和功能均显著恢复,113例咬合关系恢复正常,占97.4%;115例张口度恢复正常,占99.1%;X线复查髁突骨折解剖复位率94.8%;15例儿童患者恢复良好,无下颌骨发育障碍等严重并发症发生。结论：坚强内固定技术是治疗髁突骨折的较好方法,严重移位或脱位的儿童髁颈和髁颈下骨折应采用可吸收接骨板进行内固定。     

口内入路治疗髁突低位骨折

目的:探讨口内入路治疗髁突低位的安全性及有效性。方法:回顾性研究本院2014年1月~2016年4月所收治8例髁突低位骨折的患者,选择口内入路对髁突低位骨折进行切开复位内固定术。结果:8例患者,10侧髁突低位骨折,其中5例患者合并下颌骨体部骨折。髁突低位骨折患者行内窥镜辅助下穿颊器或侧壁螺丝刀口内入路进行手术治疗。术后患者创口均Ⅰ期愈合,未发现面瘫及涎瘘等并发症,术后复查全口曲面断层片和三维CT示骨折断端对位良好。3个月后复查,面部无明显疤痕,张口度正常,咬合关系良好。结论:利用穿颊器或侧壁螺丝刀口内入路治疗髁突低位骨折,相对于传统的耳前、颌下及颌后入路,手术创伤小,面部无明显瘢痕,外形良好,配合内窥镜的使用,更加便于直视下完成骨折复位固定,是治疗髁突低位骨折安全有效的手术入路。     

翼外肌-髁突解剖复位内固定治疗髁突颈骨折60例的临床分析

目的 探讨髁突颈部骨折时进行髁突-翼外肌解剖复位坚强内固定的适应证、手术方法 及术后效果。方法 对髁突颈部骨折出现髁头脱位突破关节囊、髁突和髁突颈下骨折移位成角大于30°~45°、下颌支垂直高度降低超过4~5 mm的骨折患者,采用耳屏前绕耳轮脚向上后耳颅沟切口,行翼外肌-髁突肌解剖复位坚强内固定方法 治疗。术后1、3、6个月复诊,检查面型、开口度、开口型、牙合关系、咀嚼力、面神经功能,三维CT重建上下颌骨,根据临床和影像学进行评价。结果 术后1月,所有患者面型对称、牙合关系好、开口度均较术前增大;无骨折移位、患侧咀嚼力减弱、8例额纹变浅。3月后,所有病例面型对称、开口度≥3.5 cm、开口型无偏斜、骨折一期愈合、髁突表面未见骨质吸收、面神经瘫痪症状恢复、双侧咬合力对称。6月后观察所有项目同术后3月。结论 髁突骨折经耳屏前后上绕耳轮脚切口,能较好的保护颞下颌关节区相关血管神经;对髁突颈部骨折行翼外肌-髁突解剖结构开放性复位内固定,是一种恢复解剖形态和关节功能的有效方法 ,在术后3月内可判定其效果。     

下颌升支垂直截骨内固定术治疗髁突高位骨折

目的:比较手术和非手术方法治疗单侧下颌骨髁突高位骨折的临床效果。方法:19例髁突高位骨折患者,其中10例行下颌升支截骨内固定术+颌间牵引术(手术组),其余9例单纯行颌间牵引术(非手术组),随访0.5～1年。结果:手术组和非手术组之间比较,开口度及前伸运动度均无显著性差异(P>0.05);侧方运动度手术组优于非手术组,有显著性差异(P<0.01)。非手术治疗的患者,下颌骨平面不对称,X线片显示髁突的解剖位置欠佳。手术患者,下颌下区存在线形疤痕,但下颌骨平面对称,X线片显示患侧髁突与健侧形态相似。19例中无1例出现明显的颞下颌关节紊乱综合征。结论:采用下颌升支垂直截骨内固定术+颌间牵引术治疗下颌骨髁突高位复杂骨折,兼顾美观和功能,手术简便,不失为一种理想的治疗方法。