耳颞切口联合可吸收接骨板治疗颧弓粉碎性骨折——附8例报告

目的：评价耳颞切口联合可吸收板治疗颧弓粉碎性骨折的疗效。方法：采用耳颞切口,显露复位颧弓骨折段后应用可吸收接骨板对8例单纯颧弓粉碎性骨折病例进行坚强内固定,通过面形、张口度、伤口愈合情况及X线片评价手术效果。结果：8例患者除1例术后有轻度张口受限,1例出现暂时性面瘫外,其余均开口度正常,面形对称,切口甲级愈合,手术效果良好。结论：以耳颞切口入路,可吸收接骨板行颧弓骨折坚强内固定,操作简便,损伤小,并发症少,效果良好,是一种较好的颧弓粉碎性骨折治疗方法。     

A study on coronal incision for treating zygomatic complex fractures

Objective  To study the value of coronal incisions for treating zygomatic complex fractures and evaluate the advantages, indications and complications associated with it. Method  In this prospective study, 12 patients were randomly selected regardless of age, sex requiring open reduction and internal fixation of communited zygomatic complex fractures with or without other associated fractures of the midface. Patients were all treated by coronal approach for open reduction and internal fixation of fracture of the zygomatic complex. Other local incisions were used if required. Results  In all cases postoperative complications were relatively minor except in one case were the temporal branch of facial nerve weakness persisted at 3 months. Whereas 5 cases reported with slight weakness of the temporal branch of the facial nerve which resolved at the end of 3 months. The time taken for exposure of the fracture site via the coronal incision had a mean of 28.7 minutes. There were no cases of flap infection and just 1 case of stitch abscess reported. The same case later reported with a hypertrophic scar formation of greater than 0.5cm at 3months. In all other cases scar formation was negligible and well hidden within the hairline. There were no reported cases of paraesthesia at the operated site or hollowing of the temporal fossa. Conclusion  The coronal incision provides excellent access to the zygomatic arch and zygomatic complex, aiding in good anatomical reduction and also has the added advantage of the scar hidden in the hairline. It also has disadvantages like long operating time, risk of facial nerve injury, scarring in patients with male pattern baldness, paraesthesia of operated site etc. Therefore the incision should be judiciously used and not overused and indications strictly applied.     

Modification of surgical technique in isolated zygomatic arch fracture repair: seven case studies

Closed reduction is applied in most cases of isolated zygomatic arch fracture. Open reduction and internal rigid fixation through a coronal incision have to be performed in other comminuted arch fractures. The authors introduced an endoscopic-assisted approach via a small preauricular incision to achieve reposition and osteosynthesis of isolated zygomatic arch fractures. The endoscopic-assisted surgical technique was performed in 7 patients with unilateral isolated zygomatic arch fractures. Endoscopically controlled management of the isolated zygomatic arch fracture was feasible in all 7 patients. The follow-up period was 1 year. All preauricular scar and facial lateral contour were aesthetically satisfactory. The endoscope-assisted approach via a small preauricular incision can achieve in situ reduction and fixation in zygomatic arch fracture and it should become an integral part of isolated zygomatic fracture repair, assuming the development of specialized training programs and improvements in endoscopes.     

耳前角形切口在髁突骨折切开复位内固定术中的应用

目的:探讨应用耳前角形切口在髁突骨折切开复位内固定术中的应用效果。方法:对78例100侧下颌骨髁突骨折患者采用耳前角形切口术区皮下行肿胀液注射后沿皮下翻瓣在颧弓上方2 cm切开颞深筋膜浅层并沿此层深面剥离到颧弓,分离显露骨折部位,直视下行髁突骨折解剖复位内固定术。结果:术后通过临床及影像学检查随访,效果满意,无严重并发症。结论:耳前角形切口结合皮下肿胀分离技术可为髁突骨折切开复位内固定术提供良好的视野,方便骨折复位固定,安全便捷,值得临床推广。     

颌面部骨折微型夹板坚强内固定18例报告

目的 :总结颌面部骨折开放复位 ,微型夹板坚强内固定的临床疗效。方法 :18例颌面部骨折病例进行开放复位 ,微型夹板坚强内固定。其中颧骨颧弓骨折 3例、上颌骨LefortI型骨折 3例、下颌骨多发性骨折 10例、下颌骨粉碎性骨折 2例。结果 :18例颌面部骨折病例手术后均达到解剖复位 ,咬合关系恢复正常 ,外观及功能均获得满意效果 ,无一例并发症发生。结论 :应用微型夹板在颌面部骨折中进行坚强内固定 ,可使骨折达到解剖复位 ,获得满意临床疗效。     

头皮半冠状切口在面中份复杂骨折治疗中的应用

目的：探讨面中份复杂骨折手术切口设计和坚固内固定治疗的临床效果。方法：对86例面中份复杂骨折病例进行手术切开复位和坚固内固定,术后对骨折复位、面形、咬合关系、张口度、面瘫等项目进行评估。结果：运用该方法治疗面中份复杂骨折86例,术后伤口均Ⅰ期愈合,术后3～6个月复查,面部外形恢复正常,咬合关系恢复正常或接近正常,张口度全部恢复正常,X线或CT复查骨折段均达到解剖复位。结论：头皮半冠状切口隐蔽安全,不影响美观,术野暴露清楚,便于直视下操作,坚固内固定稳定,组织相容性好,是治疗面中份复杂骨折的一种理想切口。     

Treatment of zygomatic fractures without inferior orbital rim fixation

Zygomatic fractures can be associated with functional and esthetic problems. Recent improvements in surgical techniques and materials have enabled stable fixation of zygmomatic fractures. Multiple-point fixation is most commonly used for internal fixation. Generally, reduction and fixation are performed through lateral brow, subciliary, temporal, or intraoral incisions (three-point fixation). Our experience indicates that postoperative scarring and sensory disturbances are caused by a subciliary incision with inferior orbital rim fixation. It is thus recommended that inferior orbital rim fixation with mini- or microplates be avoided. In patients in whom the fracture does not involve the orbital floor, reduction of the zygoma and zygomatic arch through a temporal incision is performed at this institution. Fixation of the lateral zygomaticomaxillary buttress and anterior wall of the maxilla with miniplates through an intraoral incision is also performed. If necessary, zygomaticofrontal suture fixation with a miniplate or wire is performed through a lateral brow incision. The status of inferior orbital rim reduction is confirmed by palpitation. Inferior orbital rim fixation with mini- or microplates is recommended for reduction of comminuted fractures and orbital floor fractures with herniation of internal orbit components. Patients who did not undergo inferior orbital rim fixation were free of inferior orbital rim deformity, diplopia, and postreduction rotation.     

Analysis of zygomatic fractures

The purpose of this study was to evaluate the natural history of zygomatic fractures in 469 cases over 14 years. The medical records of patients seeking treatment for zygomatic fractures were reviewed. The zygomatic fractures were classified as monopod, dipod, or tripod fractures for most patients. The monopod fractures included (1) zygomaticofrontal, (2) zygomaticomaxillary, and (3) zygomatic arch fractures. The dipod fractures were subclassified into 3 types according to combination of the previously mentioned 3 sites, which were 1 and 2, 1 and 3, and 2 and 3. Tripod fracture included all 1, 2, and 3. Among 469 cases of zygomatic fractures, tripod fractures (n = 238, 50.7%), zygomaticomaxillary fracture (n = 121, 25.8%), and isolated fracture of the zygomatic arch (n = 98 20.9%) formed most of the cases (n = 457, 97.4%). About one-half cases were tripod fractures (n = 238, 50.7%), and another half cases were monopod fractures (n = 220, 46.9%). Only 11 cases (2.4%) were dipod fractures. Most of the monopod fractures were zygomaticomaxillary (n = 121, 25.8%) and zygomatic arch fractures (n = 98, 20.9%). Among the dipod fractures, no cases of zygomaticofrontal and zygomatic arch fractures were reported. An open reduction was performed in 73.8% (346 cases), closed reduction in 24.5% (115 cases), and conservative treatment in only 1.7%. In tripod fracture (n = 238), an open reduction and internal fixation was performed for most of the cases (n = 225, 94.5%), and closed reduction was performed in only 11 cases (4.6%). In monopod zygomaticomaxillary fracture (n = 121), internal fixation was performed for most of the cases (n = 108, 89.3%), and closed reduction was performed in only 9 cases (7.7%). However, in monopod fracture of the zygomatic arch (n = 98), most of the cases (n = 95, 96.9%) were treated with closed reduction; open reduction was performed in only 1 case (1.0%). At zygomaticofrontal area (n = 241), internal fixation was performed in most of the cases (n = 198, 82.2%). At the infraorbital rim (n = 364), internal fixation was carried out in most cases (n = 257, 70.6%). At the zygomaticomaxillary buttress (n = 279), internal fixation was performed in about one third of the cases (n = 91, 32.6%). At the zygomatic arch (n = 339), only 1 case (0.3%) was fixed internally. The postoperative complication rate occurred in 88 cases (19.1%) among 461 cases operated. The most common complication was hypesthesia (50 cases, 56.8%), followed by diplopia (15 cases, 17.0%), limitation of mouth opening or closure (11 cases, 12.5%), infection (6.8%), and hematoma (4.5%). Most patients with hypesthesia improved at 2 months. About 90% of the patients with diplopia improved within 2 months. Limitation of mouth opening was improved immediately after operation in most of the cases. Our findings demonstrate significant differences in the demographics and clinical presentation that will enable a more accurate diagnosis and prediction of concomitant injuries and sequelae.     

A New Simplified Technique for Intermaxillary Fixation by Loop-Designed Wire

In the treatment of maxillofacial fractures, Inter-maxillary fixation (IMF) is an important. The upper and lower arch bars or Ivy eyelet wiring is secured by wires and IMF is done with the help of box wiring. Here, we present a new type of IMF technique, using 26-gauze stainless steel ‘loop-design’ wire, which is a simple, quick, economical and minimally invasive technique without using arch bars. Typical indications for its use are minimally displaced fractures, deep bite cases, stabilization of fracture during open reduction and internal fixation, orthognathic surgeries and in tumor resection surgeries.     

Malunited fracture of the body and condyle of the mandible : A Case Report

Mandibular fractures are the most common facial fractures seen in hospitalized children and their incidence increases with age. Treatment options include soft diet, intermaxillary fixation with eyelet wires, arch bars, circummandibular wiring, or stents. Alternative options include open reduction and internal fixation through either an intraoral or extraoral approach. Many factors complicate the management of pediatric mixed-dentition mandibular fractures: tooth eruption, short roots, developing tooth buds and growth issues. One major factor is the inherent instability of the occlusion in the mixed deciduous-permanent tooth phase. This case report documents a child in mixed dentition period with a complication arising due to direct fixation of the fractured mandible.     

耳前长角形切口在复杂颧骨复合体骨折复位内固定术中的应用

目的：探讨应用耳前长角形切口在复杂颧骨复合体骨折切开复位内固定术中的应用效果。方法：在106例复杂颧骨复合体骨折切开复位内固定术中采用耳前长角形切口,术区皮下肿胀分离后沿皮下翻瓣,在颧弓上方2cm切开颞深筋膜浅层并沿此层深面剥离到颧弓,分离显露骨折部位,直视下行骨折复位内固定术。结果：术后通过临床及影像学检查随访,效果满意,无严重并发症。结论：耳前长角形切口结合皮下肿胀分离技术不但为复杂颧骨复合体骨折复位内固定术提供良好的视野,方便骨折复位固定,而且与头皮冠状切口相比大大减少了损伤和出血,值得临床推广。     

评价颌间结扎钉配合小型钛板联合治疗下颌骨骨折的临床应用

目的：评价颌间结扎钉进行颌间牵引固定的疗效。方法：对63例下颌骨骨折切开复位内固定的患者随机采用牙弓夹板或颌间结扎钉进行颌间牵引固定，比较操作时间、治疗后牙周指数、张口度、咬合关系及骨折愈合情况。结果：采用颌间结扎钉治疗的患者咬合关系、骨折愈合及张口度与采用牙弓夹板的患者无明显差别，其操作时间较采用牙弓夹板明显缩短，牙周健康指数明显好于采用牙弓夹板的患者。结论：颌间结扎钉操作简单省时、易于保持口腔清洁，是较理想的颌间牵引固定新方法。     

改良耳屏切口应用于髁突骨折切开复位内固定术的临床观察

目的探讨改良耳屏切口在髁突骨折切开复位内固定术应用的效果。方法 16例髁突骨折患者经改良耳屏切口行髁突骨折切开复位内固定术。方法为沿耳屏切开,在外耳道和腮腺后缘间钝性分离,注意保护耳屏处软骨,把腮腺组织向前牵开,这样能把面神经完整地推向前方,不必专门解剖面神经。直视下觅得两骨折段,按原位置和方向复位,以小型钛板坚固内固定。术后半年复诊。结果 16例病例术后伤口均Ⅰ期愈合,咬合关系恢复良好,面部形态满意。术后半个月张口度大于3.0 cm,半个月及半年后X线片检查,髁突复位良好,无骨折部位不愈或延迟愈合表现,无内固定物松脱,愈合后瘢痕隐蔽,美观效果好,均无面神经损伤症状,临床疗效满意。结论改良耳屏切口在髁突骨折切开复位内固定术的应用中,由于其切口隐蔽安全,利于保护面神经及重要血管,减少并发症,是一种恢复解剖形态和关节功能的有效方法。     

3D打印术前设计和内镜辅助在颧骨颧弓骨折复位固定术中的应用

目的: 探讨3D打印术前设计和内镜技术应用于颧骨颧弓骨折复位固定手术的可行性及效果。方法: 选择4例B型颧骨颧弓骨折患者,均伴发颧弓骨折,面部凹陷明显伴开口受限。术前行CT扫描后将数据转化为STL格式,3D打印骨折模型和镜像模型,在模型上完成手术设计和钛板预弯制。手术采用耳屏前小切口和颧弓表面隧道手术入路,内镜辅助下完成颧弓骨折的复位及坚固内固定。结果: 所有患者术后面部恢复对称性,面部凹陷消失,开口度正常,面部瘢痕不明显,无感染和神经损伤等并发症。结论: 术前3D模型手术设计降低了内镜辅助下行颧弓骨折复位固定术的难度,提高了手术精准度,避免了头皮冠状切口,创伤小,美容效果好。     

Treatment of fractures of zygomatic bone and zygomatic arch. A method for the reduction of fracture by the use of U-shaped elevator

The occurrence of maxillofacial bone fractures has gradually increased. These were two-hundred-fifty-nine cases of maxillofacial bone fractures from 1981 to 1988, in which fourteen cases were fractures of zygomatic bone and zygomatic arch. (The number of the fractures of zygomatic bone, zygomatic arch, zygomatic bone and arch, and zygomatic bone and mandibular bone were 5, 2, 4, and 3 cases, respectively). Pathognomonic symptoms were infra-orbital neuroparalysis, tristmus and recess of the buccal region. The incisional for open reduction were applied for the lateral brow, the lower eyelid, or intra-oral approach. U-shaped elevator was used for the reduction and miniplate and stainless wire were used for fixation.     

口内途径坚强内固定术治疗下颌骨骨折29例报告

目的 :评价口内途径坚强内固定术及术中暂时性小环结扎治疗下颌骨骨折的效果。方法 :对 2 9例 47处下颌骨体部骨折先作两侧磨牙区和切牙区三点式颌间小环结扎 ,骨折线两侧作牙间结扎 ,初步恢复下颌骨的弓形和咬合关系后 ,自下颌前庭沟作切口 ,显露骨折处并复位后进行小型钛板坚强内固定术。术毕拆除颌间结扎 ,恢复下颌运动。分别于术后第 1d和 90d进行临床和X线检查 ,评价其咬合关系、骨折复位及愈合情况。结果 :2 9例47处下颌骨体部骨折均获得良好的复位和骨性愈合 ,咬合关系良好 ,无并发症。结论 :口内途径小型钛板坚强内固定术可对下颌骨体部骨折进行良好的固定 ,获得满意的咬合关系。     

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??Objective    To analyze surgical reduction of zygomatic arch M-shaped fractures?? and to summarize experience of the application of navigation. Methods    Forty-seven zygomatic arch M-shaped fractures were divided into two groups??group without navigation??26 cases??and group with navigation??21??. In group without navigation??20 cases were reduced by intraoral incision??and 6 by temporal incision??junior surgeons conducted the reduction in 3 cases. In group with navigation??all the cases were treated by intraoral reduction with navigation??junior surgeons conducted the reduction in 7 cases. The duration of follow-up ranged from 3 to 6 months. Results    In group without navigation??one case failed to be restored by intraoral incision??and another case was identified fracture fragment collapse postoperatively. All other fractures healed without complications in both groups. Conclusion    Intraoral reduction of zygomatic arch M-shaped fracture with computer-assisted navigation system is an effective and useful way to achieve better treatment effects??and especially easy for junior surgeons to master.     

应用计算机辅助手术导航系统经口内径路复位颧弓M型骨折临床观察

目的    探讨应用计算机辅助手术导航系统经口内径路复位颧弓M型骨折的技巧及经验。方法    2012年1月至2014年12月武汉大学口腔医学院47例颧弓M型骨折分为非导航组（26例）和导航组（21例）。非导航组患者20例经口内径路,6例经颞部小切口,26例中低年资医师开展3例。导航组患者均应用计算机辅助手术导航系统经口内径路进行开放复位,其中7例由低年资医师完成。术后随访3 ~ 6个月。 结果    非导航组1例经口内径路复位效果不佳,另1例术后复查X线片显示颧弓骨段塌陷,其他病例以及导航组全部病例均复位效果满意。结论    应用计算机辅助手术导航系统经口内径路复位颧弓M型骨折是一种安全、高效、易于掌握的方法,尤其有利于低年资医师快速掌握手术技巧。     

Treatment methods for fractures of the mandibular angle.

Fractures of the mandibular angle are plagued with the highest rate of complication of all mandibular fractures. Over the past 10 years, various forms of treatment for these fractures were performed on an indigent inner city population. Treatment included: 1) closed reduction or intraoral open reduction and non-rigid fixation; 2) extraoral open reduction and internal fixation with an AO/ASIF reconstruction bone plate; 3) intraoral open reduction and internal fixation using a solitary lag screw; 4) intraoral open reduction and internal fixation using two 2.0 mm mini-dynamic compression plates; 5) intraoral open reduction and internal fixation using two 2.4 mm mandibular dynamic compression plates; 6) intraoral open reduction and internal fixation using two non-compression miniplates; 7) intraoral open reduction and internal fixation using a single non-compression miniplate; and 8) intraoral open reduction and internal fixation using a single malleable non-compression miniplate. This paper reviews the results of those modes of treatment when used for the same patient population at one hospital. Results of treatment show that, in this patient population, the use of either an extraoral open reduction and internal fixation with the AO/ASIF reconstruction plate or intraoral open reduction and internal fixation, using a single miniplate, are associated with the fewest complications.     

微创下实施内固定治疗颧骨骨折的疗效及安全性

目的 探讨经口内微创入路实施内固定治疗颧骨骨折的临床疗效及安全性。方法 选取2005年6月—2013年6月收治的71例颧骨骨折患者,随机分为实验组和对照组。实验组采用经口内径路切开复位及微型钛板内固定术,对照组采用经冠状切口切开、明视下骨折复位及微型钛板内固定术。比较2组患者术前及术后3个月的伤侧鼻侧、颞侧运动度、开口度和眼球内陷程度,比较2组患者术后6个月的临床疗效及术后并发症发生率。采用SPSS18.0软件包对数据进行统计学分析。结果 2组患者术后3个月的伤侧鼻侧、颞侧运动度均显著低于术前（P<0.01）;实验组术后3个月的伤侧鼻侧、颞侧运动度均显著低于对照组（P<0.01）。2组患者术后3个月的开口度显著大于术前,眼球内陷程度显著小于术前（P均<0.01）;实验组术后3个月的开口度显著大于对照组,眼球内陷程度显著小于对照组（P均<0.01）。实验组术后半年的临床疗效显著高于对照组（P<0.05）。实验组的术后并发症发生率显著低于对照组（P<0.05）。结论 经口内微创实施内固定治疗颧骨骨折创伤较小,同时手术疗效佳,术后并发症发生率低,值得临床推广应用。