穿腮腺入路治疗髁颈及髁突基底部骨折

目的：探讨穿腮腺入路治疗髁颈及髁突基底部的安全性及有效性。方法：对15例（21侧）髁颈及髁突基底部骨折患者选择穿腮腺入路切开复位内固定术。结果：15例患者,21例侧髁突骨折行手术治疗。19例侧髁突骨折选择2块接骨板固定,2例侧选择1块接骨板固定。所有患者伤口均一期愈合,术后复查全口曲面断层片或三维CT示骨折断端对位良好。除1例患侧后牙暂时性轻度开外,所有患者咬合关系恢复良好。术后1个月复查,张口度32～45mm（平均38mm）。3例侧出现面神经损伤症状,术后3个月内均恢复正常,无1例出现永久性面瘫。所有患者均未出现涎瘘、感染等并发症。结论：相对于髁突骨折的颌后及颌下入路,穿腮腺入路行髁突骨折切开复位内固定术,容易暴露,可直视下完成骨折复位固定,是治疗髁颈和髁突基底部骨折安全有效的手术入路。

Transparotid Approach for Surgical Treatment of Condylar Neck Fractures and Condylar Base Fractures

Objective： To discuss the safety and efficiency of surgical treatment for condylar neck fractures and condylar base fractures using a transparotid approach.Methods： A clinical study was conducted on 15 patients with 21 fractures of the condylar neck and condylar base.The fractures were treated surgically with a transparotid approach using plates and screws for internal fixation.Results： Fifteen patients with 21 condylar fractures were treated.Nineteen fractures were fixed with two plates and two fractures were fixed with one plate.Primary healing occurred in all 15 patients.Postoperative X-ray or CT images showed anatomical reduction.Except for a slight degree of transient postoperative open bite on the injured side in one case,all cases achieved perfect occlusion after operation.Postoperative maximal mouth opening was 32-45mm（mean 38mm）.Three cases had transient facial palsy and all recovered in 3 months.No patients had permanent facial palsy.Postoperative salivary fistulae and infection were not observed in any patient.Conclusion： Transparotid approach provides a much clearer and more direct exposure than retromandibular or submandibular approaches.It is a safe and efficient surgical approach for open reduction and internal fixation of condylar neck fractures and condylar base fractures.