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。

Endoscopic-assisted open treatment of displaced subcondylar mandibular fracture in adults

PURPOSE： To evaluate the feasibility of the endoscopy assisted transoral approach for open reduction of subcondylar mandible fractures with limited incisions in order to reduce the risk of facial nerve damage and extensive visible scars. METHODS： From April 2003 to December 2005, the minimally invasive transoral approach for endoscopically assisted reduction and osteosynthesis of 11 displaced subcondylar mandible fractures （with/ without mandibular symphysis fracture and zygomatic maxillary complex fracture） was performed in 11 consecutive patients. By means of limited transoral incision, the endoscopically assisted reduction and fixation of condylar fractures was performed using 30-degree angled endoscopes. All the 11 fractures were subcondylar. The condylar neck of the proximal fragment was displaced medially in 4 fractures and laterally in 7 fractures. RESULTS： Using angled endoscopes, good visibility of the fracture site was obtained, which allowed for precise anatomical reduction in 9 out of 11 patients. A transbuccal drill and screwdriver facilitated miniplate fixation by a 3mm-in-length skin incision. Postoperatively,all patients showed limited swelling, quick recovery to pre-injury occlusion and short in-hospital time. No facial nerve injury and visible scars were observed. Normal temporomandibular joint function was noted 6 months after surgery in all patients. CONCLUSIONS： The transoral endoscopically assisted treatment using an transbuccal drill and screwdriver is the method of choice for surgical management of displaced subcondylar fractures. Facial nerve injury and visible scars can be avoided by using the transoral approach.