颞部发际前缘切口在颧骨复合体骨折内固定术中的应用

目的：探讨颞部发际前缘切口在颧骨复合体骨折(ZCF)内固定术中的应用方法、优势和效果。方法：沿颞部发际前缘作纵行切开分离，注意保护跨越颧弓的面神经颧、额支，横向切开颧弓表面深筋膜和骨膜，暴露骨折部位。Al型病例仅采用颞部发际前缘切口，B、C型病例配合眶周及口腔前庭等小切口，利用该切口撬动整个颧骨体复位，重建颧骨体外形轮廓。精确复位后，采用微型钛板作坚强内固定。不作头皮冠状切口。结果：99例107侧ZCF患者术后疗效优良率达86．0％。颞部发际前缘切口均一期愈合。面神经颧、额支麻痹引起的暂时性瘫痪率为24.3％，6个月内全部恢复，无永久性面瘫发生。结论：颞部发际前缘切口具有术野清晰，操作方便，创伤小，出血少，提高复位固定准确性及瘢痕隐蔽等优点。

Application of temporal anterior hairline incision in internal fixation of zygomatic complex fracture

PURPOSE: To investigate the methods, merits and effects of temporal anterior hairline incision in internal fixation of zygomatic complex fracture (ZCF). METHODS: 99 cases of ZCF were treated via vertical incision in temporal anterior hairline. During dissection, the zygomatic branch and the frontal branch of the facial nerve, which crossed over the zygomatic arch, were protected. The deep fascia superficial to the zygomatic arch was horizontally incised, the periosteum was elevated at the fracture sites. Cases of type A1 were treated through the above approach; while minor periorbital and oral vestibule incisions were also used in cases of type B and C. The fracture segments were reduced accurately and fixed with titanium microplates. Coronal incision was not applied in all cases. RESULTS: The clinical results were good in 99 cases (86.0%). All the temporal anterior hairline incisions healed primarily. The rate of temporary facial paralysis, due to injury of the zygomatic and frontal branch of the facial nerve, was 24.3% ; but all recovered six months later, without any permanent paralysis. CONCLUSION: The temporal anterior hairline incision has many merits including clear field of operation , convenient manipulation, minimal trauma, less bleeding , high accuracy of reduction and inconspicuous scar.