口内入路辅助颊部小切口穿颊微创治疗下颌骨角和升支骨折

Treatment of Mandibular Angle and Ramus Fractures by Intraoral and Transoral Approach

目的观察口内和经颊小切口手术入路处理下颌骨角部和升支部骨折,并用小钛板坚固内固定的疗效。方法2000年1月—2006年7月期间21例连续的下颌骨角部和升支骨折患者,经口内切口联合颊部小切口复位内固定。随机选取同期的另26例同类型骨折患者,按照传统口外入路行手术切开复位内固定,对两组间的效果进行对比。结果用口内辅助经颊小切口入路患者中有1例内固定术后出现面瘫;口外入路行颌间固定手术患者中有6例出现面瘫,有2例需行术后颌间固定。没有术后感染需切开引流或取出固定物的病例。结论口内辅助颊部小切口入路行坚固内固定对不伴有严重错位或粉碎性骨折的下颌骨角部和升支部骨折有较好疗效。

Objective To evaluate the treatment with screwed miniplates through an intraorM and transoral approach for patients with angle and ramus fractures. Methods A total of 21 cases of mandibular angle and ramus fractures were treated by screwed miniplates placed through an intraoral incision with transbuccal mini-incision from January 2000 to July 2006. Another 26 cases chosen at random were treated by traditional extraoral approach, serving as control group. Results One patient treated by intraoral approach and six by extraoral approach resulted in facial paralyses. Two cases treated by extraoral approach required a period of maxillomandibular fixation because of fracture fragment motion. No postoperative inection ocurred in all the cases. Conclusion The use of rigid internal fixation through an intraoral and transoral approach can be applied to the patients of angle and ramus fractures without severely dislocated fracture fragment.