绕耳轮脚切口行翼外肌-髁突解剖复位内固定治疗髁突颈骨折

External pterygoid muscle-condyle anatomic reduction and rigid internal fixation of condylar neck fracture by aural-helix foot incision

目的探讨下颌骨髁突颈骨折翼外肌-髁突解剖复位内固定新入路的方法及疗效。方法对60例(73侧)髁突颈骨折行耳屏前绕耳轮脚切口,向前下沿外耳道前缘颞下颌韧带关节囊表面将覆盖在关节表面的腮腺上极翻起,向前牵拉腮腺组织,不用显露耳颞神经、颞浅血管及面神经,显露颞下颌韧带和关节囊;在直视下寻找移位的髁突,将翼外肌-髁突解剖复位坚固内固定。术后1、3、6月复诊。结果术后3月,所有局部伤口耳轮脚上切口隐蔽仅见耳屏前愈合线、面型对称、开口度≥3.5cm、开口型无偏斜、关系好、骨折一期愈合、髁突表面未见骨质吸收、面神经瘫痪症状恢复、双侧咬合力对称、伤口愈合线隐蔽。结论髁突颈骨折经耳屏前后上绕耳轮脚切口,切口隐蔽,能较好的保护颞下颌关节区相关血管神经;对髁突颈部骨折行翼外肌-髁突解剖结构开放性复位内固定,是一种恢复解剖形态和关节功能的有效方法,在术后3月内可判定其效果。

Objective To explore the therapeutic efficacy of a new access to external pterygoid muscle-condyle anatomic reduction and rigid internal fixation （RIF） for condylar neck fracture.Methods Sixty patients with 73 unilateral condylar neck fractures were treated with preauricular beeline and helix foot arc incision. Vagina of parotid gland was dissected and separated along the front edge of auricle path in the surface of temperomadibular ligament and joint bursa,fashioned parotid flap without exposing the superficial temporal blood vessel,nerve and facial nerve when expose fracture. The displaced condylar neck was checked under sufficient exposure; the fractures were treated by external pterygoid muscle-condyle anatomical reduction and RIF. According the clinical and radiographic results,all the patients were followed up and evaluated 1 to 6 months after surgery.Results All the patient had a concealable incision on helix foot and only a preauricular beeline curing incisions can be seen,symmetrical face,normal occlusion and mouth opening≥3.5cm,no displacement condyle and condylar surface absorption,primary bone healing,symmetrical bilateral mastication power,and temporal facial paralysis recovered by conservative therapy after operation within 3 month.Conclusion Aural-helix foot incision can preferably protect blood vessel,nerve of temporomandibular joint region in condylar neck fracture cases,reserved cure incision is covert,no scar and lose hair in temporal incision. Clinical effect can be determined within 3 month.