睑缘切口联合耳颞切口行颧骨复合体骨折内固定

Reposition of zygomatic complex fracture via subciliary incision combined with preauricular temporal approach

目的 探讨睑缘切口联合耳颞切口进行颧骨复合体骨折复位内固定的临床应用效果.方法 53例颧骨复合体骨折患者,采用睑缘下切口联合耳颞切口进行骨折复位及坚固内固定,观察术后患者面部外形、开口度、咬合关系、神经损伤、视力、眼球运动以及手术瘢痕等变化.结果 全部患者均Ⅰ期愈合,面部畸形明显改善;开口度、咬合关系恢复正常;复视及眼球运动障碍得到改善;眶下神经及面神经损伤的患者均有不同程度的恢复,并有部分患者完全恢复;没有出现因手术而导致的面神经颞支、眶上神经永久性损伤,术后部分患者面神经颞支有不同程度的暂时性损伤,1～3个月均完全恢复,无颞肌萎缩现象;无眼睑水肿、睑外翻、睑内翻出现;眼睑及耳颞部瘢痕隐蔽,不影响美观.结论 睑缘切口联合耳颞切口进行颧骨复合体骨折的复位与坚固内固定,不但术野显露充分利于复位与内周定,而且手术后瘢痕隐蔽,不影响美观,也无明显手术并发症发生.

Objective To investigate the application of subciliary incision combined with preauricular temporal approach in the treatment of zygomatic complex fracture. Methods Fifty-three patients with zygomatic complex fracture including 41 males and 12 females were selected. Subciliary incision combined with preauricular temporal incision was employed to exp the site of fracture. After reduction of the fractures, rigid internal fixation was applied to fix the fractured bones. The facial profile, mouth opening, occlusion, view sight, movement of eye ball and local scar were evaluated postoperatively. Results The wounds of all the cases healed by first intension. All the cases had been recovered with normal face profile, mouth opening, occlusion, view-sight and eye ball movement. Facial nerve function of one case among the three cases with facial nerve trauma preoperatively was recovered totally after surgical treatment. And one case with suborbital nerve dysfunction preoperatively was not recovered. There was no case with the complications of entropion and ectropion, visible scar and temporal amyotrophia. Permanent trauma of temporal branch of facial nerve and supraorbital nerve was not observed after surgical therapy, but temporary facial nerve dysfunction occurred in 18 cases postoperative 1-3 months. Conclusion It is suggested that the approach of subciliary incision combined with preatrricular temporal incision could be employed to treat zygomatic complex fracture.