经咬肌颌后入路治疗髁突中低位骨折

Transmasseter approach to mid-and-low condylar fractures by mini-retromandibular access

目的探讨下颌骨髁突中低位骨折内固定术新入路的方法及治疗效果。方法对16例单侧髁突中低位骨折患者沿下颌后作2 cm小切口,顺表浅肌肉腱膜系统(SMAS)表面向前方分离,确认骨折线后钝性分离SMAS,避开腮腺,于咬肌内平行咬肌肌束钝性分离暴露骨折线后,直视下对髁突骨折端进行复位固定。结果所有患者复位满意,咬合关系良好,术后关节活动功能正常,瘢痕隐蔽。结论经咬肌颌后入路是治疗髁突中低骨折的较好方法,该改良术式不但降低了损伤面神经的危险性,而且减少了术后瘢痕。

Objective To explore a new access for internal rigid fixation of mandibular mid-and-low condylar frac-ture.Methods 16 patients of unilateral mid-and-low condylar fractures were treated with a 2 cm mini-retromandibular approach.The subcutaneous tissues superficial to the superficial muscular aponeurotic system（SMAS） were dissected forward that parallel to the masseter muscle fiber bundles,aiming to the fracture.After exposing the fracture,the fracture segments were reduced and fixed under sufficient exposure.Results Correct anatomic reduction and occlusion were achieved in all cases.Additionally,all patients showed normal articular function and the surgical scars were barely visible.Conclusion The transmasseter approach by retromandibular access is one of the feasible methods for curing mid-and-low condylar fracture,which minimizeing the risk of facial nerve injury and reducing the visible scars.