经口腔前庭入路解剖眶下神经血管束复位固定完全性颧骨骨折

Surgical Replacement and Fixation on Zygomatic Fracture after Dissection Iinfraorbital Nerve from Oral Vestibule Incision

目的总结经口腔前庭入路解剖眶下神经血管束复位固定闭合性完全性颧骨骨折的治疗经验。方法将18例需手术复位固定的B型颧骨骨折患者纳入观测范围。全麻下经口腔内患侧前庭沟切口入路,暴露颧弓、眶下缘、颧颌缝处的骨折断端。分离保护眶下神经血管束、复位颧骨后,微型接骨板固定眶下缘、颧颌缝处骨折断端。评价切口愈合、局部不对称畸形改善程度,张口受限改善情况,以及相关并发症。结果患者中16例(89%)切口I期愈合,15例(83%)双侧颧突区软硬组织完全对称。术后4周16例(89%)张口度达III横指,比术前的7例(39%)明显改善(χ2=4.876,P=0.025)。10例(56%)解剖复位坚固内固定颧骨骨折的眶下缘和颧颌缝2处骨折断端,颧弓及眶外侧骨折断端只作解剖复位处理;5例(28%)在颧弓表面做长约1.5cm平行于颧弓的小切口,行眶下缘、颧颌缝及颧弓3处骨折断端坚固内固定;3例(16%)除眶下缘、颧颌缝、颧弓3处外,眶外侧缘骨断端以眉弓内长约1.5cm小切口入路坚固内固定。全组18例患者均未出现下睑外翻、面神经颧支损伤、鼻泪管损伤、眶周软组织水肿、眶周软组织萎缩、眼球塌陷、复视等并发症。结论通过口腔前庭沟入路,解剖眶下神经血管束,可以复位固定大部分B型颧骨骨折。陈旧性或复杂性颧骨骨折可同时选用颧弓表面或眶外侧小切口,从而完善骨折治疗。

Objective To oral vestibule. Methods summarize the experience on surgical treatment zygomatic fracture from incision of Eighteen ＂type B＂ zygomatic fractures were treated from incision of oral vestibule. The infraorbital nerve was dissected from infraorbital soft tissue about 1 - 1.5 cm after the fracture of temporal process, maxillary process and infraorbital margin were exposed. Micro -plates were fixed on infraorbital margins and maxillary processes after the fractured zygoma was anatomical replaced. Results The incisions healed normally in 16 cases （89%）. The outlines at zygomatic area were symmetric both on soft tissue level and on bone level in 15 cases （83%）. The mouth opening was improved in 16 cases （89%） 4 weeks post operation （χ^2 = 4. 876, P = 0. 025）. The plates were fixated at infraorbital margins and zygomatic maxillary sutures in 10 cases （56%）. The plates were fixated at zygomatic arches besides infraorbital margins and zygomatic maxillary sutures in 5 cases （28%）. And the plates were fixated at infraorbital margins, zygomatic maxillary sutures, zygomatic arches and lateral orbital margins in 3 cases （16%）. The were no surgical complications such as ectropin, injury of zygomatic branch of facial nerve, injury of nasolacrimal duct, soft tissue edema around orbit, atrophy around eyeball and diplopia. Conclusion The incision from oral vestibule is a viable way on surgical replacement and fixation of zygomatic fracture. The local mini - incision is necessary in old or complicated zygomatic fracture.