穿腮腺手术径路治疗下颌骨髁突骨折的临床效果评价

Assessment of clinical effects using the transparotid approach for open treatment of condylar fractures

目的评价穿腮腺手术径路治疗下颌骨髁突骨折的临床效果。方法对31例（共36侧）下颌骨髁突骨折的患者,穿腮腺入路行下颌骨髁突骨折切开复位钛钉钛板坚固内固定术、髁突骨折碎片取出术并髁突成形术。术后观察面型、张口度、咬合关系、面神经损伤、有无唾液腺瘘及复查颌面部CT观察骨折段的复位情况等。结果 24例（共29侧）行下颌骨髁突骨折切开复位钛钉钛板坚固内固定术,7例（共7侧）髁突骨折碎片取出术并髁突成形术,术后随访6~18个月（平均11.3个月）;通过穿腮腺手术径路骨折断端复位准确、固定良好、咬合功能恢复正常、面部外形均满意;4例患者早期出现Ⅰ~Ⅱ度张口受限,经过张闭口训练后恢复正常;5例患者出现面神经暂时性麻痹,8周后均恢复正常;1例患者出现唾液腺瘘,经过加压包2周后扎后创口愈合;4例患者出现创伤性关节紊乱症,有关节弹响、疼痛等。结论穿腮腺手术径路治疗下颌骨髁突骨折安全有效,手术并发症少,值得临床推广应用。

Objective To evaluate the clinical effects of the transparotid approach for open treatment of condylar fractures. Methods In this study,31 patients with mandibular condylar fractures（36 sides）,were treated using a transparotid approach for open treatment of condylar fractures. Follow-up examinations and postoperative CT scan were performed. The degree of mouth opening,occlusal relationship,facial nerve function,and other complications in the patients were assessed and evaluated.Results 24 patients with mandibular condylar fractures（29 sides）were treated through the transparotid approach with rigid internal fixation using miniplates;7 patients whose condyle fracture′ fragments were removed and had arthroplasty of temporomandibular joints. Follow-up examinations were performed for a minimum of 6 months and a maximum of 18 months（average 11.3 months）after surgical treatment.Postoperative CT scan showed that all the condyles had been repositioned and fixed in the normal position;Occlusal function recovered well and facial symmetry was achieved in all of the patients;4 patients developed Ⅰor Ⅱgrade of limited mouth opening in the early period,and returned to normal after serial trainings;5 patients developed palsy of the facial nerve that was completely recovered after 8 weeks;1patient developed a fistula of the parotid gland who had a second wound healing after bandage treatment for2 weeks;4 cases developed traumatic articular diseases that the relevant symptoms such as joint snappingand ache. Conclusion The transparotid approach for the open treatment of condylar fractures is feasibleand safe,also worthy of clinical application and popularization.