下颌后越腮腺前缘穿咬肌入路治疗髁突低位骨折的临床研究

Clinical Study of Transmasseteric Anterior Parotid Approach for Treatment of Mandibular Subcondylar Fractures

目的:探讨下颌后越腮腺前缘穿咬肌入路在髁突低位骨折手术中的应用。方法:利用5具国人成人男性标本,对颞下颌关节及腮腺区解剖进行观察。结合局部解剖,对18例髁突低位骨折患者采用下颌后越腮腺前缘穿咬肌入路,切开皮肤及皮下组织达腮腺筋膜表面,沿腮腺筋膜表面向前解剖分离到腮腺前缘,将腮腺组织向后牵开显露咬肌表面,钝分离咬肌,暴露骨折断端,用一块L型钛板复位固定骨折。结果:18例患者术后咬合关系恢复良好,张口度正常,无1例患者出现面瘫。术后3个月复诊骨折愈合良好。结论:对于髁突低位骨折,应用下颌后越腮腺穿咬肌入路,操作简单,创伤小,利于保护面神经,术野清晰,便于复位固定。且切口隐蔽,术后瘢痕不明显。熟知颞下颌关节及腮腺区的解剖可明显减少手术创伤及预防手术并发症的发生。

Objective：To evaluate the efficacy of transmasseteric anterior parotid approach for open reduction of mandibular subcondylar fractures.Methods：From July 2014 to July 2016,18 cases with mandibular subcondylar fractures were recruited in this study.The skin flap with the subcutaneous layer was elevated anteriorly in the plane superficial to the platysma muscle and the parotid fascia,and then the fracture was exposed by blunt dissection of the masseter between the upper and lower buccal branches of the facial nerve after revealing the surface of the masseter muscle through the anterior border of the parotid gland.Finally,the fracture was reducted using single Lshaped titanium plate.Moreover,before all surgeries,temporomandibular joint and parotid region were studied at five Chinese adult cadavers fixed by 10% formalin.Results：All 18 patients achieved satisfactory occlusion and mouth opening,no postoperative facial paralysis occurred in all cases.Conclusion：It is crucial to know well the anatomy of both the temporomandibular joint and the parotid region to reduce the surgical trauma and complications.Transmasseteric anterior parotid approach is a feasible approach in the surgical treatment for the mandibular subcondylar fractures because it can provide adequate exposure and minimal facial nerve injury,achieve reduction easily,and avoid conspicuous scar.