全颜面骨折的整形外科治疗

Plastic surgical treatment of panfacial fracture

目的探讨全颜面骨折整形外科治疗的方法和效果。方法分析自2013年9月至2016年12月治疗的25例全颜面骨折患者,将术中失血量、切口瘢痕、面部轮廓对称性、开口度与开口型及咬关系和相关并发症进行分析,观察手术治疗效果。结果 25例患者平均术中失血量(176±147)ml,所有患者切口瘢痕不明显,面部轮廓基本对称,咬关系恢复正常。22例患者术后开口度>3 cm;3例患者开口度2~3 cm,开口型无偏斜;1例患者外耳道皮肤破溃,髁突内固定钛板外露,经再次全身麻醉手术清创、拆除钛板后伤口愈合,1例患者出现颞区凹陷;1例患者出现单侧面神经额支损伤。结论按照整形外科的切口设计原则,采用肿胀麻醉及切开复位内固定技术,能够很好地恢复全颜面骨折患者颌面骨的力学支柱、面部轮廓对称及咬功能,同时手术失血较少,瘢痕较轻,效果较满意。

Objective To investigate the methods and results of plastic surgical treatment of panfacial fracture. Methods The clinical data of 25 patients with panfacial fracture treated in our department from September 2013 to December 2016 were retrospectively analyzed to observe the results of surgical treatment, which included intraoperative blood loss, incision scars, facial symmetry,mouth-opening, mandibular deviation during mouth opening, occlusion and related complications. Results The mean intraoperative blood loss was（176±147） ml in the 25 patients. The symmetry of facial contours and occlusion relationships recovered well without any obvious scars. The mouth opening of 22 patients exceeded 3 cm, while the mouth opening in the 3 remaining patients ranged from 2 cm to 3 cm.All of the patients＇ mouths opened without deviation of mandible. One patient suffered from skin rupture of the external auditory canal and the titanium plate of the condyle was exposed. The wound healed after debridement and removal of the titanium plate. One patient presented with temporal depression, and another patient suffered from injury of the unilateral frontal branch of the facial nerve. Conclusion The combined application of design principles for plastic incisions, tumescent anesthesia and internal fixation techniques is a superior method for restoring the mechanical pillars of the maxillofacial region, facial symmetry and occlusal function. At the same time, the results of the operation are satisfactory with less bleeding and mild scars.