颌后腮腺入路行髁突颈部及髁颈下骨折复位手术治疗

Retromandibular Transparotid Approach in the Treatment of Codylar Neck Fracture of the Mandible

目的:探讨颌后经腮腺入路行髁突颈部及髁颈下骨折手术治疗的效果。方法:对34例共40侧髁突颈部或髁颈下骨折患者,采用颌后切口,经面神经两干间解剖分离腮腺组织,显露复位骨折断端,并用两块钛板在髁突前后缘行内固定术。结果:所有患者髁突颈部或颈下部骨折均得到解剖复位,咬合关系及张口度恢复良好。两侧髁突形态对称,无吸收现象,钛板螺钉固定良好。术后无腮腺涎瘘及Frey′s综合症发生。面神经损伤发生率为17.5%(7/40),均为暂时性轻微损伤。结论:颌后经腮腺入路行髁突颈部及髁颈下骨折切口隐蔽,易于清晰显露,骨折复位固定安全高效,值得临床推广应用。

Objective： To summarize and discuss the surgical outcome of a retromandibular transparotid approach for the treatment of condylar neck or subcondylar fractures of the mandible. Methods： 34 cases（40 sides） suffered condylar neck or subcondylar fractures were retrospectively reviewed. Surgical reduction consisted of retromandibular incision and parotid tissue approach between the branchs of facial nerve, fracture sites were reduced and fixed with two miniplates and screws.Occlusal relations, maximum mouth opening, complications, and imaging examinations were followed up to assess the post-operative results. Results： All patients with condylar fracture were gain better anatomical reposition and reliable fixation.Both sides of the condyle were symmetrical, none suffered from bone resorptions or condylar necrosis. No case had com-plicated with salivary fistula or Frey′ s syndrome.7 sides had transient facial nerve paralysis and all recovered 5 months later. Three patients suffered with malocclusion after reduction. Conclusions： It is suggested that the retromandibular transparotid approach for condylar or subcondylar fracture reduction offers minimum invasion, safe and efficient, and less complications.