改良耳颞切口在颞下颌关节手术中的应用

A modified preauricular and temporal approach to the temporomandibular joint

目的:评价改良耳颞切口在颞下颌关节手术中的效果。方法:回顾分析1998年7月～2002年11月间收治的72例颞下颌关节病患者,男性35例,女性38例,年龄4～72岁,平均年龄36.1岁。所有患者均采用改良耳颞切口及进路术式,于耳颞部行美容切口设计,先翻开耳前皮瓣,暴露颞浅血管分支,然后沿耳颞神经血管束前缘进入,向前下翻开颞深筋膜瓣,倒“L”形切开关节囊后暴露髁突。结果:72例患者中获得随访38例(49侧),随访期4～45个月,平均17.7个月。仅1侧右颞区皮肤麻木,3侧额纹消失,总体对手术切口满意度为97.4%(37/38),不满意1例为髁突骨折患者,术后8个月术区瘢痕仍很明显,伴有颞区皮肤麻木和额纹消失。结论:改良耳颞切口及进路是目前治疗颞下颌关节疾病的理想术式之一。

PURPOSE:To evaluate the usefulness of modified preauricular and temporal approach to the temporo-mandibular joint(TMJ).METHODS:72cases with temporomandibular joint disorders were retrospectively reviewed be-tween Jul.1998and Nov.2002.There were35males and38females,ranging from4to72years in age.All patients un-derwent the open surgery to the temporomandibular joint by means of the modified preauricular and temporal approach which produced a double-layered flap,ie the skin flap and the deep temporal fascia flap.The incision for surgical access to the TMJ could easily identified the course of the superficial temporal vessels and nerves to avoid ligating them and de-velop a fairly large access to the joint and temporal area.It also markedly minimized visible scar and patients were pleased with the cosmetic results.RESULTS:38cases(49sides)were followed-up.The followed-up period ranged from4to45months,with a mean of17.7months.There was only1case who had numbness on the temporal region.The tem-porary paresis of temporal branch of facial nerve was seen in3patients.Only1patient was dissatisfactory with the inci-sion because of the preauricular scar,the temporary numbness and paresis.CONCLUSION:The modified preauricular and temporal approach is one of the optimal methods for open surgery to treat temporomandibular joint disorders.