Nam Seung Min, Kim Yong Bae, Cha Han Gyu, Wee Syeo Young, Choi Chang Yong
From the *Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Bucheon; and †Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Gumi, Republic of Korea.
Ann Plast Surg. 2015 Sep;75(3):295-301. doi: 10.1097/SAP.0000000000000011.
The management of subcondylar mandibular fractures has been a matter of controversy. Although closed reduction is the most useful method, it can be difficult to achieve anatomical reduction with this technique compared with open reduction and internal fixation (ORIF). Most surgeons prefer to treat subcondylar fractures by extraoral approaches rather than intraoral approaches because extraoral approaches provide good visualization of the operative field. The retromandibular, submandibular, and perilobular approaches are commonly performed in the treatment of displaced condylar or subcondylar fractures and that the functional results of these treatments are good. However, extraoral approaches have a high rate of surgical complications such as salivary fistula formation, visible scarring, and facial nerve injury, compared with intraoral approaches. Therefore, this clinical study evaluated the clinical results of ORIF for mandibular subcondylar fractures through a transoral approach using an angulated screwdriver system without endoscopic assistance.
A study was conducted between March 2011 and October 2012. Eleven patients with subcondylar fractures of the mandible were treated through a transoral approach using an angulated screwdriver. There were 10 male patients and 1 female patient aged 21 to 72 years (mean, 38 years). Nine patients had a symphyseal or parasymphyseal fracture, and 2 patients had isolated subcondylar fractures of the mandible.
Eleven patients with subcondylar fractures of the mandible were treated with a transoral approach using an angulated screwdriver. The subcondylar fracture was on the left side in 6 patients and on the right in 5. All patients achieved satisfactory ranges of temporomandibular joint movement with an interincisal distance of more than 40 mm without deviation and stable individual centric occlusion. The maximum operation duration was 165 minutes, and the average duration of ORIF was 97 minutes. The association between the operation duration and the number of operations was statistically significant.
Our clinical study shows that subcondylar fractures of the mandible can be treated using an angulated screwdriver system through a transoral approach and that this technique provides reliable, satisfactory, and safe clinical outcomes.
下颌骨髁突骨折的治疗一直存在争议。尽管闭合复位是最常用的方法，但与切开复位内固定术（ORIF）相比，采用该技术实现解剖复位可能较为困难。大多数外科医生更倾向于通过口外入路而非口内入路治疗髁突骨折，因为口外入路能提供良好的术野视野。下颌后、下颌下及腮腺叶旁入路常用于治疗移位的髁突或髁突下骨折，且这些治疗的功能效果良好。然而，与口内入路相比，口外入路手术并发症发生率较高，如涎瘘形成、明显瘢痕及面神经损伤。因此，本临床研究评估了使用成角螺丝刀系统经口内入路且无内镜辅助的ORIF治疗下颌骨髁突骨折的临床效果。
研究于2011年3月至2012年10月进行。11例下颌骨髁突骨折患者采用成角螺丝刀经口内入路治疗。患者年龄21至72岁（平均38岁），其中男性10例，女性1例。9例患者伴有颏部或颏旁骨折，2例患者为孤立的下颌骨髁突骨折。
11例下颌骨髁突骨折患者采用成角螺丝刀经口内入路治疗。6例患者髁突骨折位于左侧，5例位于右侧。所有患者颞下颌关节活动范围均达到满意程度，切牙间距离超过40mm，无偏斜，个体正中咬合稳定。最长手术时间为165分钟，ORIF平均时间为97分钟。手术时间与手术次数之间的关联具有统计学意义。
我们的临床研究表明，下颌骨髁突骨折可通过成角螺丝刀系统经口内入路治疗，该技术可提供可靠、满意且安全的临床效果。
