Shi Dan, Patil Pavan Manohar, Gupta Ritika
Department of Stomatology, Yantaishan Hospital, Yantai 264025, Shangdong Province, China.
Department of Oral and Maxillofacial Surgery, School of Dental Sciences, Sharda University, Plot 32, 34, Knowledge Park 3, Greater Noida, Uttar Pradesh, 201308, India.
J Craniomaxillofac Surg. 2015 Apr;43(3):402-7. doi: 10.1016/j.jcms.2014.12.009. Epub 2014 Dec 20.
To document facial nerve (FN) injuries after surgical treatment of mandibular condylar fractures using the retromandibular transparotid approach and to identify risk factors associated with these injuries.
A retrospective study of patients surgically treated for mandibular condylar fractures using the retromandibular transparotid approach over seven years was conducted. The primary study variable was the postoperative change in FN function after fracture fixation. Risk factors were categorized as demographic, anatomic, experience of the operator, fracture displacement/dislocation and number of miniplates placed at the fracture site. Appropriate statistics were computed.
Ninety patients with 102 fractures were analysed. Thirty two fractures (31%) were located in the condylar neck and 70 fractures (69%) were subcondylar (located below the sigmoid notch). The condylar segment was undisplaced in twelve cases (12%), displaced medially in thirty five (34%), laterally displaced in thirty (29%) and dislocated in 25 (24.5%). In 18 fractures (18%), postoperative examination revealed various degrees of damage to the FN. All nerve injuries recovered completely in 8-24 weeks. In a multivariate model, condylar neck fractures, fracture dislocation and operator inexperience were associated with a statistically significant risk of postoperative deterioration of FN function (P ≤ 0.05).
The majority of facial nerve injuries after surgical treatment of condylar fractures by the retromandibular transparotid approach are transient in nature. Condylar neck fractures, fracture dislocation and operator inexperience were associated with an increased risk for FN injury.
记录采用下颌后窝透明腮腺入路手术治疗下颌髁突骨折后面神经（FN）损伤情况，并确定与这些损伤相关的危险因素。
对采用下颌后窝透明腮腺入路手术治疗下颌髁突骨折达7年的患者进行回顾性研究。主要研究变量为骨折固定术后FN功能的变化。危险因素分为人口统计学因素、解剖学因素、术者经验、骨折移位/脱位以及骨折部位放置微型钢板的数量。进行了适当的统计学计算。
分析了90例患者的102处骨折。32处骨折（31%）位于髁突颈部，70处骨折（69%）位于髁突下（位于乙状切迹下方）。髁突段无移位的有12例（12%），向内侧移位的有35例（34%），向外侧移位的有30例（29%），脱位的有25例（24.5%）。18处骨折（18%）术后检查显示FN有不同程度损伤。所有神经损伤均在8 - 24周内完全恢复。在多变量模型中，髁突颈部骨折、骨折脱位和术者经验不足与FN功能术后恶化的统计学显著风险相关（P≤0.05）。
采用下颌后窝透明腮腺入路手术治疗髁突骨折后，大多数面神经损伤本质上是短暂性的。髁突颈部骨折、骨折脱位和术者经验不足与FN损伤风险增加增加相关。
