Barham H P, Collister P, Eusterman V D, Terella A M
Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, 533 Bolivar Street, Suite 566, New Orleans, LA 70112, USA.
Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, CO, USA.
Int J Otolaryngol. 2015;2015:715126. doi: 10.1155/2015/715126. Epub 2015 Sep 3.
Introduction. The mandibular condyle is the most common site of mandibular fracture. Surgical treatment of condylar fractures by open reduction and internal fixation (ORIF) demands direct visualization of the fracture. This project aimed to investigate the anatomic relationship of the tragus to the facial nerve and condylar process. Materials and Methods. Twelve fresh hemicadavers heads were used. An extended retromandibular/preauricular approach was utilized, with the incision being based parallel to the posterior edge of the ramus. Measurements were obtained from the tragus to the facial nerve and condylar process. Results. The temporozygomatic division of the facial nerve was encountered during each approach, crossing the mandible at the condylar neck. The mean tissue depth separating the facial nerve from the condylar neck was 5.5 mm (range: 3.5 mm-7 mm, SD 1.2 mm). The upper division of the facial nerve crossed the posterior border of the condylar process on average 2.31 cm (SD 0.10 cm) anterior to the tragus. Conclusions. This study suggests that the temporozygomatic division of the facial nerve will be encountered in most approaches to the condylar process. As visualization of the relationship of the facial nerve to condyle is often limited, recognition that, on average, 5.5 mm of tissue separates condylar process from nerve should help reduce the incidence of facial nerve injury during this procedure.
引言。下颌髁突是下颌骨骨折最常见的部位。通过切开复位内固定术（ORIF）对髁突骨折进行手术治疗需要直接观察骨折情况。本项目旨在研究耳屏与面神经及髁突的解剖关系。材料与方法。使用了12个新鲜的半侧尸体头部。采用下颌后窝/耳前扩展入路，切口平行于下颌支后缘。测量了从耳屏到面神经及髁突的距离。结果。在每次入路过程中均遇到面神经颞颧支，其在下颌髁突颈部越过下颌骨。面神经与髁突颈部之间的平均组织深度为5.5毫米（范围：3.5毫米至7毫米，标准差1.2毫米）。面神经上支在耳屏前方平均2.31厘米（标准差0.10厘米）处越过髁突后缘。结论。本研究表明，在大多数髁突入路中都会遇到面神经颞颧支。由于面神经与髁突关系的可视化通常受限，认识到髁突与神经之间平均有5.5毫米的组织间隔应有助于减少该手术中面神经损伤的发生率。
