Rajmohan Susmitha, Tauro David, Bagulkar Bhupesh, Vyas Anuj
Professor, Department of Oral and Maxillofacial Surgery, Sri Aurobindo College of Dentistry , Indore, Madhya Pradesh, India.
Consultant, Taulins Clinic, Center For Facial Plastic and Reconstructive Surgery , Banguluru, India .
J Clin Diagn Res. 2015 Aug;9(8):PC01-5. doi: 10.7860/JCDR/2015/14797.6296. Epub 2015 Aug 1.
The coronal incision with its various modifications provides the most versatile approach to various areas in the craniomaxillofacial region coupled with excellent exposure. The aesthetic advantage of a hidden scar in the hairline, accounts for its continued popularity. The aim of this study was to review the surgical anatomy, technique and problems of post-operative morbidity pertinent to coronal approach in various clinical situations such as craniofacial trauma, tumour resections and reconstructive craniofacial procedures.
In this study, ten patients who presented to Oral and maxillofacial surgery department with various craniofacial problems requiring the use of coronal and hemicoronal approach for treatment were evaluated over a period of two years. Five patients needed coronal approach and another five underwent the surgical procedures through hemicoronal approach. This was an observational study.
It was observed that a well-planned and carefully designed coronal/hemicoronal incision with strict adherence to surgical principles posed minimal complication during surgery as well as post-operatively. None of the patients developed infection or heamatoma in the postoperative period. Sensory nerve deficits along the distribution of supraorbital nerve was observed in four patients of bicoronal approach and three patients of hemicoronal approach which completely resolved at the end of six months. Motor nerve weakness was observed in four patients in immediate postoperative period which gradually improved. But it persisted in one patient even after six months who had pathology of temporo-orbital region. All the patients had transient alopecia along the line of incision which improved at the end of six months. No other significant disadvantages or complications were noted.
This approach offers widest accessibility and visibility to the entire upper and middle one third of the face in less than twenty minutes as observed in our study. The postoperative complications are minimal, minor and outweigh the advantages for surgical treatment in any given clinical situation as observed in this study. This proves the brilliance of coronal approach in solving an array of surgical problems pertinent to craniomaxillofacial region with superior aesthetic outcomes.
ZMC-Zygomatico maxillary complex, NOE-Nasoethmoidal complex, LF-Lefort, ORIF-open reduction internal fixation.
冠状切口及其各种改良术式为颅颌面区域的各个部位提供了最为通用的手术入路，且显露效果极佳。发际线处隐蔽瘢痕的美学优势，使得该术式一直颇受欢迎。本研究的目的是回顾在诸如颅面创伤、肿瘤切除及颅面重建手术等各种临床情况下，与冠状入路相关的手术解剖、技术及术后发病问题。
在本研究中，对两年期间在口腔颌面外科就诊的10例患有各种颅面问题、需要采用冠状或半冠状入路进行治疗的患者进行了评估。5例患者需要冠状入路，另外5例通过半冠状入路接受手术。这是一项观察性研究。
观察发现，精心规划和设计的冠状/半冠状切口，严格遵循手术原则，在手术期间及术后引发的并发症极少。术后无一例患者发生感染或血肿。在双冠状入路的4例患者及半冠状入路的3例患者中观察到沿眶上神经分布区域的感觉神经功能缺损，在6个月末完全恢复。术后即刻在4例患者中观察到运动神经无力，随后逐渐改善。但1例颞眶区域有病理性改变的患者在6个月后仍存在运动神经无力。所有患者在切口沿线均出现暂时性脱发，在6个月末有所改善。未发现其他明显的缺点或并发症。
如我们的研究中所观察到的，该入路在不到20分钟的时间内为面部整个上三分之一和中三分之一提供了最广泛的可达性和视野。术后并发症极少且轻微，在任何特定临床情况下，与手术治疗的优势相比微不足道。这证明了冠状入路在解决一系列与颅颌面区域相关的手术问题方面的卓越性以及出色的美学效果。
ZMC - 颧上颌复合体，NOE - 鼻筛复合体，LF - 勒福，ORIF - 切开复位内固定
