Bruneau Stéphane, Courvoisier Delphine S, Scolozzi Paolo
Chief Resident, Chirurgie maxillo-faciale et stomatologie, chirurgie plastique et réparatrice, Hôpital Nord, Marseille, France.
Biostatistician, Division of Oral and Maxillofacial Surgery, Department of Surgery, University of Geneva and University Hospitals of Geneva, Geneva, Switzerland.
J Oral Maxillofac Surg. 2018 Apr;76(4):812-818. doi: 10.1016/j.joms.2017.11.003. Epub 2017 Dec 6.
To estimate the prevalence and identify risk factors for facial nerve paralysis (FNP) and other postoperative complications after the use of the retromandibular subparotid approach (RMSA) for the treatment of condylar fractures.
Radiologic and clinical data from all patients who underwent an RMSA from 2007 through 2015 at the University Hospital of Geneva (Geneva, Switzerland) were retrospectively reviewed. The primary and secondary outcome variables were, respectively, FNP and other complications (unesthetic scars, infection, nonunion, malocclusion, salivary fistula, Frey syndrome, and loosening or breaking of plates and screws). Predictor variables included age, gender, mechanism of injury, delay from injury to surgery, surgeon's experience, location of fracture, side and pattern of fracture, concomitant facial fractures, and status of healing. Univariable logistic regression statistics were computed.
Forty-eight subcondylar fractures in 43 consecutive patients were treated using the RMSA. Six fracture sites (12.5%) developed a temporary FNP that completely resolved within 4 months. Fractures at the neck level and with the comminution pattern were significant risk factors of postoperative FNP (P = .04 and P < .001, respectively; odds ratio = 82). Eight patients (18.6%) developed a slight transient malocclusion that was completely corrected within 3 to 4 weeks using guiding elastics and 1 patient (2.3%) had a wound dehiscence that resolved with a visible but thin and linear scar.
The present study showed that 1) the FNP rate after the RMSA to surgery for condylar fractures was similar to that reported after the transparotid variant; 2) the FNP was transient and completely resolved in all patients; 3) neck and comminuted condylar fractures were statistically associated with increased risk of developing a postoperative temporary FNP; and 4) the final outcome was favorable with no major complications in any of the patients.
评估采用下颌后下腮腺下入路（RMSA）治疗髁突骨折后面神经麻痹（FNP）及其他术后并发症的发生率，并确定其危险因素。
回顾性分析2007年至2015年在瑞士日内瓦大学医院接受RMSA治疗的所有患者的放射学和临床资料。主要和次要结局变量分别为FNP和其他并发症（不美观的瘢痕、感染、骨不连、错牙合、涎瘘、Frey综合征以及钢板和螺钉松动或断裂）。预测变量包括年龄、性别、损伤机制、受伤至手术的延迟时间、外科医生经验、骨折部位、骨折侧别和类型、合并面部骨折以及愈合状况。计算单因素逻辑回归统计量。
连续43例患者的48处髁突下骨折采用RMSA治疗。6处骨折部位（12.5%）出现暂时性FNP，4个月内完全恢复。颈部骨折及粉碎性骨折类型是术后FNP的显著危险因素（分别为P = 0.04和P < 0.001；比值比 = 82）。8例患者（18.6%）出现轻微短暂错牙合，使用引导性弹力牵引在3至4周内完全矫正，1例患者（2.3%）伤口裂开，愈合后留下可见但细小的线性瘢痕。
本研究表明，1）RMSA治疗髁突骨折后的FNP发生率与经腮腺变异入路术后报告的发生率相似；2）FNP是暂时性的，所有患者均完全恢复；3）颈部和粉碎性髁突骨折与术后发生暂时性FNP的风险增加在统计学上相关；4）最终结果良好，所有患者均无重大并发症。
