Assistant Professor, Department of Oral & Maxillofacial Surgery, H.P.Govt. Dental College & Hospital, Shimla, Himachal Pradesh, India.
Professor, Department of Oral & Maxillofacial Surgery, H.P.Govt. Dental College & Hospital, Shimla, Himachal Pradesh, India.
J Oral Maxillofac Surg. 2021 May;79(5):1104.e1-1104.e9. doi: 10.1016/j.joms.2020.12.039. Epub 2020 Dec 29.
The purpose of this study was to measure the frequency and identify risk factors for facial nerve injury (FNI) in the open treatment of condylar neck and subcondylar fractures.
A prospective cohort study was conducted over 5 years on patients who were treated surgically for mandibular condylar fractures using the retomandibular transparotid approach (RMTA). The primary result was FNI occurrence (yes/no). The predictor variables were demographic, fracture location, and pattern (dislocation, present or not), as well as surgeon experience. Post-treatment functional facial nerve changes were initially assessed in the operating room as the patient regained consciousness and documented thereafter within, the 1st and 3rd weeks, and 3rd and 6th months. Appropriate statistics were computed and, SPSS version 16 was used to analyze the data. χ test and Fisher exact test were used to assess significance (P ≤ 0.05).
Eighty-nine patients with 102 condylar fractures (63 subcondylar and 26 condylar neck), with a mean age of 28.5±7.5 years and 91% men were evaluated. There were 15 subjects (16.8%) with FNI and among them 6 subjects had persistent facial weakness for 6-8 weeks that completely resolved within 3 months, with no permanent facial nerve paralysis. The marginal mandibular (n = 7), buccal (n = 6), and zygomatic (n = 2) were the facial nerve branches involved. Risk factors for FNI were operator' inexperience, fracture-dislocation, and condylar neck fracture to the site and location of the fracture. Multivariate logistic regression showed that the location of the fracture at neck level (0.030∗), fracture dislocation (<0.001∗), and operator's inexperience (0.003∗) were significant risk factors for postoperative facial nerve injury (P ≤ 0.05).
If conducted properly, the RMTA is a safe method for treating condylar fractures with rare major complications; however, fracture dislocation, fractured condylar neck, and operator' in-experience were significantly associated with increased risk of developing transient postoperative FNI.
本研究旨在测量面神经损伤（FNI）的频率，并确定髁颈和髁下骨折开放式治疗中面神经损伤的危险因素。
对 5 年内采用经下颌后透明带入路（RMTA）手术治疗下颌骨髁突骨折的患者进行前瞻性队列研究。主要结果是 FNI 的发生（是/否）。预测变量为人口统计学、骨折部位和模式（脱位，存在或不存在）以及外科医生的经验。术后功能面神经变化在患者恢复意识时在手术室中进行初步评估，并在术后 1 周、3 周和 6 个月内进行记录。计算了适当的统计数据，并使用 SPSS 版本 16 分析数据。χ 检验和 Fisher 精确检验用于评估显著性（P≤0.05）。
共评估了 89 例 102 例髁突骨折（63 例髁下骨折和 26 例髁颈骨折）患者，平均年龄 28.5±7.5 岁，91%为男性。有 15 例（16.8%）患者出现 FNI，其中 6 例患者面部无力持续 6-8 周，3 个月内完全缓解，无永久性面神经瘫痪。受累的面神经分支为下颌缘支（n=7）、颊支（n=6）和颧支（n=2）。FNI 的危险因素是术者经验不足、骨折脱位和髁颈骨折位于骨折部位和位置。多变量逻辑回归显示，骨折位于颈段（0.030*）、骨折脱位（<0.001*）和术者经验不足（0.003*）是术后面神经损伤的显著危险因素（P≤0.05）。
如果正确进行，RMTA 是治疗髁突骨折的一种安全方法，很少出现严重并发症；然而，骨折脱位、髁突颈骨折和术者经验不足与术后发生暂时性面神经损伤的风险增加显著相关。
