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多发性面部骨折的手术困境——冠状皮瓣与微创手术:病例报告及文献综述

Surgical Dilemmas in Multiple Facial Fractures - Coronal Flap Versus Minimally Invasive: Case Report and Literature Review.

作者信息

Nseir Saleh, Abu Shqara Fadi, Krasovsky Andrei, Rachmiel Adi

机构信息

Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, Haifa, Israel.

The Ruth and Bruce Rappaport Faculty of Medicine, Institution of Technion, Haifa, Israel.

出版信息

Ann Maxillofac Surg. 2021 Jan-Jun;11(1):191-194. doi: 10.4103/ams.ams_452_20. Epub 2021 Jul 24.

DOI:10.4103/ams.ams_452_20
PMID:34522683
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8407624/
Abstract

THE RATIONALE

Pan-facial fracture is a complex trauma that involves the upper, middle, and lower third of the facial bones. The surgical management of such complex cases is either by the posterior approach (coronal flap) or anterior approach through local incisions.

PATIENT CONCERNS

This report describes the case of severe pan-facial trauma in a 52-year-old male who sustained a severe pan-facial trauma.

DIAGNOSIS

He suffered from multiple facial fractures that included: Frontal bone, skull base, Naso-orbitoethmoid (NOE), zygomatic and sub-condylar fractures.

TREATMENT

He was managed by minimally local periorbital and lynch incisions.

OUTCOMES

Fractures were properly reduced with resultant symmetrical facial dimensions. No postoperative complications were demonstrated including facial nerve function.

TAKE-AWAY LESSONS: We should consider minimally invasive local incisions in pan-facial fractures when there is no need to restore the frontal sinus and the anterior-posterior dimensions of the zygomatic arch.

摘要

理论依据

全面部骨折是一种涉及面骨上、中、下三部分的复杂创伤。此类复杂病例的手术治疗可采用后路(冠状皮瓣)或通过局部切口的前路。

患者情况

本报告描述了一名52岁男性严重全面部创伤的病例。

诊断

他患有多处面部骨折,包括:额骨、颅底、鼻眶筛(NOE)、颧骨和髁突下骨折。

治疗

通过最小限度的局部眶周和林奇切口进行治疗。

结果

骨折得到妥善复位,面部尺寸对称。未出现术后并发症,包括面神经功能。

经验教训

当无需恢复额窦和颧弓的前后尺寸时,对于全面部骨折应考虑采用微创局部切口。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9c46/8407624/3aae00287e2c/AMS-11-191-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9c46/8407624/45dbff44ed53/AMS-11-191-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9c46/8407624/a02c812192ae/AMS-11-191-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9c46/8407624/0fabeade69ce/AMS-11-191-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9c46/8407624/75f7a08c072a/AMS-11-191-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9c46/8407624/3aae00287e2c/AMS-11-191-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9c46/8407624/45dbff44ed53/AMS-11-191-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9c46/8407624/a02c812192ae/AMS-11-191-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9c46/8407624/0fabeade69ce/AMS-11-191-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9c46/8407624/75f7a08c072a/AMS-11-191-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9c46/8407624/3aae00287e2c/AMS-11-191-g005.jpg

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本文引用的文献

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Endoscopically Assisted Open Reduction and Internal Fixation of Sub-Condylar Fractures: Debunking Some of the Myths.内镜辅助下髁下骨折切开复位内固定术:破除一些误区。
J Craniofac Surg. 2020 Sep;31(6):1727-1730. doi: 10.1097/SCS.0000000000006480.
2
Management of Panfacial, Naso-Orbital-Ethmoid and Frontal Sinus Fractures.
Atlas Oral Maxillofac Surg Clin North Am. 2019 Sep;27(2):83-92. doi: 10.1016/j.cxom.2019.04.001. Epub 2019 Jun 22.
3
Treatment of Panfacial Fractures and Three-Dimensional Outcome Analysis: The Occlusion First Approach.
J Craniofac Surg. 2019 Jun;30(4):1255-1258. doi: 10.1097/SCS.0000000000005528.
4
Panfacial Bone Fracture and Medial to Lateral Approach.面中部骨折与内外侧联合入路
Arch Craniofac Surg. 2016 Dec;17(4):181-185. doi: 10.7181/acfs.2016.17.4.181. Epub 2016 Dec 23.
5
Submental Intubation in Cases of Panfacial Fractures: A Retrospective Study.面中部骨折病例中的颏下插管:一项回顾性研究。
Anesth Prog. 2017 Fall;64(3):153-161. doi: 10.2344/anpr-64-04-07.
6
Management of Panfacial Fracture.面中份骨折的治疗
Semin Plast Surg. 2017 May;31(2):108-117. doi: 10.1055/s-0037-1601579.
7
A Comparative Prospective Study of Two Different Treatment Sequences i.e. Bottom Up-Inside Out and Topdown-Outside in, in the Treatment of Panfacial Fractures.两种不同治疗顺序即由下至上-由内向外和由上至下-由外向内治疗面中份骨折的比较前瞻性研究
J Maxillofac Oral Surg. 2015 Dec;14(4):986-94. doi: 10.1007/s12663-015-0769-2. Epub 2015 Jun 20.
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Airway Management of the Patient with Maxillofacial Trauma: Review of the Literature and Suggested Clinical Approach.颌面创伤患者的气道管理:文献综述及建议的临床方法
Biomed Res Int. 2015;2015:724032. doi: 10.1155/2015/724032. Epub 2015 Jun 16.
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Orbital fractures in children.儿童眼眶骨折
Br J Oral Maxillofac Surg. 2013 Jan;51(1):41-6. doi: 10.1016/j.bjoms.2012.03.006. Epub 2012 Apr 10.
10
Minimally invasive approaches in severe panfacial fractures.严重面中份骨折的微创入路
Ulus Travma Acil Cerrahi Derg. 2010 Nov;16(6):541-5.