Kumar Praveen, Jeyaraman Balaji, Rajiah Davidson, Kamalakaran Arunkumar, Thirunavukkarasu Rohini, Palani Triveni
Oral and Maxillofacial Surgery, Tamil Nadu Government Dental College and Hospital, Chennai, IND.
Cureus. 2022 Nov 21;14(11):e31725. doi: 10.7759/cureus.31725. eCollection 2022 Nov.
Introduction Mandibular fractures have the highest incidence next to nasal bone fractures of which condylar fractures account for one-third of it. Various approaches for condylar fracture include intraoral and extraoral approaches such as coronal, preauricular, postauricular, endaural, endoscopic, rhytidectomy, transparotid, submandibular, and retromandibular approaches. The purpose of this study was to evaluate the mini-preauricular incision in open reduction and internal fixation of condylar and subcondylar fractures of the mandible. Materials and methods Twenty patients with condylar fracture underwent open reduction and internal fixation under general anesthesia using a modified mini-preauricular incision and subdermal dissection approach. Parameters assessed were pain, mouth opening, occlusal derangement, accessibility of fracture site, duration of surgery, neurosensory deficit (facial nerve), postoperative edema, wound infection, wound dehiscence, and scar. Patients were followed up at an interval of one week, one month, three months, and six months. Results On comparing the parameters preoperatively and postoperatively, occlusal derangement, mouth opening, and pain showed statistical significance with a p-value of 0.01, while nerve weakness and scar assessment showed a high level of statistical significance with a p-value of 0.001. The anatomical reduction of the condyle and internal fixation with miniplates was easy when this approach was used. Patients showed transient facial nerve paralysis only. No permanent damage was noted. The resultant scar was aesthetically acceptable. Discussion The mini-preauricular approach is an effective and safe technique for open reduction and internal fixation of condylar and subcondylar fractures. This approach provided good access, good cosmetic results, and patient satisfaction. This approach resulted in very less morbidity to the facial nerve.
引言
下颌骨骨折的发病率仅次于鼻骨骨折，其中髁突骨折占其三分之一。髁突骨折的各种手术入路包括口内和口外入路，如冠状切口、耳前、耳后、耳道内、内镜、除皱、腮腺下入路、下颌下和下颌后入路。本研究的目的是评估微型耳前切口在下颌骨髁突和髁下骨折切开复位内固定术中的应用。
材料与方法
20例髁突骨折患者在全身麻醉下采用改良微型耳前切口及皮下剥离法进行切开复位内固定。评估的参数包括疼痛、开口度、咬合紊乱、骨折部位的可达性、手术时间、神经感觉障碍（面神经）、术后水肿、伤口感染、伤口裂开和瘢痕。患者分别在术后1周、1个月、3个月和6个月进行随访。
结果
术前和术后参数比较显示，咬合紊乱、开口度和疼痛具有统计学意义，p值为0.01，而神经功能减弱和瘢痕评估具有高度统计学意义，p值为0.001。采用该入路时，髁突解剖复位及微型钢板内固定操作简便。患者仅出现短暂性面神经麻痹，未发现永久性损伤。最终瘢痕在美学上是可接受的。
讨论
微型耳前入路是下颌骨髁突和髁下骨折切开复位内固定的一种有效且安全的技术。该入路提供了良好的手术视野、良好的美容效果以及患者满意度。该入路对面神经的损伤极小。
