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经口内“低位耳前”咬肌前腮腺入路(TMAP)技术作为治疗髁突囊外骨折的标准方法。

The "low preauricular" transmasseteric anteroparotid (TMAP) technique as a standard way to treat extracapsular condylar fractures.

机构信息

Division of Maxillo-facial Surgery, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy.

Division of Maxillo-facial Surgery, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy.

出版信息

J Craniomaxillofac Surg. 2024 Jan;52(1):108-116. doi: 10.1016/j.jcms.2023.11.001. Epub 2023 Nov 28.

DOI:10.1016/j.jcms.2023.11.001
PMID:38129188
Abstract

Condylar fracture treatment is a debated topic among maxillofacial surgeons. Various surgical techniques are used today, each one with advantages and disadvantages. The aim of this study is to present and evaluate our technique adopted for treatment of any type of extracapsular condylar fractures. Between 2020 and 2022, 16 condylar fractures were treated. In two patients with bilateral condylar fractures, the present technique was compared to the mini-retromandibular approach. All the patients were checked for clinical and radiological outcomes, facial nerve injury, scar visibility and presence of salivary complications. Dental occlusion was always restored, and facial nerve damage or salivary disorders were not observed. The skin incision, limited to the caudal two-thirds of the auricle, made the scar almost invisible and greatly improved the surgical field in the condylar neck area, facilitating the treatment. The proposed technique provides easier internal fixation for both neck and base condylar fractures with good cosmetic results, ensuring better protection of the facial nerve and parotid gland. The surgical technique described has not shown disadvantages in terms of operational difficulty, results, and complications. This novel surgical technique could represent a new choice in the treatment of extracapsular condylar fractures, although further studies are needed to support this new proposal.

摘要

髁突骨折的治疗是颌面外科医生争论的话题。目前使用了各种手术技术,每种技术都有其优点和缺点。本研究旨在介绍和评估我们用于治疗任何类型的关节囊外髁突骨折的技术。2020 年至 2022 年期间,共治疗了 16 例髁突骨折。在 2 例双侧髁突骨折的患者中,将本技术与小下颌下入路进行了比较。所有患者均进行了临床和影像学结果、面神经损伤、瘢痕可见度和唾液腺并发症的检查。所有患者的牙咬合均得到了恢复,未观察到面神经损伤或唾液腺紊乱。耳屏下部的皮肤切口限制在耳屏的后三分之二,使瘢痕几乎不可见,并大大改善了髁突颈部区域的手术视野,便于治疗。所提出的技术为颈髁突骨折和基底部髁突骨折提供了更简单的内固定,美容效果良好,面神经和腮腺得到了更好的保护。就手术难度、结果和并发症而言,所描述的手术技术没有显示出劣势。虽然需要进一步的研究来支持这一新的建议,但这种新的手术技术可能是治疗关节囊外髁突骨折的新选择。

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