Abstract: Objective: The purpose of this study was to compare the clinical efficacy of 2 modified techniques for dissecting and exposure of the facial nerve during open reduction for subcondylar fractures of the mandible. Methods: 36 patients with unilateral mandibular subcondylar fractures underwent open reduction and rigid internal fixation between June 2010 and December 2014 were retrospectively reviewed. Group A, 11 patients were treated with a anterograde technique  for dissection and exposure of the facial nerve. Group B, 25 patients  were treated with a retrograde technique for dissection and exposure of the facial nerve. The double-miniplate fixation, injury to the facial nerve, and salivary fistulae after surgery between the two groups were compared. Results: A significant difference (P=0.023) was found in the double-miniplate fixation: In the anterograde group, 8 patients were used the double-miniplate fixation (3 were used a single plate), and in the retrograde group, All of the 25 patients were used the double-miniplate fixation. There was a significant difference between two groups (P=0.020) in facial nerve injuries after surgery: 7 patients manifested a temporary paralysis in the anterograde group as compared with 5 patients in the retrograde group. No permanent facial paralysis was observed. Salivary fistulae after surgery also showed a significant difference (P=0.023): 4 patients had a salivary fistulae in the anterograde group compared with 1 patients in the retrograde group. Conclusion: Retrograde dissection of the facial nerve technique is preferable during open reduction and rigid internal fixation for subcondylar fractures of the mandible using a modified incision.

Key words: subcondylar fractures, dissection of the facial nerve, modified incision

摘要： 目的：在用改良切口行下颌骨髁颈下骨折切开复位坚固内固定手术时，比较顺行和逆行2种方法解剖面神经的效果。方法：2010?鄄06—2014?鄄12期间收治了36例患者(均为单侧髁颈下骨折)，均在三明市第一医院口腔颌面外科，采用改良切口行下颌骨髁颈下骨折切开复位坚固内固定术。其中有11例使用顺行面神经解剖方法(顺行组)，有25例使用逆行面神经解剖方法(逆行组)，对比两组的双钛板固定情况和术后的面神经的损伤、涎漏方面的数据。结果：两组在双钛板固定方面有显著差异(P=0.023)。在顺行组中，有8例为双钛板固定，3例只固定1块钛板；在逆行组中，25例全部为双钛板固定。两组在面神经损伤方面差异有统计学意义(P=0.020)，在顺行组中暂时性面瘫7例，而在逆行组中暂时性面瘫有5例，两组均无永久性面瘫。在术后涎漏方面差异有统计学意义(P=0.023)，顺行组术后发生涎漏4例，而在逆行组发生涎漏的只有1例。结论：用改良切口行下颌骨髁颈下骨折切开复位坚固内固定手术时，逆行性面神经解剖法更好。

关键词: 髁颈下骨折,  ,  , 面神经解剖,  ,  , 改良切口

CLC Number: 

• R782.4