Abstract:

Objective: To explore the clinical efficacy of a concealed pre-tragal incision combined with a trans-cartilaginous approach in the treatment of sagittal fracture of the mandibular condyle. Methods: A retrospective analysis was performed on the clinical data of 40 patients with mandibular condylar fracture admitted to Tangshan Second Hospital from January 2021 to June 2023. All patients underwent rigid internal fixation via the concealed pre-tragal incision combined with a trans-cartilaginous approach. They were systematically followed up for 6 months postoperatively. Evaluation indicators included mandibular movement function (occlusal relationship, maximum mouth opening, mouth opening pattern), facial nerve function, imaging findings, postoperative complications (abnormal pain, infection, salivary fistula, Frey syndrome, great auricular nerve paresthesia), and patient satisfaction with the appearance of the incision. Results: All patients achieved good recovery of occlusal relationship. At 6 months after surgery, the maximum mouth opening reached (38.50±1.65) mm, which was significantly increased compared with that before surgery (P<0.001), and the mouth opening pattern showed no deviation. Postoperatively, only 1 case (2.5%) exhibited transient forehead wrinkle shallowing, which recovered after drug treatment, and no permanent facial nerve injury occurred. Imaging examination showed that all patients achieved anatomical reduction, the internal fixation was in good position, and the fracture healed satisfactorily. No complications occurred in any patient during the follow-up period. The patient satisfaction score with the appearance of the incision was 10 points (full score), with a satisfaction rate of 100%. Conclusion: The concealed pre-tragal incision combined with the trans-cartilaginous approach for the treatment of sagittal fracture of the mandibular condyle offers the advantages of minimal trauma, few complications, and excellent aesthetic outcomes, making it a safe and effective surgical option.

Key words: concealed pre-tragal incision, sagittal condylar fracture, pre-cartilaginous approach, treatment outcomes, rigid internal fixation

摘要：

目的：探讨采用耳屏缘内侧隐蔽切口联合外耳道软骨前缘入路治疗下颌骨髁突矢状骨折的临床疗效。方法：回顾性分析2021年1月至2023年6月唐山市第二医院收治的40例下颌骨髁突骨折患者的临床资料，所有患者均采用耳屏缘内侧隐蔽切口联合外耳道软骨前缘入路行切开复位内固定术。术后系统随访6个月，评估内容包括下颌运动功能（咬合关系、最大开口度、开口型）、面神经功能、影像学表现、术后并发症（异常疼痛、感染、涎瘘、Frey综合征、耳大神经感觉异常）情况及患者对切口外观的满意度。结果：所有患者咬合关系均恢复良好；术后6个月最大开口度达（38.50±1.65） mm，较术前显著增加（P<0.001），开口型无偏斜；术后仅有1例（2.5%）患者出现短暂性额纹变浅，经药物治疗后恢复，无永久性面神经损伤；影像学检查显示所有患者均实现解剖复位，内固定物位置良好，骨折愈合顺利；随访期内所有患者均未发生并发症；患者对切口外观满意度评分为10分（满分），满意度达100%。结论：耳屏缘内侧隐蔽切口联合外耳道软骨前缘入路治疗下颌骨髁突矢状骨折具有创伤小、并发症少、美观效果佳等优势，是一种安全有效的术式选择。

关键词: 耳屏缘内侧隐蔽切口, 髁突矢状骨折, 外耳道软骨前缘入路, 治疗效果, 坚固内固定