Research And Development And Cinical Application Of Sagittal Fracture Of Mandibular Condyle Operation Retractor

ObjectiveThe treatment of sagittal fracture of mandibular condyle(sagittal fracture of mandibular condyle,SFMC)among objects of maxillofacial injuries is always a difficulty.If treated inaptly,the temporomandibular joint(temporomandi-bular joint,TMJ)would get pain,click,mouth opening and closing dysfunction and TMJ ankylosis and else related complications would occur easily.Due to its special anatomical structure,lack of visible space and operation space and difficulty to decrease mandibular rumas are usually greater difficulty in SFMC open reduction and internal fixation operation and postoperative complications are easly caused.By analyzing the operation data of a group of cases of condylar fractures,the purpose of this study is to create sagittal fracture of mandibular condyle operation retractor(sagittal fracture of mandibular condyle operation retractor,SFMCOR),a surgical instrument which is suitable to clinical characteristics of condylar sagittal fracture surgical.On SFMC operation,it is used to decrease mandibular ramus to increase surgical visual space and operation space,to reduce the di fficulty of operation,and is conducive to shorten operation time,reduce the surgical trauma,increase the satisfaction of surgical effect,accelerate postoperative recovery,improve TMJ function after operation and to be beneficial to the recovery of TMJ patients at last.Method20 cases(22 sides)of SFMC patients diagnosed by three-dimensional CT underwent open surgical treatment to measure the distance of bone surface of ramus condyle fracture end to body surface.Using statistical methods,the purpose is to work out the depth of SFMC surgery before tragus incision,and according to the depth and local anatomical structure of TMJ,to develop SFMCOR.Then,40 SFMC patients diagnosed by three-dimensional CT,randomly were divided into experimental group and control group and each group of 20 cases(20 sides)underwent surgery treatment.The experimental group had open reposition and internal fixation with the SFMCOR.While the control group used Traditional methods to exposure the operation space and common instrument to finish reduction and internal fixation.During the operation,the change of joint space(distance of dropping mandibular ramus)by using SFMCOR and the traditional method were recorded.At the same time,the operation time,postoperative first months and 6 months occlusion,the maximum mouth opening degree(MMO)and the visual analogue scale(VAS)of first months after surgery,and click and noise of TMJ were also marked douwn.And the datas were analyzed in statistical method with SPSS19.0 statistical software.ResultThe average depth of SFMC surgery before tragus incision is 25.44±8.12 mm.Preoperative joint space is zero.After droped ramus in traditional method,the joint space maked out by hands is 2.85±0.95mm and maked out with dovetail fork is 4.25 ± 1.24mm,while with SFMCOR is 8.05 ± 1.32mm.That is showing significant difference.The mean operation times of experimental group and control group are(73.85 ± 11.11)min?(88.70 ± 7.98)min(t=-4.85,P=0.00<0.05),operation time of the experimental group shortened obviously.MMO of The experimental group and control group 1st month and 6th month after operation respectively are[31.80±4.60mm(40.85±4.92)mm]and[24.70±5.55 mm(36.95 ± 4.08)mm].VAS of the experimental group and control group 1st month after operation respectively are respectively(2.65 ± 1.04)and(3.65±0.88).The difference of MMO and VAS after operation in the experiment group has statistical significance.The experimental group and control group after operation were normal about occlusion.There is only 1 click case in control group followed up within 1 month after operation.And there is no click nor noise cases followed up within 6 month after operation.Conelus ionIn SFMC open reduction and internal fixation surgery,small incision before the tragus,can reduce the surgical trauma,but at the same time,because of the special structure of the condyle,operation area is narrow.SFMCOR enlarges the operation space in limited operation area effectively and drop mandibular rumas to facilitate the operation.Hence,SFMCOR can help shorten SFMC open reduction and internal fixation operation time and improve the MMO and vas obviously.But,in the operation process,existing general surgical instruments are not in full suited to the special structure of the condyle.Moreover,because of rich facial nerve and vein aroujoint space and increasing the operative space.This kind of surgery,also nd,apart from openning needs to corresponding devices to pul and pertcet surrounding soft tissues.Therefore,the SFMC operation still needs to continue to study to develop a set of perfect sagittal condylar fracture operation instrument.