Clinical Study Of Improved Surgical Approach Of Condylar Fractures

Object:The modified tragus incision approach,modified ear temporal incision approach and posterior incision approach were used to treat different types of condylar fractures,and the incidence of complications and the incidence of complications were compared.Shortcomings,to provide the best choice for clinical surgery.Methods:Collected in July 2014-December 2016 in the Southwest Medical University Hospital of oral and maxillofacial surgery in 88 patients with mandibular condylar fractures,the location of the fracture line will be divided into condylar high?median?low three groups,Each group of patients according to the level of fracture using the appropriate surgical approach.Condylar high fracture with modified ear temporal incision?the modified tragus incision;median fracture with modified ear temporal incision,the modified tragus incision? the posterior jaw incision;low fracture using The modified tragus incision?the posterior jaw incision was followed by surgery.The evaluation of fracture operation,incision,occlusal relationship,facial nerve function,joint symptom and salivary fistula were evaluated by imaging.Results:33 cases of modified ear temporal incision,postoperative opening degree and occlusal relationship recovered well,a total of 7 cases of temporary facial nerve injury,0 case of joint symptoms,1 case of salivary fistula.58 cases of The modified tragus incision were used to improve the opening degree and occlusal relationship.There were 6 cases of temporary facial nerve injury,6 cases of joint symptoms and no salivary fistula.27 cases of posterior incision,postoperative opening degree and occlusal relationship recovered well,a total of 2 cases of temporary facial nerve injury,7 cases of joint symptoms,no salivary fistula.Facial nerve injury rate:There was no significant difference between the modified tragus incision(6.67%)and the modified ear temporal incision group(5.56%)in the condylar hyperplasia group(P>0.05).Condylar medial fracture group,There was significant difference between the modified tragus incision group(4.55%)and the modified ear temporal incision group(33.33%),the difference was statistically significant(P<0.05)?Improve the tragus incision group(4.55%)compared with jaw after incision group(11.11%),there was no statistically significant difference(P>0.05);Condylar fractures in low,improved within the tragus incision group(33.33%)compared with jaw after incision group(0%),the difference was statistically significant(P<0.05),postoperative facial nerve temporary dysfunction,given nutritional supplements and other symptomatic support treatment,the patient did not see permanent facial paralysis.The incidence of joint symptoms: condylar high fracture group,There was significant difference between the modified tragus incision group(27.78%)and the modified ear temporal incision group(0%)(P<0.05).Condylar median fracture group,There was no joint symptoms occured.There was significant difference between the modified tracheal incision group(0%)and the posterior approach group(27.78%)(P<0.05).Condyle low fracture group,There was no significant difference between the modified tragus incision approach(8.33%) and the posterior jaw posterior incision group(13.33%)(P>0.05).There are difficulties in the mouth,the review period continued to open mouth training;joint pain,octopus who given the surgery area,the occurrence of temporomandibular joint stiffness,according to the specific circumstances of elective line arthroplasty.Salivary fistula incidence: condylar high fracture group,There was no significant difference between the modified tragus incision group(0%)and the modified ear temporal incision group(6.67%).There was no significant difference between the two groups(P>0.05)No salivary fistula occurred.After salivary fistula,given the patient head and face compression bandage,oral atropine and other symptomatic support treatment.Conclusions:1.Modified ear temporal incision for the high condylar fractures,the incision is easy to explore the fracture ends,full exposure surgery,fixed at the same time to restore the articular disc,repair the temporomandibular joint soft tissue around the reduction of postoperative temporomandibular joint The incidence of incision hidden.2.The modified tragus incision for the condylar median fracture,the approach through the parotid front,the effective protection of facial nerve branch,anatomical reduction can be repaired after the repair of temporomandibular joint tissue around the effective reduction of postoperative temporomandibular The incidence of arthritis,incision concealed.3.The posterior approach of the posterior approach of the parotid gland is suitable for the low condyle fracture,the surgical area is exposed,does not destroy the parotid bite muscle fascia,to avoid the occurrence of postoperative salivary fistula,effectively protect the facial nerve branch.