The Clinical Research Of Mandibular Condylar (Middle Or High) Fractures Using By The ORIF With The Anterior Auricular Incision Through The Parotid Gland

Objective To evaluate the clinical therapeutic effect of the treatment of mandibular condylar(middle or high)fractures using by the straight line incision of the anterior ear screen through the parotid gland.Methods Open reduction and internal fixation was performed on 27 patients(29 sides in total)with middle and high condylar fractures in the mandible.According to the different surgical approaches,27 patients were randomly divided into two groups,namely,14 patients(15 sides)in the observation group were treated with parotid gland approach through a linear incision in front of the tragus.In the control group,13 cases(14 sides)were treated with traditional incision,namely,the crutch incision in front of the ototyrus.The average operation time,postoperative opening degree,occlusal relationship,facial nerve injury,salivary fistula,temporomandibular joint symptoms and imaging examination(oral curved tomography and three-dimensional reconstruction of maxillofacial CT)of the two groups of patients were recorded respectively to understand the reduction of fracture and fracture,whether there were complications such as titanium plate fracture,titanium nail detachment and condyle absorption.The clinical effect of the anterior straight-line incision through parotid gland approach in the treatment of mandibular condylar and high-level fracture reduction was evaluated.Results The average operation time of all patients in the observation group was shorter than that in the control group,and the degree of opening and occlusal relationship were significantly improved.There were no salivary fistula,facial paralysis,good fracture and fracture end reduction,no titanium plate fracture,titanium nail detachment and condylar absorption and other complications.In the control group,the degree of opening and occlusal relationship were restored well,and the anatomical reduction of the fracture end was achieved.No salivary fistula,titanium plate fracture,titanium nail shedding and condylar absorption occurred.However,postoperative facial nerve injuries occurred in 3 patients,mainly in the temporal branch and zygomatic branch of the facial nerve.The clinical manifestations were eyebrow lifting disorder,superficial forehead wrinkles and ptosis of the upper eyelid,and the upper and lower eyelids could not be completely closed.It was found that that three patient who found facial paralysis were given a local massage of oral neurotrophic drug and the guidance of the patient’s facial nerve distribution area.3 months or so completely normal,no case of permanent facial paralysis;One patient had a right temporomandibular joint popping at the end of mouth opening and the beginning of mouth closing 3 months after surgery,but no mandibular deviation or pain,and the degree of mouth opening and facial shape were normal.The patients were instructed to pay attention to matters such as avoiding wide mouth,biting hard objects,and regularly receiving physiotherapy treatment and regular and timely re-examination.The symptoms of ringing were found to be gradually improved.Conclusion The treatment of high condylar fracture in the mandible by the ORIF with the anterior auricular incision through the parotid gland,with good reduction of fracture,short operative time,less trauma and less complications,is safe and effective and worthy of clinical application.