改良耳屏缘切口腮腺前缘穿咬肌入路在髁突重建术中的应用

doi:10.7518/hxkq.2023.2022496

华西口腔医学杂志 ›› 2023, Vol. 41 ›› Issue (3): 290-296.doi: 10.7518/hxkq.2023.2022496

改良耳屏缘切口腮腺前缘穿咬肌入路在髁突重建术中的应用

唐辉¹(), 王浪¹^,², 王雷¹, 饶鹏程¹^,³, 罗道文¹, 付光新¹^,⁴, 肖金刚¹^,³^,⁴()

^1.西南医科大学附属口腔医院口腔颌面外科，泸州 646000
^2.资阳市雁江区人民医院口腔科，资阳 641300
^3.西南医科大学附属口腔医院口腔种植科，泸州 646000
^4.西南医科大学附属医院口腔颌面外科，泸州 646000

收稿日期:2022-12-15 修回日期:2023-02-02 出版日期:2023-06-01 发布日期:2023-06-02
通讯作者: 肖金刚 E-mail:626417294@qq.com;drxiaojingang@163.com
作者简介:唐辉，硕士，E-mail：626417294@qq.com
基金资助:
国家自然科学基金项目(81870746);中华口腔医学会西部临床科研基金资助项目(CSA-W2017-08)

Modified tragus edge incision and transmasseteric anteroparotid approach to condyle reconstruction

Tang Hui¹(), Wang Lang¹^,², Wang Lei¹, Rao Pengcheng¹^,³, Luo Daowen¹, Fu Guangxin¹^,⁴, Xiao Jingang¹^,³^,⁴()

^1.Dept. of Oral and Ma-xillofacial Surgery, The Affiliated Stomatological Hospital of Southwest Medical University, Luzhou 646000, China
^2.Dept. of Stomatology, Yanjiang District People’s Hospital of Ziyang, Ziyang 641300, China
^3.Dept. of Oral Implantology, The Affiliated Stomatological Hospital of Southwest Medical University, Luzhou 646000, China
^4.Dept. of Oral and Maxillofacial Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China

Received:2022-12-15 Revised:2023-02-02 Online:2023-06-01 Published:2023-06-02
Contact: Xiao Jingang E-mail:626417294@qq.com;drxiaojingang@163.com
Supported by:
The National Natural Science Foundation of China(81870746);Project of Chinese Stomatological Association West China Clinical Research Fund(CSA-W2017-08)

摘要/Abstract

摘要：

目的探讨一种改良的耳屏缘切口腮腺前缘穿咬肌入路在髁突重建术中的应用价值。方法对16例患者（女性9例，男性7例）采用改良的耳屏缘切口腮腺前缘穿咬肌入路行髁突重建术。术后定期随访，通过患者腮腺涎瘘、面神经功能、张口度、咬合关系、面部瘢痕等临床指标评价髁突重建后的功能，通过曲面体层片、CT及三维CT重建影像学检查评估移植肋骨肋软骨的位置和形态。结果术后随访6个月~3年，所有患者面形恢复好，切口瘢痕隐蔽，无腮腺涎瘘，张口度和咬合关系良好，1例出现暂时性面瘫，经治疗后痊愈。影像学结果显示，所有移植肋骨肋软骨存活，处于正常解剖位置。结论改良的耳屏缘切口腮腺前缘穿咬肌入路在髁突重建术中可降低涎瘘和面神经损伤的发生率，术野清晰，且切口瘢痕隐蔽，未增加其他并发症的发生率，值得临床推广。

关键词: 改良耳屏缘切口, 腮腺前缘穿咬肌入路, 肋骨肋软骨移植, 髁突重建, 面神经损伤, 腮腺涎瘘, 切口瘢痕

Abstract:

Objective This study aimed to analyze the application value of a modified tragus edge incision and transmasseteric anteroparotid approach to condyle reconstruction. Methods Condyle reconstruction was performed in 16 patients (9 females and 7 males) with modified tragus edge incision and transmasseteric anteroparotid approach. After regular follow-up, the function of condyle reconstruction was evaluated by clinical indicators, such as parotid salivary fistula, facial nerve function, mouth opening, occlusal relationship, and facial scar. The morphology of rib graft rib cartilage was evaluated by imaging indicators, such as panoramic radiography, CT, and three-dimensional CT image reconstruction. Results At 6-36 months postoperative follow-up, all patients had good recovery of facial appearance, concealed incisional scar, no parotid salivary fistula, good mouth opening, and occlusion. One case had temporary facial paralysis and recovered after treatment. Radiographic evaluation further showed that costochondral graft survived in normal anatomic locations. Conclusion The modified tragus edge incision and transmasseteric anteroparotid approach can effectively reduce parotid salivary fistula and facial nerve injury in condylar reconstruction. The surgical field was clearly exposed, and the incision scar was concealed without increasing the incidence of other complications. Thus, this approach is worthy of clinical promotion.

Key words: modified tragus edge incision, transmasseteric anteroparotid approach, costochondral graft, condylar reconstruction, facial nerve injury, parotid salivary fistula, incision scar

中图分类号:

R 782.6

唐辉, 王浪, 王雷, 饶鹏程, 罗道文, 付光新, 肖金刚. 改良耳屏缘切口腮腺前缘穿咬肌入路在髁突重建术中的应用[J]. 华西口腔医学杂志, 2023, 41(3): 290-296.

Tang Hui, Wang Lang, Wang Lei, Rao Pengcheng, Luo Daowen, Fu Guangxin, Xiao Jingang. Modified tragus edge incision and transmasseteric anteroparotid approach to condyle reconstruction[J]. West China Journal of Stomatology, 2023, 41(3): 290-296.

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改良耳屏缘切口腮腺前缘穿咬肌入路在髁突重建术中的应用

Modified tragus edge incision and transmasseteric anteroparotid approach to condyle reconstruction

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序号	年龄/岁	性别	髁突病变	单侧/双侧	张口度/mm			面瘫	涎瘘	咬合错乱	曼彻斯特瘢痕评分	移植物
序号	年龄/岁	性别	髁突病变	单侧/双侧	术前	术后1周	术后3月	面瘫	涎瘘	咬合错乱	曼彻斯特瘢痕评分	骨不连/骨坏死	明显吸收	移位
1	40	男	颞下颌关节强直	单侧	7	30	35	无	无	无	7	无	无	无
2	34	女	颞下颌关节强直	单侧	8	32	36	无	无	无	8	无	无	无
3	51	男	肿瘤	单侧	15	34	39	无	无	无	7	无	无	无
4	35	女	肿瘤	单侧	21	30	34	无	无	无	5	无	无	无
5	20	男	颞下颌关节强直	双侧	5	33	38	无	无	无	8	无	无	无
6	53	女	肿瘤	单侧	12	36	42	暂时性面瘫	无	无	7	无	无	无
7	29	女	颞下颌关节强直	单侧	9	32	37	无	无	无	5	无	无	无
8	35	女	颞下颌关节强直	单侧	11	33	37	无	无	无	5	无	无	无
9	41	女	肿瘤	单侧	8	21	26	无	无	无	7	无	无	无
10	37	男	骨关节病	单侧	14	32	36	无	无	无	8	无	无	无
11	26	男	髁突粉碎性骨折	单侧	6	32	41	无	无	无	6	无	无	无
12	24	男	颞下颌关节强直	单侧	9	32	37	无	无	无	7	无	无	无
13	46	男	肿瘤	单侧	15	31	35	无	无	无	5	无	无	无
14	50	女	髁突粉碎性骨折	单侧	11	33	38	无	无	无	5	无	无	无
15	51	女	肿瘤	单侧	17	32	37	无	无	无	6	无	无	无
16	28	女	颞下颌关节强直	单侧	9	31	36	无	无	无	5	无	无	无