- 期刊
以頷後進路方式治療下顎骨髁頭下區骨折
Retromandibular Approach for Mandibular Subcondylar Fracture
摘要
下顎骨髁頭區骨折的發生機率，近二十年來的統計數據國內外皆落在20-35%之間，其差異性主要是以國情不同及各地方主要使用的交通工具不同有關係。初始針對此區域骨折的分類的方法是採斷線發生於何處的解剖位置而定，進而注意經由兩側斷骨的位移距離、相對的角度與是否產生脫臼來分類歸納。評估此區骨折的依據也從二維空間的傳統X光發展到三度空間的影像。國內、外現今在治療此類型骨折主要仍是以閉合式骨折復位手術配合上下顎間固定方式治療為主，不過近年來各國嘗試以開放性骨折復位手術治療下顎骨髁頭區骨折的比例明顯逐漸增加。比較這兩類治療方式病例的術後追蹤，普遍認為以開放性方式治療下顎骨髁頭區骨折，患者在下顎運動功能性恢復上會有較好的成果。各種開放性骨折復位手術切線進入此區骨折處復位時，皆會有顏面神經受損及唾液腺產生滲漏或廔管的可能併發症。此病例我們選擇以頷後進路手術方式進行開放性骨折復位手術並配合上下顎間固定及術後張口的復健練習，術後追蹤至今達八個月，在患處解剖構造的復位及功能行使的恢復上皆良好。
並列摘要
Mandibular condyle process fracture had been reported between 20-35% of mandible fracture in the world and with a major group of motorcycle traffic accident. There were many classification systems which defined the fractured anatomy location, the high or base level at condylar process, the deviation, displacement or dislocation of fractured proximal segment. Image survey including Panoramic film, Posterioanterior view, Reverse Towne's view, Computed tomography, Magnetic Resonance Image. The major treatment strategy was closed reduction with intermaxillary fixation but there was a trend toward to open reduction with internal double miniplate fixation technique via several approach method in this half century. Compared these two main therapy result, the open reduction with internal fixation for mandibular condyle process fracture showed better anatomical reduction and functional movement of mandible than conservative closed reduction method. The main complication of surgical intevention for mandibular condyle process fracture include 1. facial nerve and great auricular nerve palsy 2. Parotid gland leakage or fistulae 3. hypertrophic scar 4. Frey's syndrome. We review recent twenty years journal papers find that there were few complication rate and has direct access to treat mandibular condyle process fracture via retromandibular approach.