하악골 과두하 골절의 이하선 경유 접근법을 통한 관혈적 정복술 증례보고 (Case Report of Transparotid Approach of Mandibular Subcondylar Fracture)

서지정보

· 발행기관 : 대한두개안면성형외과학회
· 수록지 정보 : Archives of Craniofacial Surgery / 10권 / 1호 / 33 ~ 36페이지
· 저자명 : 문민철, 오석준, 고성훈

초록

Purpose: Fractures of the mandibular condylar area are
common injuries that account for 29% to 40% of fractures
of the facial bones and represent 20% to 62% of all
mandibular fractures. Currently 3 main methods are being
used in the treatment of mandibular subcondylar fractures:
closed reduction; open reduction and internal fixation;
Endoscopic reduction and internal fixation. Each method
has its proponents and opponent as well as advantages
and disadvantages, and indications for each vary among
surgeons. There are six approaches of open reduction:
submandibular, retromandibular, preaurilcular, postauricular,
intraoral, transparotid approach. Among them, transparotid
approach has been described for subcondylar exposure
with dissection in the direction of facial nerve fibers to
expose the bone through the parotid gland. This approach
carries the risk of a parotid glandular fistula as well as
facial nerve injury but has the advantage of being directly
over the fracture site. We report safety and efficacy of
surgical treatment using a transparotid approach for direct
plating.
Methods: A 43-year-old man sustained multiple facial
bone fractures by driver traffic accident. Mandibular subcondyle
was fractured and dislocated internally. We performed
open reduction and internal fixation by transparotid
approach. Fractured site was fixed by titanium mini plate
& screw. We applicated arch bar for approximately 3
weeks.
Results: Follow-up length was about 5months. Scar of
surgical incision was indistinct, there was no symptoms
and signs of facial nerve and parotid gland injury, and
maximal mouth opening was measured 49.5 mm.
Conclusion: Transparotid approach has high risks of
facial nerve and parotid gland injury, but paradoxically it
is the most effective technique in saving facial nerve.
Open reduction and internal fixation of mandibular subcondylar
fracture by transparotid approach with precise
and versed procedure, best outcome can be expected.

영어초록

Purpose: Fractures of the mandibular condylar area are
common injuries that account for 29% to 40% of fractures
of the facial bones and represent 20% to 62% of all
mandibular fractures. Currently 3 main methods are being
used in the treatment of mandibular subcondylar fractures:
closed reduction; open reduction and internal fixation;
Endoscopic reduction and internal fixation. Each method
has its proponents and opponent as well as advantages
and disadvantages, and indications for each vary among
surgeons. There are six approaches of open reduction:
submandibular, retromandibular, preaurilcular, postauricular,
intraoral, transparotid approach. Among them, transparotid
approach has been described for subcondylar exposure
with dissection in the direction of facial nerve fibers to
expose the bone through the parotid gland. This approach
carries the risk of a parotid glandular fistula as well as
facial nerve injury but has the advantage of being directly
over the fracture site. We report safety and efficacy of
surgical treatment using a transparotid approach for direct
plating.
Methods: A 43-year-old man sustained multiple facial
bone fractures by driver traffic accident. Mandibular subcondyle
was fractured and dislocated internally. We performed
open reduction and internal fixation by transparotid
approach. Fractured site was fixed by titanium mini plate
& screw. We applicated arch bar for approximately 3
weeks.
Results: Follow-up length was about 5months. Scar of
surgical incision was indistinct, there was no symptoms
and signs of facial nerve and parotid gland injury, and
maximal mouth opening was measured 49.5 mm.
Conclusion: Transparotid approach has high risks of
facial nerve and parotid gland injury, but paradoxically it
is the most effective technique in saving facial nerve.
Open reduction and internal fixation of mandibular subcondylar
fracture by transparotid approach with precise
and versed procedure, best outcome can be expected.

참고자료

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