하악과두하 골절 시 후하악 접근법과 내시경을 이용한 구강 내 접근의 비교
Retromandibular Approach versus an Endoscope-assisted Transoral Approach to Treat Subcondylar Fractures of the Mandible
김동우, 박대송, 이상칠, 김성용, 임호용, 염학열, 김현민,
소속 상세정보
김동우 ( Kim Dong-Woo ) - 가천의과학대학교 길병원 구강악안면외과
박대송 ( Park Dae-Song ) - 가천의과학대학교 길병원 구강악안면외과
이상칠 ( Lee Sang-Chil ) - 가천의과학대학교 길병원 구강악안면외과
김성용 ( Kim Sung-Yong ) - 가천의과학대학교 길병원 구강악안면외과
임호용 ( Lim Ho-Yong ) - 가천의과학대학교 길병원 구강악안면외과
염학열 ( Yeom Hak-Yeol ) - 가천의과학대학교 길병원 구강악안면외과
김현민 ( Kim Hyeon-Min ) - 가천의과학대학교 길병원 구강악안면외과
KMID : 0360120110330060497
Abstract
Purpose: Patients who had a subcondylar fracture with a displaced or deviated condylar segment were treated with a retromandibular approach (RMA) or an endoscope-assisted transoral approach (EATA) in our department of oral and maxillofacial surgery. The clinical results of the approaches were compared. A comparative study of specific approaches for subcondylar fractures has not been published before in Korea.
Methods: Twenty-one patients with subcondylar fractures of the mandible were included. Ten patients were treated with the retromandibular approach and 11 were treated with an endoscope-assisted transoral approach. We examined patient age, gender, fracture sites, classifications, period of maxillomandibular fixation, facial nerve (FN) or greater auricular nerve (GAN) injuries, maximal mouth opening, deflection, occlusal changes, number of plates, follow-up period, and other complications. Preoperative computed tomography and pre-operative, post-operative, and follow-up panoramic views were taken of each patient.
Results: Mean maximal mouth openings were similar between the two approaches. FN and GAN injuries were more frequent in the RMA group but the deflective rate with mouth opening was higher in the EATA than that in RMA group. Two cases of post-operative infection occurred in the EATA group, and occlusal changes were observed in one case for both approaches.
Conclusion: The RMA offers more direct access and visualization of the surgical field but it can cause scars and retractive injuries of the FN and GAN. But, EATA did not result in consequent nerve injuries or scars postoperatively, but unfavorable fractures such as medial override condyles were more difficult to reduce endoscopically. Except cases of an expected difficult reduction, the treatment of choice for a displaced subcondylar fracture may be an EATA.
키워드
Subcondylar fractures; Retromandibular; Endoscope; Transoral; Open reduction internal fixation
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