Maxillofacial Plastic and Reconstructive Surgery

  • 제33권6호
  • /
  • Pages.497-504
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  • 2011
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  • 2288-8101(pISSN)
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  • 2288-8586(eISSN)
대한악안면성형재건외과학회 (Korean Association of Maxillofacial Plastic and Reconstructive Surgeons)
권호 표지

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 (가천의대 길병원 구강악안면외과) ;
  • 박대송 (가천의대 길병원 구강악안면외과) ;
  • 이상칠 (가천의대 길병원 구강악안면외과) ;
  • 김성용 (가천의대 길병원 구강악안면외과) ;
  • 임호용 (가천의대 길병원 구강악안면외과) ;
  • 염학열 (가천의대 길병원 구강악안면외과) ;
  • 김현민 (가천의대 길병원 구강악안면외과)
  • Kim, Dong-Woo (Department of Oral and Maxillofacial Surgery, Gachon University Gil Hospital) ;
  • Park, Dae-Song (Department of Oral and Maxillofacial Surgery, Gachon University Gil Hospital) ;
  • Lee, Sang-Chil (Department of Oral and Maxillofacial Surgery, Gachon University Gil Hospital) ;
  • Kim, Sung-Yong (Department of Oral and Maxillofacial Surgery, Gachon University Gil Hospital) ;
  • Lim, Ho-Yong (Department of Oral and Maxillofacial Surgery, Gachon University Gil Hospital) ;
  • Yeom, Hak-Yeol (Department of Oral and Maxillofacial Surgery, Gachon University Gil Hospital) ;
  • Kim, Hyeon-Min (Department of Oral and Maxillofacial Surgery, Gachon University Gil Hospital)
  • 투고 : 2011.07.29
  • 심사 : 2011.08.22
  • 발행 : 2011.11.30
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초록

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

참고문헌

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