背景:面神经功能障碍是下颌骨髁突骨折切开复位术中的潜在并发症。
目的:本研究的目的是测量和比较经腮腺(TP)和经尿道腮腺前(TMAP)手术入路切开复位内固定髁突骨折术后面神经功能。使用肌电图。
■设计了一项随机对照临床试验。这项研究是在住院的一家三级医院中进行的。包括年龄在18岁以上的颌骨单侧髁突骨折或仅在一侧接受手术的双侧髁突骨折患者。如果患者头部骨折,将被排除在外,双侧髁突骨折计划手术,以前在下颌后区域的手术史,现有的接近髁的撕裂,术前表现为面神经无力,或者腮腺手术史.
方法:预测变量是手术方法,受试者被随机分配到TMAP和TP。
■主要结果变量是采用House-Brackmann量表和肌电图(EMG)记录神经功能的任何细微弱点的手术方法后面神经功能。术后1周(T1)以3个时间间隔记录面神经功能,1个月(T2),3个月(T3)。研究的次要结果是手术时间和记录的任何其他并发症。
■年龄,性别,根据Loukata等将髁突骨折分类为髁颈或基础骨折的骨折模式。4描述解剖位置的下颌骨骨折,即联合和旁骨(下颌骨前),身体,记录对侧髁或大于1的相关骨折。同样,还记录了是否存在任何相关的中面骨折,这表明研究参与者在所有方面都是同质的.
方法:分析统计包括χ2检验,t检验,重复测量方差分析,然后进行事后检验,以比较包括额骨在内的面部肌肉的2种手术方法(TPvsTMAP)之间的EMG数据(平均功率和平均幅度)。oculi,并在不同的时间间隔(T0,T1,T2,T3)。还对每组患者进行了分析,以检查随访期间发生的神经恢复情况。显著性水平设定为P<0.05。
结果:研究样本由22例患者组成,TMAP组的平均年龄分别为32.82±11.21岁和TP组的平均年龄分别为27.82±8.54岁(P=.26);TMAP和TP组的男性优势分别为81.8%和90.9%(P=.53)。通过House-Brackmann量表临床评估的面神经缺损,为54%(T1),36.4%(T2),TP组为9.1%(T3)和27%(T1),9%(T2),和TMAP组的0%(T3);然而,结果无统计学意义(P=.31)。在表面肌电图评估中,T3时TMAP入路中额肌的平均功率显著较高(105.03±9.7vs89.56±10;95%CI-24.28~-6.65,P值=.002).TP方法更快,平均暴露时间为9.9分钟。
结论:结果表明,两种方法均可获得与TMAP组相当的长期结果,表现出额肌活动更好。
BACKGROUND: Facial nerve (FN) dysfunction is a potential complication during open reduction of mandibular condylar fractures.
OBJECTIVE: The purpose of this
study was to measure and compare the postoperative FN function following transparotid (TP) and transmasseteric anterior parotid (TMAP) operative approaches in open reduction and internal fixation of condylar fractures using electromyogram.
UNASSIGNED: A randomized controlled clinical
trial was designed. The
study was conducted in a single tertiary-care hospital in the inpatient setting. Patients aged above 18 years with unilateral condylar fracture of the jaw or bilateral condylar fractures undergoing surgery on only 1 side were included. Patients were excluded if they had fractures of the head, bilateral condylar fractures with surgery planned on both sides, a previous history of surgery in the retromandibular area, existing lacerations to approach condyle, preoperative signs of FN weakness, or a history of parotid surgery.
METHODS: The predictor variable was the operative approach and the subjects were allocated randomly to TMAP and TP.
UNASSIGNED: The primary outcome variable was postoperative FN function in the surgical approach employed using the House-Brackmann scale and electromyography (EMG) to record any subtle weakness in nerve function. The FN function is recorded at 3 time intervals postoperatively 1 week (T1), 1 month (T2), and 3 months (T3). The secondary outcomes studied were operating time and any other complications recorded.
UNASSIGNED: Age, sex, fracture pattern with classification of condylar fractures into condylar neck or base fractures according to Loukata et al.4 Any associated fracture of mandible describing the anatomical location viz symphysis and parasymphysis (anterior mandible), body, contralateral condyle or greater than 1 associated fracture were recorded. Similarly, the presence or absence of any associated midface fracture was also recorded to suggest that the
study participants were homogenous in all aspects.
METHODS: Analytical statistics included χ2 test, t-test, and repeated measures ANOVA followed by post hoc test to compare EMG data (mean power and mean amplitude) between 2 operative approaches (TP vs TMAP) for facial muscles including frontalis, oculi, and buccinator at different time intervals (T0, T1, T2, T3). Patients within each group were also analyzed to check for nerve recovery occurring during the follow-up period. The level of significance was set at P < .05.
RESULTS: The
study sample was composed of 22 patients with a mean age of 32.82 ± 11.21 years in TMAP and 27.82 ± 8.54 years in the TP group respectively (P = .26); male predominance of 81.8 and 90.9% in TMAP and TP group respectively (P = .53) was noted. The FN deficit as assessed by the House-Brackmann scale clinically, was at 54% (T1), 36.4% (T2), and 9.1% (T3) for the TP group and 27% (T1),9% (T2), and 0% (T3) for TMAP group; however, the results were statistically insignificant (P = .31). In surface EMG evaluation, the mean power for the frontalis muscle was significantly higher in the TMAP approach at the T3 time (105.03 ± 9.7 vs 89.56 ± 10; 95% confidence interval -24.28 to -6.65 with P value = .002). TP approach was faster with a mean exposure time of 9.9 minutes.
CONCLUSIONS: The results show that both approaches give comparable long-term results with the TMAP group showing better frontalis muscle activity.