颞中静脉在头皮冠状切口中的临床应用

doi:10.13701/j.cnki.kqyxyj.2023.05.006

摘要/Abstract

摘要： 目的: 探讨颞中静脉在颧骨复合体骨折行冠状切口颞区翻瓣中的临床价值。方法: 选取从2016年1月~2022年3月在南华大学附属长沙中心医院口腔颌面外科住院的颧骨复合体患者,根据患者手术需要,经自愿同意本研究的改良式冠状切口入路行开放复位坚强内固定,术后随访不少于6个月,收集患者术后伤口感染、术后血肿、张口度、面神经损伤、颞部凹陷、局部秃发、骨折、愈合患者满意度情况,并与2013年1月~2016年1月间在我科进行非此种改良术式的颧骨复合体骨折患者情况进行分析和比较。结果: 共对47例患者进行了在颞中静脉指引下的冠状切口入路颞部翻瓣行颧骨复合体骨折内固定手术,47例患者术后手术创面均一期愈合,骨折愈合良好,无术后血肿及面神经损伤,存在术后颞窝轻度凹陷1例,局部秃发2例,轻度张口受限3例,术后满意度97.87%(46例)。非颞中静脉翻瓣组病例共31例,术后骨折愈合良好,但存在术后伤口感染1例,术后血肿4例,轻度张口受限3例,面神经损伤3例,其中额纹消失2例,额纹消失合并闭眼不能1例,颞部凹陷1例,局部秃发3例,术后满意度83.87%(26例)。对两组病例的术后并发症以及满意度进行统计学分析,非颞中静脉组术后血肿、面神经损伤发生率均显著高于颞中静脉组,两者间差异有统计学意义(P<0.05);颞中静脉组术后满意度显著高于非颞中静脉组,两者间差异有统计学意义(P<0.05);颞部凹陷、张口度、局部秃发两者间无统计学差异。结论: 颧骨复合体骨折行颞区翻瓣时以颞中静脉结合颞中静脉的起始端和跨颧弓根处为重要手术安全标志,在充分保护面神经的同时也保证了颞部脂肪层的静脉回流,可降低面神经损伤和术后血肿发生率,而且利用此手术标志使得颞区翻瓣更加简洁,避免了由于手术医生临床经验不同而导致的手术效果差异,获得更高的临床满意度,有进一步研究和推广的价值。

关键词: 颞中静脉, 冠状切口, 哨兵静脉, 颧骨复合体, 面神经损伤, 颞部凹陷

Abstract: Objective: To investigate the application value of middle temporal vein in coronal incision flap surgery for zygomatic complex fractures. Methods: Patients with zygomatic complex fractures who were hospitalized in Department of Oral Surgery, Changsha Central Hospital from January 2016 to March 2022 and required open reduction and internal fixation with coronal incision were selected. The flap was opened with the middle temporal vein as a marker for fracture reduction, and the postoperative follow-up was more than 6 months. Postoperative wound infection, postoperative hematoma, mouth opening, facial nerve injury, temporal depression, local alopecia, fracture, and healing satisfaction of patients were collected, analyzed, and compared with the patients with zygomatic complex fracture who underwent no such modified operation in our department. Results: A total of 47 patients underwent temporal flap with coronary incision guided by the middle temporal vein for internal fixation of zygomatic complex fracture. All patients underwent primary postoperative wound healing with good fracture healing and no postoperative hematoma or facial nerve injury. There was slight temporal fossa depression in 1 case, local alopecia in 2 cases, and slight restriction of mouth opening in 3 cases. The postoperative satisfaction rate was 97.87% (46 patients). There were 31 cases in the non-middle temporal vein flap group, and postoperative fracture healing was good, but there was postoperative wound infection in 1 case, postoperative hematoma in 4 cases, mild restriction of mouth opening in 3 cases, facial nerve injury in 3 cases, including 2 cases of frontal striae disappearance and 1 case of frontal striae disappearance combined with inability to close eyes, 1 case of temporal depression, 3 cases of local alopecia, and the postoperative satisfaction was 83.87% (26 cases). The incidence of postoperative hematoma and facial nerve injury in the non-middle temporal vein group was significantly higher than that in the middle temporal vein group (P<0.05). Postoperative satisfaction of middle temporal vein group was significantly higher than that of non-middle temporal vein group (P<0.05). There was no statistical difference between temporal depression, mouth opening, and local alopecia. Conclusion: When facing zygomatic complex fracture which needs flap surgery, using temporal vein in the temporal region combined with temporal vein across zygomatic screw as the operation sign will protect the facial nerve and ensures the venous return of temporal fat layer at the same time, reduce the incidence of facial nerve injury and postoperative hematoma, and simplify the flap surgery.

Key words: middle temporal vein, coronary incision, sentinel vein, zygomatic complex, facial nerve injury, temporal depression

贺祖武, 田甜. 颞中静脉在头皮冠状切口中的临床应用[J]. 口腔医学研究, 2023, 39(5): 406-411.

HE Zuwu, TIAN Tian. Clinical Application of Middle Temporal Vein in Scalp Coronal Incision[J]. Journal of Oral Science Research, 2023, 39(5): 406-411.

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