在治疗颞下颌关节强直时，改良耳内切口（Inviscision）与 Alkayat-Bramely 切口相比是否能减少面神经损伤并改善外观？

IF 2.3 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Oral and Maxillofacial Surgery Pub Date : 2025-02-01 DOI:10.1016/j.joms.2024.10.010

Saurabh S. Simre BDS, MDS , Sameer Pandey BDS, MDS, MCh , Ram Sundar Chaulagain BDS, MDS , Akansha Vyas BDS, MDS , Abiskar Basnet BDS, MDS , Ashi Chug BDS, MDS, PhD

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引用次数: 0

摘要

背景：面神经损伤（FNI）和不美观的疤痕是颞下颌关节（TMJ）手术令人苦恼的并发症。目的：本研究的目的是比较在颞下颌关节强直中使用改良硬膜内切口（inviscision approach [IA]）和改良耳前切口（Alkayat-Bramley approach [ABA]）的术后 FNI 和手术瘢痕外观：作者实施了一项单中心、回顾性、队列研究。作者通过查阅电子病历，确定了在 2021 年 1 月至 2023 年 12 月期间因颞下颌关节强直向瑞诗凯诗印度医学科学研究所颅颌面外科就诊并接受强直松解术的受试者。纳入标准为单侧或双侧、索尼氏 III 型或 IV 型强直。排除标准为已存在 FNI 和再强直病例：主要预测变量为手术方法（IA vs ABA）：主要结果变量：1 个月和 6 个月时的 FNI（使用 House-Brackmann 量表测量）以及 6 个月时的疤痕外观（使用患者观察员疤痕评估量表测量）。次要结果变量为手术暴露的剥离时间（分钟）、术中失血量（毫升）以及感染、开裂和增生性瘢痕等其他并发症：协变量包括人口统计学（年龄、性别）、术前（侧、位置和 Sawhney 强直类型）：数据分析采用描述性统计、学生 t 检验、Mann-Whitney U 检验和回归分析，统计显著性水平为 P 结果：研究共纳入 30 名患者（40 个关节：每组 20 个），IA 患者的平均年龄为（22.45 ± 7.09）岁，ABA 患者的平均年龄为（19.25 ± 7.06）岁（P = .99）。IA 组有 8 名男性（53.33%）、7 名女性（46.6%），ABA 组有 5 名男性（33.3%）、10 名女性（66.6%）（P = .87）。术后 1 个月的 FNI 在 IA（9 人）中占 45%，在 ABA（19 人）中占 95%，具有统计学意义（P = .001）。6 个月时，IA（3 人）的 FNI 为 15%，ABA（14 人）的 FNI 为 70%，差异有统计学意义（P = .003）。在 6 个月时的疤痕评估中，患者观察者疤痕评估量表的平均评分为：IA 40.7 ± 17.2 分，ABA 61.75 ± 17 分，差异有统计学意义（P = .001）。IA的剥离时间更短（IA-25.45 ± 2.48 mins，ABA-35.45 ± 3.97 mins；P = .0001），失血量更少（IA-52.15 ± 9.12 mL，ABA-80.05 ± 8.91 mL；P = .0001），具有统计学意义。未观察到有统计学意义的并发症：总之，IA 显示出更好的结果，如更短的剥离时间、更少的 FNI、更好的疤痕外观，可作为颞下颌关节强直手术中传统 ABA 的合适替代方案。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Does a Modified Endaural Incision Reduce Facial Nerve Injury and Improve Cosmesis When Compared to the Modified Pre-Auricular Incision for Management of Temporomandibular Joint Ankylosis?

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Does a Modified Endaural Incision Reduce Facial Nerve Injury and Improve Cosmesis When Compared to the Modified Pre-Auricular Incision for Management of Temporomandibular Joint Ankylosis?

Background

Facial nerve injury (FNI) and unesthetic scar are distressing complications of temporomandibular joint (TMJ) surgery. Insufficient evidence on whether a modified endaural incision can reduce FNI and serve as an aesthetic alternative is a concern.

Purpose

The purpose of this study was to compare the postoperative FNI and surgical scar cosmesis using modified endaural incision (Inviscision approach [IA]) and modified preauricular incision (Alkayat-Bramley approach [ABA]) in TMJ ankylosis.

Study design, Setting, Sample

The authors implemented a single-centre, retrospective, cohort study. Subjects presenting to the Division of Craniomaxillofacial surgery at All India Institute of Medical Sciences, Rishikesh with TMJ ankylosis who underwent ankylosis release between January 2021 and December 2023 were identified through electronic medical record review. Inclusion criteria were the presence of unilateral or bilateral, Sawhney's type III or IV ankylosis. Exclusion criteria were pre-existing FNI, reankylosis cases.

Predictor/Exposure/Independent Variable

The primary predictor variable was surgical approach (IA vs ABA).

Main Outcome Variables

The primary outcome variables were FNI at 1 month and 6 months, measured using House-Brackmann scale, and scar cosmesis at 6 months using the Patient and Observer Scar Assessment Scale. Secondary outcome variables were dissection time for surgical exposure (minutes), intraoperative blood loss (milliliters), and other complications of infection, dehiscence, and hypertrophic scar.

Covariates

Covariates included demographics (age, sex), preoperative (side, location and Sawhney's type of ankylosis).

Analyses

The data were analyzed using descriptive statistics, student t-test, Mann-Whitney U test and regression analysis, with the level of statistical significance at P < .05.

Results

The study included 30 patients (40 joints: 20 in each group) with mean age of 22.45 ± 7.09 years in IA and 19.25 ± 7.06 years in ABA (P = .99). IA included 8 men (53.33%), 7 women (46.6%) and ABA had 5 men (33.3%), 10 women (66.6%) (P = .87). Postoperative FNI at 1 month accounted 45% in IA (n = 9) and 95% in ABA (n = 19), which was statistically significant (P = .001). At 6 months, FNI was 15% in IA (n = 3) and 70% in ABA (n = 14) that showed statistical difference (P = .003). For scar assessment at 6 months, the mean Patient and Observer Scar Assessment Scale score was 40.7 ± 17.2 for IA and 61.75 ± 17 for ABA, which was statistically significant (P = .001). IA had statistically significant shorter dissection time (IA = 25.45 ± 2.48 mins, ABA = 35.45 ± 3.97 mins; P = .0001) and lower amount of blood loss (IA = 52.15 ± 9.12 mL, ABA = 80.05 ± 8.91 mL; P = .0001). No statistically significant complications were observed.

Conclusion and Relevance

To conclude, IA shows better outcomes like shorter dissection time, reduced FNI, better scar cosmesis and can be proposed as a suitable alternative to traditional ABA in TMJ ankylosis surgery.

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来源期刊

Journal of Oral and Maxillofacial Surgery 医学-牙科与口腔外科

CiteScore

4.00

自引率

5.30%

发文量

审稿时长

41 days

期刊介绍： This monthly journal offers comprehensive coverage of new techniques, important developments and innovative ideas in oral and maxillofacial surgery. Practice-applicable articles help develop the methods used to handle dentoalveolar surgery, facial injuries and deformities, TMJ disorders, oral cancer, jaw reconstruction, anesthesia and analgesia. The journal also includes specifics on new instruments and diagnostic equipment and modern therapeutic drugs and devices. Journal of Oral and Maxillofacial Surgery is recommended for first or priority subscription by the Dental Section of the Medical Library Association.