Abstract

Objective

This study aimed to longitudinally assess the risk of facial nerve injury (FNI) in the surgical repair of mandibular condylar neck and subcondylar fractures (CN/SCFs) and to explore its predictors.

Materials and methods

In a retrospective cohort study, the outcome was defined as FNI at 1 week and 1, 3, and 6 months postoperatively. Potential predictors included age, sex, etiology, fracture site and pattern (dislocation/non-dislocation), concomitant facial fractures, interval to surgery, surgeons’ experience, plate types, and the marginal mandibular branch-traversing approach (deep/superficial group). We employed generalized estimating equations (GEEs) for repeated measurements throughout the 6-month follow-up period.

Results

Among 102 patients with 114 fractures, 27 patients (26.5%) developed FNI within 1 week. Prolonged FNI (≥ 1 month) occurred in 19 (19.2%) of 99 patients. Multivariate GEE analyses revealed that deep surgical approaches (i.e., traditional submandibular and retroparotid approaches; odds ratio [OR], 18.90; p = 0.011), fractures with dislocation (OR, 3.60; p = 0.025), and female gender (OR, 2.71; p = 0.040) were independently associated with the overall FNI risk. Additionally, the deep approaches (OR, 15.91; p = 0.014) and female gender (OR, 3.41; p = 0.035) were correlated with a prolonged FNI risk. Sensitivity analyses for the outcomes identified the same predictors.

Conclusion

The predictors longitudinally associated with FNI in CN/SCF surgeries included a deep MMB-traversing approach, dislocated fracture, and female gender.

Clinical relevance

The superficial surgical approaches (i.e., transparotid, transmasseteric anteroparotid, and high perimandibular approaches) should be adopted for CN/SCF treatment to minimize postoperative morbidity, especially for female patients with dislocated condyles.

中文翻译：

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下颌con突骨折手术中面神经损伤风险的纵向研究：经皮入路边缘下颌分支横穿分类。

摘要

目的

这项研究旨在纵向评估下颌con突颈和sub下骨折（CN / SCFs）手术修复中面神经损伤（FNI）的风险，并探讨其预测因素。

材料和方法

在一项回顾性队列研究中，将结局定义为术后1周，1、3和6个月的FNI。可能的预测因素包括年龄，性别，病因，骨折部位和类型（脱位/不脱位），伴随的面部骨折，手术间隔，外科医生的经验，钢板类型以及下颌骨边缘横穿方法（深部/浅表组） 。在整个6个月的随访期内，我们采用广义估计方程（GEE）进行重复测量。

结果

在102例114例骨折患者中，有27例（26.5％）在1周内发展为FNI。99例患者中有19例（19.2％）发生了延长的FNI（≥1个月）。多元GEE分析显示，深层手术入路（即传统的颌下及腮腺后入路；优势比[OR]为18.90；p  = 0.011），骨折脱位（OR为3.60；p  = 0.025）和女性（OR为2.71） ；p  = 0.040）与整体FNI风险独立相关。此外，深层入路（OR，15.91；p  = 0.014）和女性（OR，3.41；p  = 0.035）与长期FNI风险相关。对结果的敏感性分析确定了相同的预测因素。

结论

在CN / SCF手术中与FNI纵向相关的预测因素包括深入的MMB穿刺方法，骨折脱位和女性。

临床相关性

对于CN / SCF治疗，应采用浅表外科手术方法（即腮腺，经肛门前突入，前颌前突入路和高颌前突入路），以最大程度地降低术后发病率，尤其是对于female突脱位的女性患者。