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Tatsumi H, Matsuda Y, Toda E, Okui T, Okuma S, Kanno T. Postoperative Complications following Open Reduction and Rigid Internal Fixation of Mandibular Condylar Fracture Using the High Perimandibular Approach. Healthcare (Basel) 2023; 11:healthcare11091294. [PMID: 37174836 PMCID: PMC10178098 DOI: 10.3390/healthcare11091294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/21/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
The high perimandibular approach is a feasible surgical technique for treating mandibular condylar fractures with open reduction and internal fixation, followed by fewer complications. Temporary trismus is the only postoperative complication that may occur. This study evaluated postoperative complications following open reduction and rigid internal fixation (OR-IF) of mandibular condylar fractures using the high perimandibular approach. Twenty consecutive patients undergoing OR-IF were included in this study. They included 11 male and 9 female patients, of an average age of 58.5 years, all of whom responded to a follow-up call at least 12 months after the surgery. All patients were evaluated for range of mouth opening, postoperative complications, and radiological findings. A statistical analysis of the relationship between range of mouth opening and related clinical parameters at 6 months postoperative evaluation was conducted. The fracture of the condylar neck was associated with a limited range of mouth opening and longer operation time. However, longer operation time was not associated with a limited range of mouth opening. The high perimandibular approach with OR-IF in mandibular condylar fractures is a feasible and safe technique; however, prolonged surgery and mandibular condylar neck fractures could affect the postoperative range of mouth opening.
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Affiliation(s)
- Hiroto Tatsumi
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Shimane University, Izumo 693-8501, Japan
| | - Yuhei Matsuda
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Shimane University, Izumo 693-8501, Japan
| | - Erina Toda
- Department of Oral and Maxillofacial Surgery, National Hospital Organization Hamada Medical Center, Hamada 697-8511, Japan
| | - Tatsuo Okui
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Shimane University, Izumo 693-8501, Japan
| | - Satoe Okuma
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Shimane University, Izumo 693-8501, Japan
| | - Takahiro Kanno
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Shimane University, Izumo 693-8501, Japan
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Louvrier A, Bertin E, Lutz JC, Meyer C. The modified Risdon approach is not only a high sub-mandibular skin incision. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e839-e840. [PMID: 35700950 DOI: 10.1016/j.jormas.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Aurélien Louvrier
- Chirurgie Maxillo-Faciale, Stomatologie et Odontologie Hospitalière, CHU Besançon, Besançon 25000, France; Laboratoire Nano Médecine, Imagerie, Thérapeutique, University Bourgogne Franche-Comté, EA 4662, Besançon 25000, France..
| | - Eugénie Bertin
- Chirurgie Maxillo-Faciale, Stomatologie et Odontologie Hospitalière, CHU Besançon, Besançon 25000, France
| | - Jean-Christophe Lutz
- Service de Chirurgie Maxillofaciale et Stomatologie, Centre Hospitalier Universitaire de Strasbourg; Faculté de Médecine, Université de Strasbourg, Strasbourg, France
| | - Christophe Meyer
- Chirurgie Maxillo-Faciale, Stomatologie et Odontologie Hospitalière, CHU Besançon, Besançon 25000, France; Laboratoire Nano Médecine, Imagerie, Thérapeutique, University Bourgogne Franche-Comté, EA 4662, Besançon 25000, France
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High Submandibular Anteroparotid Approach for Open Reduction and Internal Fixation of Condylar Fracture. Case Rep Dent 2021; 2021:5542570. [PMID: 34336305 PMCID: PMC8286183 DOI: 10.1155/2021/5542570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 05/04/2021] [Accepted: 06/24/2021] [Indexed: 11/17/2022] Open
Abstract
Aim There are several techniques for the treatment of mandibular condylar fractures. This is the first report of the high submandibular anteroparotid approach for open reduction and internal fixation of condylar fracture. Materials and Methods A 41-year-old woman fell indoors and injured her face. She was referred to our department for detailed examination and treatment of a suspected mandibular fracture. X-ray and computed tomography showed a right mandibular condylar base fracture and lateral dislocation of the fracture fragment. Open reduction and internal fixation procedures were performed for a right mandibular condylar fracture under general anesthesia. The mandibular ramus was reached by approaching from the inferior margin of the mandible, delaminating the masseter fascia posteriorly, and bypassing the anterior margin of the parotid gland. Once the fractured bone was reached, reduction and fixation were performed. Results We have achieved good results by the high submandibular anteroparotid approach, which is minimally invasive and simple, to reduce and fix condylar fractures. With this approach, no facial artery or retromandibular vein was encountered, and the mental stress for the surgeon was minimal. Postoperative wound infection, parotid gland complications such as parotitis and salivary fistula, facial nerve dysfunction such as facial paralysis, and esthetic disorders such as scarring were not observed. Conclusions Although it is necessary to examine more cases in the future, the high submandibular anteroparotid approach may be useful as a new approach for open reduction and internal fixation of condylar fractures.
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Extraoral vertical ramus osteotomy combined with internal fixation for the treatment of mandibular deformities. Br J Oral Maxillofac Surg 2021; 60:190-195. [PMID: 35034798 DOI: 10.1016/j.bjoms.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 05/03/2021] [Indexed: 11/21/2022]
Abstract
Extraoral vertical ramus osteotomy (EVRO) is used in orthognathic surgery for the treatment of mandibular deformities. Originally, EVRO required postoperative intermaxillary fixation (IMF). EVRO has been developed using rigid fixation, omitting postoperative IMF. We examined retrospectively the long-term stability and postoperative complications for patients with mandibular deformities who underwent EVRO with internal rigid fixation. Patients who were treated with EVRO for a mandibular deformity in the period 2008-2017 at the Clinic of Oral and Maxillofacial Surgery, Mölndal, Sweden were included (N = 26). Overjet and overbite were calculated digitally and cephalometric analyses were performed preoperatively, and at three days, six months, and 18 months postoperatively. There was a general setback of the mandible, decreased gonial angle and reduced degree of skeletal opening. Excellent dental and vertical skeletal stabilities were seen up to 18 months postoperatively, although relapse was seen sagitally up to six months postoperatively. Since the overjet did not show any significant change over time, the sagittal skeletal changes have been attributed to dental compensation. There was no permanent damage to the facial nerve and 5.8% neurosensory damage to the inferior alveolar nerve was observed.
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Does Surgical Specialty Impact Mandibular Fracture Outcomes? J Craniofac Surg 2021; 32:855-858. [PMID: 32941216 DOI: 10.1097/scs.0000000000007046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Maxillofacial trauma is treated by two medical specialties, plastic surgery (PRS) and otolaryngology (ENT). Differences in training exposure and practice patterns exist between specialties, but their respective outcomes have never been compared. METHODS Mandible fracture data were reviewed from the National Surgical Quality Improvement Program from 2005 to 2016. Demographics variables, repair types, and adverse outcomes were compared between PRS and ENT. RESULTS From 2005 to 2016, one thousand two hundred eighty-two cases were identified with 756 cases managed by ENT and 526 cases managed by PRS. Mean patient age was 34.6 years for both specialties (P = 0.95). Patient demographics between both cohorts were not statistically different except for higher rates of hypertension among ENT patients (10.2% for ENT versus 6.7% for PRS, P = 0.027) and higher rates of smoking history among PRS patients (46.8% versus 52.3%, P = 0.055). Mean operative time (131.3 versus 124.0 min, P = 0.090) had a trend toward being longer for ENT and mean length of stay (1.3 versus 2.0, P = 0.002) was significantly longer for PRS. Despite a greater proportion of high ASA class patients in the ENT group (P = 0.012) and patients with dirty/infected wounds in the PRS group (P = 0.013), there were no significant differences in 30-day readmission rates, 30-day reoperation rates, or wound infection rates. CONCLUSIONS No significant differences in 30-day readmission rates, reoperation rates, or wound infection rates for mandible fracture management exist between specialties. Despite differences in training between PRS and ENT, both specialties have comparable perioperative outcomes for mandible fracture management.
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Gupta S, Bansal V, Mowar A, Purohit J, Bindal M. Analysis between Retromandibular and Periangular Transmasseteric Approach for Fixation of Condylar Fracture - A Prospective Study. Ann Maxillofac Surg 2020; 10:353-360. [PMID: 33708579 PMCID: PMC7943978 DOI: 10.4103/ams.ams_28_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/06/2020] [Accepted: 04/17/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: Condylar fractures make up for an average of 17.5%–52% of all mandibular fractures. The aim of the present study was to compare the ease, success, and complications between retromandibular and periangular transmasseteric approaches when used for open reduction and internal fixation of condylar fractures. Materials and Methods: A total 20 cases with condylar fracture, ten each for retromandibular and periangular transmasseteric approach, were included in the study. Patients were evaluated at 1 week, 1 month, 3 months, and 6 months. Postoperative occlusion, maximum mouth opening, range of movement, facial nerve function, visibility, convenience of plating, and time taken for exposure, fixation, and closure were recorded. Incidence of complications such as wound dehiscence, wound infection, hematoma, sialocele formation, Frey's syndrome, and hypertrophic scars were also evaluated. Results: The mean exposure time in the retromandibular approach was 10 min 31 s and 9 min 17 s in the periangular transmasseteric approach. The incidence of facial nerve injury was 2 of 10 patients in the retromandibular group and 3 of 10 patients in the periangular transmasseteric group, all of which resolved within 6 months. The incidence of sialocoele was 2 of 10 in the retromandibular group. The time taken for exposure of the fracture site was statistically significant between the two approaches (P = 0.048) with longer time required for retromandibular approach. Discussion: It can be summarized that both the approaches are comparable and well suited for surgical management of condylar fractures. It was observed that in displaced condylar neck fractures, greater difficulty was experienced in the periangular transmasseteric approach than the retromandibular approach.
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Affiliation(s)
- Saloni Gupta
- Department of Oral and Maxillofacial Surgery, Swami Vivekanand Subharti University, Meerut, Uttar Pradesh, India
| | - Vishal Bansal
- Department of Oral and Maxillofacial Surgery, Swami Vivekanand Subharti University, Meerut, Uttar Pradesh, India
| | - Apoorva Mowar
- Department of Oral and Maxillofacial Surgery, Swami Vivekanand Subharti University, Meerut, Uttar Pradesh, India
| | - Jayendra Purohit
- Department of Oral and Maxillofacial Surgery, College of Dental Science, Amargadh, Gujarat, India
| | - Mohit Bindal
- Department of Oral and Maxillofacial Surgery, Swami Vivekanand Subharti University, Meerut, Uttar Pradesh, India
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An Anatomical Landmark for Retromandibular Transparotid Approach to Treat Subcondylar Fractures. J Craniofac Surg 2020; 32:e427-e429. [PMID: 33201073 DOI: 10.1097/scs.0000000000007233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
ABSTRACT Although the retromandibular transparotid approach (RTA) has been widely used to treat mandibular subcondyle fractures, the transient facial nerve injury (FNI) caused by this approach is not uncommon. The purpose of this paper was to present an anatomical landmark for RTA to treat subcondylar fractures, aiming to minimize FNI caused by the surgery. A total of 25 patients with subcondylar fractures but no FNI underwent RTA surgery. Intraoperatively, the plane of angulus oris was utilized as a reference to open the parotid and masseter tissues for exposing the fracture site. Postoperatively, FNI and other surgical complications were counted. The results showed that except for 2 cases of hematoma, no FNI or other complications occur. As a conclusion, utilization of plane of angulus oris as a reference for RTA to treat subcondylar fractures might make the surgery safer and less invasive.
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Louvrier A, Barrabé A, Weber E, Chatelain B, Sigaux N, Meyer C. The high sub-mandibular approach: Our experience about 496 procedures. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 121:626-633. [PMID: 32205300 DOI: 10.1016/j.jormas.2020.03.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 03/06/2020] [Accepted: 03/13/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The potential drawbacks of surgical approaches to neck and base fractures of the mandibular condyle (visible scare, facial nerve injury) are still considered by many surgeons as a brake for open reduction and internal fixation. The aim of our study was to analyze the results in terms of access, scare quality and complications that could be noticed in a 12 years period of time with the use of the high sub-mandibular approach (HSMA) we first described in 2006 for the surgical treatment of neck and base fractures. MATERIAL AND METHOD All the files of patients operated on for condylar neck and base fractures approached by mean of a HSMA between January 2006 and December 2018 in our department and containing information concerning age, sex, type of fracture, kind of osteosynthesis material, operating time, name of the surgeon, postoperative complication linked to the approach, scare quality at 6 months follow-up at least were included. The skin incision and the dissection planes followed the original publication of Meyer et al. in 2006. RESULTS 434 patients (sex ratio: 2.06, mean age: 32, 496 approaches) met the inclusion criteria. Following the AO classification, 21.2% of the fractures were classified as neck fractures and 78.8% as base fractures. 97.6% of all fractures were stabilized by mean of a 3D plate (TCP® plate, Medartis, Basel-CH), the remaining ones by mean of a combination of 1.2, 1.5 and 2.0 straight plates. Mean operating time was 40minutes per side. Patients were operated on by senior surgeons in 71.7% of the cases and by trainees under supervision for the others. Concerning the complications linked to the approach, we noticed 11 (2.2%) temporary (0 definitive) paresis of the facial nerve, 1 (0.2%) hematoma and 1 (0.2%) abscess that both needed revision. Scare was hypertrophic or considered as unaesthetic by the patient in 5 cases (1%). DISCUSSION The HSMA, if performed as initially described, is a safe and quick procedure compared to other cutaneous approaches. It gives access to all base fractures and to most of neck fractures. The very low rate of facial nerve complications is mainly explained by the plane by plane dissection making it very easy to avoid the facial nerve branches or to check them when encountered. The HSMA is particularly suited to the use of TCP plates as the upper holes of these plates, placed horizontally, are easy to reach from below. The HSMA is therefore still our preferred cutaneous approach to the condylar process.
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Affiliation(s)
- A Louvrier
- Department of Oral and Maxillofacial Surgery, University Hospital of Besançon, 3, boulevard Fleming, 25030 Besançon cedex, France; Host-Graft Interactions Lab-Tumor - Cell and Tissue engineering (UMR 1098 INSERM/UFC/EFS), University of Franche-Comté, 1, boulevard Fleming, 25020 Besançon cedex, France.
| | - A Barrabé
- Department of Oral and Maxillofacial Surgery, University Hospital of Besançon, 3, boulevard Fleming, 25030 Besançon cedex, France
| | - E Weber
- Department of Oral and Maxillofacial Surgery, University Hospital of Besançon, 3, boulevard Fleming, 25030 Besançon cedex, France
| | - B Chatelain
- Department of Oral and Maxillofacial Surgery, University Hospital of Besançon, 3, boulevard Fleming, 25030 Besançon cedex, France
| | - N Sigaux
- Department of Maxillofacial Surgery and Plastic Facial Surgery, Lyon Sud Hospital, Hospices Civils de Lyon, Claude-Bernard Lyon 1 University, 69310 Pierre-Bénite, France
| | - C Meyer
- Department of Oral and Maxillofacial Surgery, University Hospital of Besançon, 3, boulevard Fleming, 25030 Besançon cedex, France; Nanomedicine Lab Imagery and Therapeutics (EA 4662), University of Franche-Comté, 19, rue Ambroise-Paré, 25000 Besançon, France.
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Ramaraj PN, Patil V, Singh R, George A, Vijayalakshmi G, Sharma M. Variations in the retromandibular approach to the condyle-transparotid versus anteroparotid transmasseteric - a prospective clinical comparative study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2019; 121:14-18. [PMID: 31271891 DOI: 10.1016/j.jormas.2019.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 06/24/2019] [Accepted: 06/26/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND The management of mandibular condylar fracture remains controversial many surgeons still favour the open reduction and internal fixation (ORIF) which provides good result and immediate functioning as compared to closed reduction. With proven consensus for ORIF, dilemma remains in choosing the surgical approach to condyle due to proximity of complex and important anatomic structure. Various extra-oral surgical approaches are available for ORIF including preauricular, submandibular, retromandibular, transmasseteric anteroparotid etc. Variations in retromandibular approach such as transparotid, retro-parotid and anteroparotid are reported in literature. In our study we compared the retromandibular transparotid and retromandibular anteroparotid transmasseteric variations. METHODOLOGY Thirty condylar fracture in 26 patients, 15 in each group (group A - Retromandibular transparotid approach & group B - Retromandibular anteroparotid approach) were treated under general anaesthesia with naos-tracheal intubation and by the same surgeon having 20 years of experience in maxillofacial surgeries. We evaluated time taken for the procedure, amount of bone exposure, intra-operative haemorrhage. Postoperative presence of infection, sinus and fistula formation at the incision site, parotid fistula formation, facial nerve functioning using House-Brackman scale in immediate postoperative period, 3rd month postoperatively and 6 month postoperatively. RESULT The mean average time taken for group A was 78.2minutes and mean average time taken for group B was 64.8minutes. None of the patient had haemorrhage intra-operatively in both the groups. Exposure was sufficient in both the groups with same length of the incision. None of the patient suffered from postoperative infection in both the groups. Parotid fistula formation was present in 2 patients in group A while none of the patient had parotid fistula in group B. Three patients out of 15 had the transient facial nerve weakness in group A which got resolved in 6 month while none of the patient had facial nerve weakness in group B. All patients had adequate mouth opening with no occlusal discrepancies. CONCLUSION Retromandibular anteroparotid approach as described in this study has proven to be an extremely useful approach provides good access, and associated with minimal complications and morbidity compare to retromandibular transparotid approach. It is hence safe to say that this approach is relatively useful for an inexperienced and novice surgeon as well.
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Affiliation(s)
- P N Ramaraj
- Department Of Oral And Maxillofacial Surgery, K.V.G Dental College and Hospital, Sullia, India
| | - V Patil
- Department of oral and maxillofacial surgery, Nanded Rural Dental College & Hospital, Nanded, India
| | - R Singh
- Craniomaxillofacial trauma, Jabalpur Hospital & Research Centre, Jabalpur, India.
| | - A George
- Department Of Oral And Maxillofacial Surgery, K.V.G Dental College and Hospital, Sullia, India
| | - G Vijayalakshmi
- Department Of Oral And Maxillofacial Surgery, K.V.G Dental College and Hospital, Sullia, India
| | - M Sharma
- Consultant oral and maxillofacial surgeon, Jammu, India
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Mandibular subcondylar fracture accessibility with transparotid approach by rhytidectomy and modified Risdon approach: An anatomical comparative study. J Craniomaxillofac Surg 2018; 46:2256-2260. [PMID: 30420152 DOI: 10.1016/j.jcms.2018.10.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 09/25/2018] [Accepted: 10/15/2018] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The purpose of our anatomical study was to compare the accessibility of the area at the level of the neck of the condyle and the condylar head by two different approaches: the modified Risdon approach and a transparotid approach by rhytidectomy (TPAR). METHODS An anatomical study was performed on 12 heads of cadavers preserved with a solution rich in glycerin and ethanol, but very low in formalin. A modified Risdon approach and a TPAR were each performed on a hemiface of the same head. The bone surface was rendered digitally accessible on an anatomical diagram using Image J software. The software was used to determine a concordance score between the area of accessibility and the area of interest necessary for osteosynthesis of a high subcondylar fracture. This score was presented as a numerical scale from 0 to 100. We measured the total number of pixels in our area of interest and assigned it a score of 100. We then compared the area of accessibility with the area of interest necessary for osteosynthesis of a high subcondylar fracture. RESULTS Using the modified Risdon approach, an average score of 55.88 (SD = 18.96) was found, or 55.88% of the accessible area of interest. Using TPAR, we found a score of 91.05 (SD = 7.95) or 91.05% of the accessible area of interest. This difference in score between the two techniques was significantly different (p < 0.001), taking into account intra-hemiface and intra-individual correlation. CONCLUSION TPAR seems to be more effective in treating high condylar process fractures of the mandible.
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Al-Moraissi EA, Ellis E, Neff A. Does encountering the facial nerve during surgical management of mandibular condylar process fractures increase the risk of facial nerve weakness? A systematic review and meta-regression analysis. J Craniomaxillofac Surg 2018; 46:1223-1231. [PMID: 29929912 DOI: 10.1016/j.jcms.2018.04.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 03/20/2018] [Accepted: 04/10/2018] [Indexed: 12/01/2022] Open
Abstract
PURPOSE The purpose of this study was to identify whether the incidence of systematically identified or incidentally encountered facial nerve branches during dissection to approach condylar fractures increases risk of transient and/or permanent facial nerve weakness. METHODS A systematic review and meta-analysis were performed that included several databases with specific keywords, a reference search, and a manual search for suitable articles. The inclusion criteria were all clinical trials, with the aim of assessing the rate of facial nerve injuries when open reduction and internal fixation (ORIF) of condylar process fractures was performed using different surgical approaches. The articles had to have documented the number of encountered facial nerve branches during ORIF. The main outcome variable was transient and permanent facial nerve injury. The dependent variable was the event and/or number of encountered facial nerve branches during surgery, and how they were handled (i.e. dissected, retracted, etc.). RESULTS A total of 1202 mandibular condylar fractures were enrolled in 29 studies. Rate of transient facial nerve injury (TFNI) was 11.3 % (136/1202). The number of facial nerve branches encountered intraoperatively was 543, namely buccal, marginal mandibular, zygomatic and temporal nerve branches. There was a significant correlation suggesting that there is a strong positive linear relationship between TFNI and encountered facial nerve branches (Coef = 0.1916, P = 0.001). There was no significant relationship between permanent facial nerve injury and encountered facial nerve branches (P = 0.808). TFNI was 4.3% and 18.7% for those studies expressly reporting that facial nerve branches were encountered incidentally without dissection and with dissection, respectively. For studies reporting deliberate and systematic facial nerve dissection, TFNI was 20.9%. Finally, studies that did not report any encounters of facial nerve branches, TFNI was 7.9 %. CONCLUSION This meta-analysis demonstrated that manipulation of the facial nerve during different surgical approaches causes different incidences of facial nerve injury. The choice of surgical approach for a given fracture should take this into consideration.
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Affiliation(s)
- Essam Ahmed Al-Moraissi
- Dept. of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thamar University, Thamar, Yemen.
| | - Edward Ellis
- Dept. of Oral and Maxillofacial Surgery, University of Texas Health Science Center at San Antonio, USA
| | - Andreas Neff
- Dept. of Oral and Maxillofacial Surgery, University Hospital Marburg UKGM GmbH, Marburg, Germany
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Al-Moraissi EA, Louvrier A, Colletti G, Wolford LM, Biglioli F, Ragaey M, Meyer C, Ellis E. Does the surgical approach for treating mandibular condylar fractures affect the rate of seventh cranial nerve injuries? A systematic review and meta-analysis based on a new classification for surgical approaches. J Craniomaxillofac Surg 2018; 46:398-412. [DOI: 10.1016/j.jcms.2017.10.024] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 09/20/2017] [Accepted: 10/30/2017] [Indexed: 11/30/2022] Open
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Merlet FL, Grimaud F, Pace R, Mercier JM, Poisson M, Pare A, Corre P. Outcomes of functional treatment versus open reduction and internal fixation of condylar mandibular fracture with articular impact: A retrospective study of 83 adults. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2018; 119:8-15. [DOI: 10.1016/j.jormas.2017.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 08/20/2017] [Accepted: 10/02/2017] [Indexed: 10/18/2022]
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Use of a modified high submandibular approach to treat condylar base fractures: Experience with 44 consecutive cases treated in a single institution. J Craniomaxillofac Surg 2016; 44:1641-1645. [PMID: 27592023 DOI: 10.1016/j.jcms.2016.07.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 05/30/2016] [Accepted: 07/13/2016] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The aim of this article is to present our experience treating fractures of the condylar base with a modification of the high submandibular approach (HSA). MATERIALS AND METHODS Between June 2012 and April 2015, 44 fractures of the condylar base were treated in the Department of Oral and Maxillofacial Surgery of the Medical Hospital of Graz using the modified HSA. RESULTS We did not observe any damage (even transient) to the facial nerve or any complication related to violation of the parotid capsule (such as a salivary fistula, Frey syndrome, or a sialocele). CONCLUSIONS This approach provides good access to the condylar base, ensuring easier internal fixation, excellent protection of the facial nerve and parotid gland, and good cosmetic results.
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Gali R, Devireddy SK, Venkata KKR, Kanubaddy SR, Nemaly C, Dasari M. Preauricular transmasseteric anteroparotid approach for extracorporeal fixation of mandibular condyle fractures. Indian J Plast Surg 2016; 49:59-65. [PMID: 27274123 PMCID: PMC4878246 DOI: 10.4103/0970-0358.182254] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction: Free grafting or extracorporeal fixation of traumatically displaced mandibular condyles is sometimes required in patients with severe anteromedial displacement of condylar head. Majority of the published studies report the use of a submandibular, retromandibular or preauricular incisions for the access which have demerits of limited visibility, access and potential to cause damage to facial nerve and other parotid gland related complications. Purpose: This retrospective clinical case record study was done to evaluate the preauricular transmasseteric anteroparotid (P-TMAP) approach for open reduction and extracorporeal fixation of displaced and dislocated high condylar fractures of the mandible. Patients and Methods: This retrospective study involved search of clinical case records of seven patients with displaced and dislocated high condylar fractures treated by open reduction and extracorporeal fixation over a 3-year period. The parameters assessed were as follows: a) the ease of access for retrieval, reimplantation and fixation of the proximal segment; b) the postoperative approach related complications; c) the adequacy of anatomical reduction and stability of fixation; d) the occlusal changes; and the e) TMJ function and radiological changes. Results: Accessibility and visibility were good. Accurate anatomical reduction and fixation were achieved in all the patients. The recorded complications were minimal and transient. Facial nerve (buccal branch) palsy was noted in one patient with spontaneous resolution within 3 months. No cases of sialocele or Frey's syndrome were seen. Conclusion: The P-TMAP approach provides good access for open reduction and extracorporeal fixation of severely displaced condylar fractures. It facilitates retrieval, transplantation, repositioning, fixing the condyle and also reduces the chances of requirement of a vertical ramus osteotomy. It gives straight-line access to condylar head and ramus thereby permitting perpendicular placement of screws with minimal risk of damage to the facial nerve.
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Affiliation(s)
- Rajasekhar Gali
- Department of Oral and Maxillofacial Surgery, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India
| | - Sathya Kumar Devireddy
- Department of Oral and Maxillofacial Surgery, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India
| | | | - Sridhar Reddy Kanubaddy
- Department of Oral and Maxillofacial Surgery, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India
| | - Chaithanyaa Nemaly
- Department of Oral and Maxillofacial Surgery, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India
| | - Mallikarjuna Dasari
- Department of Oral and Maxillofacial Surgery, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India
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Laurentjoye M, Veyret A, Ella B, Uzel AP, Majoufre-Lefebvre C, Caix P, Ricard AS. Surgical anatomy of the preauricular anteroparotid approach for mandibular condyle surgery. Surg Radiol Anat 2014; 36:883-8. [PMID: 24614925 DOI: 10.1007/s00276-014-1284-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 02/25/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Mathieu Laurentjoye
- Medico-Surgical Anatomy Unit, Bordeaux Ségalen University, 33076, Bordeaux Cedex, France,
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Zrounba H, Lutz JC, Zink S, Wilk A. Epidemiology and treatment outcome of surgically treated mandibular condyle fractures. A five years retrospective study. J Craniomaxillofac Surg 2014; 42:879-84. [PMID: 24485271 DOI: 10.1016/j.jcms.2014.01.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Revised: 10/08/2013] [Accepted: 01/03/2014] [Indexed: 11/19/2022] Open
Abstract
Surgical management of mandibular condyle fractures is still controversial. Although it provides better outcome than closed treatment questions still remain about the surgical approach and the osteosynthesis devices to be used. Between 2005 and 2010, we managed 168 mandibular condyle fractures with open treatment. Two surgical approaches were used in this study, a pre-auricular and a high submandibular approach (one or the other or as a combined approach). Internal fixation was performed using TCP(®) plates (Medartis, Basel, Switzerland) or with two lag screws (15 and 17 mm). Delta plates were used in 15 cases (8.9%). We report the epidemiology of these fractures and the outcomes of the surgical treatment. We assessed the complications related to the surgical procedure and those related to the osteosynthesis material. The facial nerve related complication rate was very low and the osteosynthesis materials used proved to be strong enough to realize a stable fixation. The two approaches used in this study appeared to be safe with good aesthetic results. Most of the surgical procedure failures occurred in high subcondylar fractures especially when bilateral.
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Affiliation(s)
- Hugues Zrounba
- Service de Chirurgie Maxillo-Faciale (Head: Prof. Astrid Wilk), Hopital Civil, 1, Place de L'hopital, 67000 Strasbourg, France.
| | - Jean-Christophe Lutz
- Service de Chirurgie Maxillo-Faciale (Head: Prof. Astrid Wilk), Hopital Civil, 1, Place de L'hopital, 67000 Strasbourg, France
| | - Simone Zink
- Service de Chirurgie Maxillo-Faciale (Head: Prof. Astrid Wilk), Hopital Civil, 1, Place de L'hopital, 67000 Strasbourg, France
| | - Astrid Wilk
- Service de Chirurgie Maxillo-Faciale (Head: Prof. Astrid Wilk), Hopital Civil, 1, Place de L'hopital, 67000 Strasbourg, France
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Nam SM, Lee JH, Kim JH. The application of the Risdon approach for mandibular condyle fractures. BMC Surg 2013; 13:25. [PMID: 23829537 PMCID: PMC3708819 DOI: 10.1186/1471-2482-13-25] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 07/04/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many novel approaches to mandibular condyle fracture have been reported, but there is a relative lack of reports on the Risdon approach. In this study, the feasibility of the Risdon approach for condylar neck and subcondylar fractures of the mandible is demonstrated. METHODS A review of patients with mandibular condylar neck and subcondylar fractures was performed from March 2008 to June 2012. A total of 25 patients, 19 males and 6 females, had 14 condylar neck fractures and 11 subcondylar fractures. RESULTS All of the cases were reduced using the Risdon approach. For subcondylar fractures, reduction and fixation with plates was done under direct vision. For condylar neck fractures, reduction and fixation was done with the aid of a trochar in adults and a percutaneous threaded Kirschner wire in children. There were no malunions or nonunions revealed in follow-up care. Mild transient neuropraxia of the marginal mandibular nerve was seen in 4 patients, which was resolved within 1-2 months. CONCLUSIONS The Risdon approach is a technique for reducing the condylar neck and subcondylar fractures that is easy to perform and easy to learn. Its value in the reduction of mandibular condyle fractures should be emphasized.
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Ebenezer V, Ramalingam B. Comparison of approaches for the rigid fixation of sub-condylar fractures. J Maxillofac Oral Surg 2011; 10:38-44. [PMID: 22379319 DOI: 10.1007/s12663-010-0145-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2010] [Accepted: 12/01/2010] [Indexed: 11/28/2022] Open
Abstract
AIM The objective of this study was to compare the rate of complications encountered on using different incisions to access the fracture site for the open reduction and internal fixation of isolated subcondylar fractures. The parameters evaluated are: the occurrence of salivary fistula, infection, and injuries to the seventh facial nerve. An assessment of the surgical scar was also undertaken. MATERIALS AND METHODS 20 patients who met the previous criteria and were willing to participate in the study were placed (five each) into the pre-auricular, submandibular, retromandibular transparotid or retromandibular transmassetric group based on the incision scar they selected after a description of the operation and being explained about the possible complications. RESULTS AND CONCLUSION Comparison of the complications could not ascertain the superiority of any approach over the other since the outcomes were not statistically significant. However, judging by operator and assistants' subjective assessment, the retromandibular approaches seem to provide a more direct visual field and an almost straight line access for the fixation of the fracture. The transmassetric approach seems to be a safer approach since the nerves encountered can be visualized and avoided.
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