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Thean D, Chang F. Mandibular condylar fractures: a 5-year retrospective analysis comparing open versus closed reduction. ANZ J Surg 2024; 94:597-603. [PMID: 37743575 DOI: 10.1111/ans.18705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/26/2023] [Accepted: 09/05/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Mandibular fractures are common facial fractures, and contemporary management of mandibular condylar fractures is controversial. The purpose of this study was to compare the outcomes of patients who sustained a mandibular condylar fracture between 2016 and 2020, who were managed by either open or closed techniques. The outcomes of this study were: post-operative facial nerve function, occlusion, and maximal mouth opening. METHODS This study is a retrospective multicentre cohort study which assessed clinical records for 246 patients with mandibular condyle fractures in three hospitals in Perth, Western Australia. The primary outcome measure was changes in post-operative facial nerve function. RESULTS One hundred and thirty-two patients underwent open reduction and internal fixation (ORIF), and 114 patients had closed management. The overall rate of temporary facial nerve injury following ORIF was 3.28%. The overall rate of permanent facial nerve injury was 0.82%. Sialocoele occurred in 2.46% of all patients who underwent ORIF. 6.14% of patients had persisting malocclusion across both groups. There was a statistically significant association between the degree of fragment shortening and facial nerve injury (P = 0.0063), with more facial nerve changes in the group with 5 mm or greater of fragment shortening. CONCLUSIONS There is still significant debate over the management of mandibular condylar injuries. This study demonstrates a similar rate of temporary and permanent facial nerve injury as previously described, as well as a similar rate of sialocoele occurrence. Further prospective studies may provide clarity about important characteristics that will help guide decision making for mandibular condylar fractures.
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Affiliation(s)
- David Thean
- Department of Maxillofacial Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Frank Chang
- Department of Maxillofacial Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
- Department of Maxillofacial Surgery, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- Oral Surgery Department, Oral Health Centre of Western Australia, University of Western Australia, Perth, Western Australia, Australia
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Sfondrini D, Marelli S. The "low preauricular" transmasseteric anteroparotid (TMAP) technique as a standard way to treat extracapsular condylar fractures. J Craniomaxillofac Surg 2024; 52:108-116. [PMID: 38129188 DOI: 10.1016/j.jcms.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 09/14/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
Abstract
Condylar fracture treatment is a debated topic among maxillofacial surgeons. Various surgical techniques are used today, each one with advantages and disadvantages. The aim of this study is to present and evaluate our technique adopted for treatment of any type of extracapsular condylar fractures. Between 2020 and 2022, 16 condylar fractures were treated. In two patients with bilateral condylar fractures, the present technique was compared to the mini-retromandibular approach. All the patients were checked for clinical and radiological outcomes, facial nerve injury, scar visibility and presence of salivary complications. Dental occlusion was always restored, and facial nerve damage or salivary disorders were not observed. The skin incision, limited to the caudal two-thirds of the auricle, made the scar almost invisible and greatly improved the surgical field in the condylar neck area, facilitating the treatment. The proposed technique provides easier internal fixation for both neck and base condylar fractures with good cosmetic results, ensuring better protection of the facial nerve and parotid gland. The surgical technique described has not shown disadvantages in terms of operational difficulty, results, and complications. This novel surgical technique could represent a new choice in the treatment of extracapsular condylar fractures, although further studies are needed to support this new proposal.
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Affiliation(s)
- Domenico Sfondrini
- Division of Maxillo-facial Surgery, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Stefano Marelli
- Division of Maxillo-facial Surgery, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy.
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Thomas AB, Pawar SS. Approaches to the Maxillofacial Skeleton: Application of Standard and Minimally Invasive Techniques. Otolaryngol Clin North Am 2023; 56:1079-1088. [PMID: 37353367 DOI: 10.1016/j.otc.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
Abstract
Management of maxillofacial trauma is complex and challenging and requires a clear understanding of facial anatomy and function. There are multiple approaches that can be used to access each anatomical region, each with specific indications and complication profiles. Open, "invasive" approaches are being replaced or augmented with minimally invasive and endoscopic approaches when possible. Thorough knowledge of indications, surgical techniques, and potential complications allows surgeons to make appropriate decisions for access and repair of fractures. This article is a comprehensive review of standard and minimally invasive approaches, with description of techniques and pros and cons for their use.
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Affiliation(s)
- Abigail B Thomas
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
| | - Sachin S Pawar
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
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Gopal Krishnan V, Shukla D, Senthil Kumar C. Retromandibular Approach and its Different Variations in the Management of Fracture Condyle: Surgical Experience. J Maxillofac Oral Surg 2023; 22:1052-1057. [PMID: 38105855 PMCID: PMC10719431 DOI: 10.1007/s12663-023-01962-z] [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: 11/06/2022] [Accepted: 06/19/2023] [Indexed: 12/19/2023] Open
Abstract
The management of condylar fractures is a controversial topic in maxillofacial surgery. Surgical treatment is the preferred treatment choice nowadays and the article aims to describe different variations of the retromandibular approach with their surgical outcome based on experience. A total of 15 cases were managed with the retromandibular approach and its different variations. We advocate retromandibular approach for the management of condyle fractures, and among which retromandibular retroparotid and retromandibular anteroparotid provide best accessiblity with less bleeding and minimal risk of injury to the facial nerve.
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Affiliation(s)
- V. Gopal Krishnan
- Oral and Maxillofacial Surgery, Army Dental Centre (R&R), Jammu, India
| | - Deepak Shukla
- Oral and Maxillofacial Surgery, 16 Corps Dental Unit, Department of Oral and Maxillofacial Surgery, Satwari, Jammu, Jammu and Kashmir 180003 India
| | - C. Senthil Kumar
- Oral and Maxillofacial Surgery, 16 Corps Dental Unit, Department of Oral and Maxillofacial Surgery, Satwari, Jammu, Jammu and Kashmir 180003 India
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Nitesh C, Kirthi RK, Amar UP, Sarah S, Aafreen A. "Cervicomastoid Versus Retromandibular Extension of Pre-Auricular Incision in Transmasseteric Anteroparotid Approach for Condylar Fracture Management-a Prospective Study". J Maxillofac Oral Surg 2023; 22:652-660. [PMID: 37534358 PMCID: PMC10390442 DOI: 10.1007/s12663-022-01807-1] [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: 03/09/2022] [Accepted: 09/29/2022] [Indexed: 12/14/2022] Open
Abstract
Aims Treating mandibular condylar fractures has always been a matter of debate and controversy. However, there are various approaches, but it is of utmost importance that the surgical procedure must guarantee maximum safety for the facial nerve with best cosmetic outcome and minimizing complications. This prospective study was designed to compare cervicomastoid and retromandibular extension of pre-auricular incision in transmasseteric anteroparotid approach for condylar fractures management. Patients and Methods The study was conducted in the Department of Oral and Maxillofacial Surgery, Bapuji Dental College and Hospital, Davangere from November 2015 to May 2017, and a total of 16 condylar fractures were surgically accessed for the management and were divided into two groups, cervicomastoid (Group A) and retromandibular extension (Group B) for evaluating parameters such as to assess the access to condylar region, post-operative edema, cosmetic outcome, time taken to access and facial nerve injury. Results Clinically the time taken was significantly less in the cervicomastoid group even though, there was no statistically significant difference regarding access to the fracture site, post-operative edema, facial nerve injury and cosmetic outcome between two groups. Conclusion In our opinion the anteroparotid transmasseteric approach is appropriate for surgical management of mandibular condylar fractures as it provides adequate access, ensures safety of the facial nerve and is relatively easy to master. We realize that rather both incisions are good, but cervicomastoid variant is better choice in many aspects one being time taken for the surgery because of better tissue laxity of neck skin when seen in comparison.
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Affiliation(s)
- Chhikara Nitesh
- Department of Medical Education and Research, Mumbai, Haryana India
- Department of Medical Education and Research, Government of Haryana, Haryana, India
| | - Rai K. Kirthi
- Professor and HOD, Department of Oral and Maxillofacial Surgery, Bapuji Dental College and Hospital, Davangere, Karnataka India
| | - Upasi P. Amar
- Department of Oral & Maxillofacial Surgery, Bapuji Dental College and Hospital, Davangere, Karnataka India
| | - Shaik Sarah
- Resident Department of Orthodontics, Vokkaligara Sangha Dental College & Hospital, Bangalore, Karnataka India
| | - Aftab Aafreen
- Department of Oral & Maxillofacial Surgery, Rungta College of Dental Sciences and Research, Bhilai, Chattisgarh India
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Ben Slama N, Crampon F, Maquet C, Derombise B, Duparc F, Trost O. Preauricular anteroparotid transmasseteric approach of the mandibular condyle: The natural evolution after cervical dissections? An anatomical feasibility study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e598-e603. [PMID: 35545191 DOI: 10.1016/j.jormas.2022.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/20/2022] [Accepted: 05/04/2022] [Indexed: 06/15/2023]
Abstract
The purpose of this study was to evaluate the reliability and reproducibility of a novel approach for base and neck fractures of the mandible. An anatomical study was conducted on 22 given to Science subjects. A rhytidectomy-like approach was performed, followed by a transmasseteric anteroparotid dissection. Measures were taken of the incision length and bone exposure at every step. The identification of a ramus of the facial nerve during dissection was noted. The subjects were classified according to their facial adiposity. A correlation coefficient was measured between incision length and bone exposure as well as morphotype and bone exposure. Statistical analysis was carried out using the Pearson method for linear correlation, and Chi2 test for further analysis. Adequate condylar exposure was always achieved in the area of interest (i.e. in the main localization of base and neck fractures). There was no correlation between the length of the cranial cutaneous backcut and the bone exposure horizontally (p = 0.3296) or vertically (p = 0.8382). There was no correlation between the total length of the incision and the bone exposure horizontally (p = 0.5171) or vertically (p = 0.8404). There was a significant correlation between the subjects' facial adiposity and the bone exposure horizontally and vertically (p<0.005). This approach allowed adequate bone exposure to the mandible base and neck, with a possible 90° angulation of instruments for optimal bone fixation. The incidence of facial nerve rami identification during dissection was similar to other approaches. The scarring was hidden. These results allowed us to propose this approach in a clinical study.
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Affiliation(s)
- Neil Ben Slama
- Rouen University Hospital, Department of Oral and Maxillofacial Surgery, F 76000 Rouen, France.
| | - Frederic Crampon
- Rouen University Hospital, Department of Otorhinolaryngology-Head and Neck Surgery, F 76000 Rouen, France; Laboratory of Anatomy, Faculty of Medicine-Pharmacy, Rouen-Normandie University, 22 Boulevard Gambetta, 76183, Rouen, France
| | - Charles Maquet
- Rouen University Hospital, Department of Otorhinolaryngology-Head and Neck Surgery, F 76000 Rouen, France
| | - Baptiste Derombise
- Rouen University Hospital, Department of Oral and Maxillofacial Surgery, F 76000 Rouen, France
| | - Fabrice Duparc
- Laboratory of Anatomy, Faculty of Medicine-Pharmacy, Rouen-Normandie University, 22 Boulevard Gambetta, 76183, Rouen, France
| | - Olivier Trost
- Rouen University Hospital, Department of Oral and Maxillofacial Surgery, F 76000 Rouen, France; Laboratory of Anatomy, Faculty of Medicine-Pharmacy, Rouen-Normandie University, 22 Boulevard Gambetta, 76183, Rouen, France
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Ho Nguyen CT, Lam PH. Endoscopic-Assisted Intraoral Approach for Osteosynthesis of Mandibular Subcondylar Fractures. J Craniofac Surg 2022; 33:e754-e758. [PMID: 36201692 PMCID: PMC9518962 DOI: 10.1097/scs.0000000000008734] [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: 03/14/2022] [Accepted: 03/22/2022] [Indexed: 11/25/2022] Open
Abstract
The aim of this study is to follow-up and evaluate the treatment result of mandibular subcondylar (MSC) fractures by osteosynthesis via endoscopy-assisted intraoral approach.
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Girhe V, Patil V, Bhujbal R, Singh R, Dewang P, Vaprani G. Pre-auricular Transparotid Approach for the Management of Mandibular Condylar Fracture: An Experience of 82 Cases. J Maxillofac Oral Surg 2022; 21:916-922. [PMID: 36274863 PMCID: PMC9474963 DOI: 10.1007/s12663-021-01565-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 04/10/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose This paper retrospectively analyses the functional outcomes and complications associated with pre-auricular transparotid approach for the management of mandibular condylar fractures. Material and Methodology The retrospective data of 82 condylar fractures were analysing in 73 patients who underwent open reduction and internal fixation with pre-auricular transparotid approach. Evaluation of post-operative complications and the post-operative occlusion status, maximal inter-incise opening, adequacy of reduction and stability of fixation were assessed clinically and radiographically. Results The exposure of fracture segment was adequate in all the cases, and fixation was easy with 2 mm delta miniplate. Transient facial nerve palsy occurred in 2 patients (2.43%). 1 patient developed sialocele which was managed conservatively. There were slight occlusal discrepancies in 10 patients at the end of 1-week follow-up which was corrected with guiding elastics at the end of 1-month follow-up. The reduction was adequate, and fixation was stable. The functional outcomes were satisfactory in term of mouth-opening and range of motion. Conclusion The pre-auricular transparotid approach provides direct access to the fracture site resulting in less retraction of the tissue containing facial nerve and also less amount of periosteal stripping is required, thus it maintains good vascularity to the fracture segments. It provides direct visualization of the fracture without much retraction of the tissue containing facial nerve branches. It allows better fixation of the fracture with very less complication which results in good functional outcomes.
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Affiliation(s)
- Vijaykumar Girhe
- Department of Oral and Maxillofacial Surgery, DR HSRSM Dental College, Hingoli, India
| | - Vinay Patil
- Department of Oral and Maxillofacial Surgery, Nanded Rural Dental College and Research Centre, Nanded, India
| | - Ravi Bhujbal
- Department of Oral and Maxillofacial Surgery, Nanded Rural Dental College and Research Centre, Nanded, India
| | - Rohit Singh
- Craniomaxillofacial Trauma, Hitkarini Dental College & Hospital, Jabalpur, India
| | - Prashant Dewang
- Department of Oral & Maxillofacial Surgery, CSMSS Dental College and Hospital, Aurangabad, India
| | - Ganesh Vaprani
- Department of Oral and Maxillofacial Surgery, Nanded Rural Dental College and Research Centre, Nanded, India
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Kandasamy S, John R. Mini - Retromandibular access to sub condylar mandibular fractures - Our experience. Natl J Maxillofac Surg 2022; 13:117-120. [PMID: 35911807 PMCID: PMC9326208 DOI: 10.4103/njms.njms_224_20] [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: 10/15/2020] [Revised: 03/22/2021] [Accepted: 04/13/2021] [Indexed: 11/29/2022] Open
Abstract
Condylar fractures alone accounts to about 25% to 40% of all the fractures of mandible. Management of condylar fractures has always been a controversy. Nowadays there has been more emphasis on open reduction of condylar fractures by the surgeons.The reasons could be the result of complications of closed reduction where the patient may not be able to masticate properly and deviation still present thereby the structural and functional loss forcing the surgeons' choice to open up. The anterior parotid approach has lesser risk of injury to parotid gland and also to facial nerve we attempted to use mini retro mandibular access for such fractures. So the aim was to explore the feasibility of the mini retro mandibular approach to sub condylar fractures. The patients reported to the department of oral and maxillofacial surgery department clinically and radio logically diagnosed and treated for condylar fractures were included. The maximal mouth opening, protrusive and lateral excursive movements, midline orientation with opposing arch, scar visibility, sialocele and facial nerve weakness were all recorded post operatively and compared with pre-operative recording. The mini retro mandibular access with anterior parotid transmessetric approach to sub condylar fractures can be the choice for the surgical management of sub condylar fractures which is absolutely easy, reliable, with less visible scar and with less chances of landing in facial nerve complications.
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Retromandibular Transparotid Approach for the Treatment of Benign Nontraumatic Conditions of the Mandible. A Retrospective Consecutive Case-Series Study. J Craniofac Surg 2021; 32:2677-2681. [PMID: 34727470 DOI: 10.1097/scs.0000000000007971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT The retromandibular transparotid approach enables the most direct access to the central and posterior part of the mandibular ramus including the condylar region. So far it has not been widely used for the management of benign pathology of the mandible. The purpose of this study was to evaluate the utilization rate of this approach in the nontrauma setting including the determination of suitable indications for this access. In total, 105 patients with 107 retromandibular transparotid approaches performed in the 6.5 years (from May 2014 to November 2020) were evaluated. Patients suffering from nontrauma pathology accounted for 4.7% of all cases. The recurrences of different types of odontogenic cysts and secondary chronic osteomyelitis were surgically managed via this approach with aesthetically acceptable resultant scar achievement and no identified postoperative complications. All lesions resolved and no recurrences occurred during the follow-up 32.0 ± 20.7 months (range 6 to 59 months, median = 26 months). The retromandibular transparotid approach may be considered for the enucleation of benign bone lesions in selected patients. Another type of surgery for the management of benign nontraumatic conditions in an accessible area without requirements for continuity resection and jaw reconstruction may be also suitable for using this approach.
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Raiteb M, Elmrini S, Azami Hassani F, Razem B, Slimani F. Surgical treatment of a mandibular condyle fracture. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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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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Imai T, Uzawa N. Concept of facial nerve relevance in the mandible: Proposal to optimize the application of extraoral approaches in fracture surgery. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 123:320-321. [PMID: 34118471 DOI: 10.1016/j.jormas.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Tomoaki Imai
- Department of Oral and Maxillofacial Surgery II, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka 565-0862, Japan.
| | - Narikazu Uzawa
- Department of Oral and Maxillofacial Surgery II, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka 565-0862, Japan
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Tandon S, Verma V, Rashid M, Srivastava S, Sharma NK. WITHDRAWN: Is the facial nerve at risk following surgical correction of mandibular condylar fracture: A systemic review and meta analysis. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2021. [DOI: 10.1016/j.adoms.2021.100052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Rai A, Jain A, Thukral R. Two miniplates versus 3-dimensional plate in the management of mandibular subcondylar fractures: a retrospective analysis. Oral Maxillofac Surg 2021; 25:457-461. [PMID: 33432472 DOI: 10.1007/s10006-021-00938-y] [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: 06/07/2020] [Accepted: 01/03/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of the present study was to evaluate the outcomes in patients with subcondylar fracture of mandible treated with 2 single miniplates compared to a 3-dimensional (3D) plate. PATIENTS AND METHODS This is a retrospective study which included patients diagnosed and treated for mandibular subcondylar fracture from January 2015 to December 2019. Included patients were divided into two groups, group 1: 2 miniplate group and group 2: 3D plate group. The data was obtained from the patients' records and evaluated for various outcomes including occlusal stability, postoperative complications like plate fracture, non-union, plate or screw loosening, and plate or screw infection leading to implant removal, wound dehiscence, salivary fistula, and facial nerve paralysis. The statistical analysis was performed using chi square test and Student's t test. RESULTS A total 58 patients (43 males and 15 females) were enrolled in the two groups ranging from 21 to 59 years. A total of 35 patients were recruited in group 1, whereas 23 patients were recruited in group 2. There was no statistically significant difference in the two groups with regard to the age range, gender, diagnosis, side of fracture, and accompanying fractures. Occlusal instability, wound dehiscence, and facial nerve paralysis was found in both the groups. Group 1 had 1 patient which required implant removal due to screw loosing, whereas group 2 had 2 patients which required plate removal due to plate fracture. One patient in group 2 required second surgery for fixation of fracture due to non-union. One patient in group 1 developed a sialocele postoperatively. However, there was no statistically significant difference in any of the variables assessed among the two groups (p > 0.05). CONCLUSION The results of our study indicate that the 2 miniplates and 3D plate system are effective in the management of mandibular subcondylar fractures.
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Affiliation(s)
- Anshul Rai
- Department of Dentistry, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Anuj Jain
- Consultant Oral and Maxillofacial Surgeon, Nagpur, Maharashtra, India. .,Department of Trauma and Emergency Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.
| | - Rishi Thukral
- Department of Dentistry, Atal Bihari Vajpayee Government Medical College, Vidisha, Madhya Pradesh, India
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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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Mandal J, Bhutia O, Roychoudhury A, Yadav R, Adhikari M, Chaudhary G. Does the Retromandibular Transparotid Approach Provide Quicker Access to Fracture of Mandibular Subcondyle Compared With the Retromandibular Transmasseteric Anterior Parotid Approach? J Oral Maxillofac Surg 2020; 79:644-651. [PMID: 33160921 DOI: 10.1016/j.joms.2020.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Limited studies are available in the literature comparing various surgical approaches for the management of condylar fractures, and those comparing different types of retromandibular approaches are even fewer in number. This study aimed to compare the efficacy of 2 variants of the retromandibular approach-retromandibular transmasseteric anterior parotid (RMTMAP) and retromandibular transparotid (RMTP) in terms of exposure time, blood loss, facial nerve palsy, sialoceles or parotid fistula formation, infection, and esthetics of scar tissue. PATIENTS AND METHODS A randomized controlled trial was designed in patients with mandibular subcondylar fractures requiring operative intervention. Patients were randomized into 2 groups based on a computer-generated randomization table. Group A included 37 cases, treated with the RMTMAP approach, and group B included 38 cases treated with the RMTP approach. The primary outcome variable was exposure time. Secondary outcome variables were blood loss during exposure, complications like facial nerve palsy, sialocele formation, surgical site infection, and scar esthetics. All patients were followed for 3 months. Collected data were analyzed using the χ2 and analysis of variance tests. RESULTS The mean exposure time for fractures treated with the RMTMAP approach and RMTP approach was 21.08 ± 9.18 and 13.57 ± 6.09, respectively (P < .05). The mean blood loss for RMTMAP and RMTP approach was 11.75 ± 5.11 and 9.9 ± 3.77 mL, respectively (P = .078). No facial nerve injury was seen in patients treated with the RMTMAP approach, whereas 3 (7.8%) patients in the RMTP group had transient facial nerve injury (P = .08). CONCLUSIONS This study concludes that the RMTP approach provides quicker access to the condyle as compared with the RMTMAP approach. However, the incidence of transient facial nerve injury was more in the RMTP approach. Except for reduced blood loss in the RMTP approach, all other parameters were comparable in both the approaches.
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Affiliation(s)
- Jeetendra Mandal
- Junior Resident, Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ongkila Bhutia
- Professor, Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Ajoy Roychoudhury
- Professor and Head, Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Rahul Yadav
- Associate Professor, Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Manoj Adhikari
- Junior Resident, Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ganesh Chaudhary
- Junior Resident, Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
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Parhiz A, Parvin M, Pirayvatlou SS. Clinical Assessment of Retromandibular Antero-Parotid Approach for Reduction of Mandibular Subcondylar Fractures: Report of 60 Cases and Review of the Literature. Front Dent 2020; 17:1-9. [PMID: 33615293 PMCID: PMC7883655 DOI: 10.18502/fid.v17i17.4180] [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: 11/29/2019] [Accepted: 06/13/2020] [Indexed: 11/24/2022] Open
Abstract
This study assessed the efficacy of the retromandibular antero-parotid approach for open reduction and internal fixation (ORIF) of subcondylar fractures. Sixty patients with the mean age of 31.03 years underwent surgical reduction with a 20–25mm incision in the retromandibular area with an antero-parotid transmasseteric approach. All patients were followed between 6 to 12 months. At the end of the first week, six patients exhibited postoperative malocclusion. At the next visits, all patients had optimal occlusion. Maximal interincisal opening (MIO) of 56 patients (93.3%) was >37mm, and only four patients (6.7%) had MIO<37mm. In three patients (5%), weakness of the buccal branch of the facial nerve was noticed postoperatively. No salivary gland complications were seen. The surgical scar was hardly noticeable. Retromandibular access with transmasseteric antero-parotid approach is the technique of choice for treatment of high- and low-level subcondylar fractures with adequate visibility and direct access to the condylar area.
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Affiliation(s)
- Alireza Parhiz
- Dental Research Center, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran.,Department of Oral and Maxillofacial Surgery, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Milad Parvin
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Sasan Sanjari Pirayvatlou
- Dental Research Center, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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The trans-masseteric anteroparotid approach to the mandibular condyle : A reappraisal. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 121:611. [PMID: 32450317 DOI: 10.1016/j.jormas.2020.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/07/2020] [Indexed: 11/24/2022]
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Imai T, Fujita Y, Takaoka H, Motoki A, Kanesaki T, Ota Y, Chisoku H, Ohmae M, Sumi T, Nakazawa M, Uzawa N. Longitudinal study of risk for facial nerve injury in mandibular condyle fracture surgery: marginal mandibular branch-traversing classification of percutaneous approaches. Clin Oral Investig 2019; 24:1445-1454. [DOI: 10.1007/s00784-019-03163-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 11/20/2019] [Indexed: 11/30/2022]
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Machoň V, Desai A, Levorová J, Hirjak D, Brizman E, Foltán R. Evaluation of Complications Following a Trans-masseteric Antero-parotid Approach for Patients with Sub-condylar Fractures of Their Temporomandibular Joint. A Retrospective Study. Prague Med Rep 2019; 120:64-73. [PMID: 31586505 DOI: 10.14712/23362936.2019.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Sub-condylar fractures of the temporomandibular joint can be treated by an extraoral or intraoral approach. Trans-masseteric antero-parotid approach (TMAP) is an extraoral approach utilising a retromandibular incision. The authors evaluated patients' status and any complications of using TMAP from the years 2013-2017. There were 39 patients (44 fractures). When using TMAP, in 43 fractures the fragments were favourably positioned, in one case the position was compromised. Of the complications, postoperative palsy of the facial nerve was reported 6.8% - in all cases this was only temporary. Late occlusion had an equal number of complications (in 2 cases this was as a result of an infectious complication of the wound, and in 2 cases due to resorption of the proximal fragment). Muscular pain and dysfunction of the temporomandibular joint following trauma were observed consistently in 6.8% of patients. Sialocoele, a non-conforming scar, and infectious complications were observed in 4.5% of patients. TMAP allows rapid surgical performance, with a good view for perfect repositioning and fixation of fragments of sub-condylar fractures of the temporomandibular joint. The complications associated with this approach are, for the most part, temporary, the aesthetic handicap of a scar is considered by patients to be acceptable. Overall, it is possible to evaluate retromandibular TMAP as safe, and the authors recommended it for treatment of sub-condylar fractures of the mandible.
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Affiliation(s)
- Vladimír Machoň
- Department of Dental Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.
| | - Avni Desai
- Department of Dental Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Jitka Levorová
- Department of Dental Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Dušan Hirjak
- Department of Dental Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Eitan Brizman
- Department of Dental Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - René Foltán
- Department of Dental Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
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Parihar VS, Bandyopadhyay TK, Chattopadhyay PK, Jacob SM. Retromandibular transparotid approach compared with transmasseteric anterior parotid approach for the management of fractures of the mandibular condylar process: a prospective randomised study. Br J Oral Maxillofac Surg 2019; 57:880-885. [PMID: 31402192 DOI: 10.1016/j.bjoms.2019.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 07/09/2019] [Indexed: 12/18/2022]
Abstract
Fractures of the mandibular condyle lead to displacement of the condyle and loss of the height of the ramus. A retromandibular approach is the most commonly used for open reduction and internal fixation (ORIF) of such fractures. We aimed to compare the complications associated with a retromandibular transparotid approach with a retromandibular transmasseteric anterior parotid (TMAP) approach for their management. Thirty patients were randomly selected into two groups (15 in each): Group A comprised the retromandibular transparotid approach and Group B the retromandibular TMAP. The variables evaluated were: operating time, facial nerve injury, occurrence of Frey syndrome, and sialocoele at one week, four weeks, three months, and six months. The mean (SD) age in group A and B was 33.93 (17.97) years and 33.53 (16.15) years, respectively, and there were 28 men and two women. Mean (SD) exposure time in the transparotid approach was 26.93 (5.19) minutes and 25.4 (8.35) minutes in the TMAP approach. The incidence of facial nerve injury was 2/15 patients in the transparotid group and 3/15 in the TMAP group, all of which resolved within six months. The incidence of sialocoele was 2/15 in the transparotid group. The results did not show any significant difference in complications between the two approaches, but the retromandibular transparotid approach provided straight-line access in fractures of the condylar neck, with fewer incidences of nerve injury. The anterior parotid approach, on the other hand, provided easier access for fractures that were medially dislocated or of the condylar base but had an increased incidence of facial nerve injuries.
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Affiliation(s)
- V S Parihar
- Department of Oral and Maxillofacial Surgery, Army Dental Center (Research and Referral), Delhi Cantt, New Delhi, India.
| | - T K Bandyopadhyay
- Department of Oral and Maxillofacial Surgery, Army Dental Center (Research and Referral), Delhi Cantt, New Delhi, India
| | - P K Chattopadhyay
- Department of Oral and Maxillofacial Surgery, Army Dental Center (Research and Referral), Delhi Cantt, New Delhi, India
| | - S M Jacob
- Department of Oral and Maxillofacial Surgery, Army Dental Center (Research and Referral), Delhi Cantt, New Delhi, India
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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: 6] [Impact Index Per Article: 1.2] [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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Imai T, Fujita Y, Motoki A, Takaoka H, Kanesaki T, Ota Y, Iwai S, Chisoku H, Ohmae M, Sumi T, Nakazawa M, Uzawa N. Surgical approaches for condylar fractures related to facial nerve injury: deep versus superficial dissection. Int J Oral Maxillofac Surg 2019; 48:1227-1234. [PMID: 30833093 DOI: 10.1016/j.ijom.2019.02.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/10/2019] [Accepted: 02/14/2019] [Indexed: 11/26/2022]
Abstract
The aim of this study was to investigate the probability of facial nerve injury (FNI) in the treatment of condylar neck and subcondylar fractures (CN/SCFs) with percutaneous approaches and to identify factors predicting FNI. The data of 80 patients with 87 CN/SCFs were evaluated retrospectively. The primary outcome was FNI occurrence. The predictor variables were age, sex, aetiology, alcohol consumption, fracture site and pattern (dislocation or not), concomitant fractures, time interval to surgery, surgeon experience, plate type, and the dual classification of percutaneous approaches. The approaches were classified based on whether subcutaneous dissection traversed the marginal mandibular branch (MMB) deeply (deep group: submandibular and retroparotid approaches) or superficially (superficial group: transparotid, transmasseteric anteroparotid (TMAP), and high cervical-TMAP approaches). Twenty-two patients (27.5%) suffered FNI, of whom two in the deep group had permanent paralysis of the MMB. In the multivariate logistic regression model, deeply traversing surgery approaches (odds ratio 12.4, P=0.025) and the presence of a dislocated fracture (odds ratio 6.66, P=0.012) were associated with an increased risk of FNI. These results suggest that percutaneous approaches in the superficial group should be recommended for the treatment of CN/SCFs to reduce the risk of FNI.
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Affiliation(s)
- T Imai
- Department of Oral and Maxillofacial Surgery II, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan; Department of Oral and Maxillofacial Surgery, Saiseikai Senri Hospital, Suita, Osaka, Japan.
| | - Y Fujita
- Department of Oral and Maxillofacial Surgery, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan
| | - A Motoki
- Department of Oral and Maxillofacial Surgery, Rinku General Medical Centre, Izumisano, Osaka, Japan
| | - H Takaoka
- Department of Oral and Maxillofacial Surgery, Higashiosaka City Medical Centre, Higashiosaka, Osaka, Japan
| | - T Kanesaki
- Department of Oral and Maxillofacial Surgery, Saiseikai Senri Hospital, Suita, Osaka, Japan; Department of Oral and Maxillofacial Surgery, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan
| | - Y Ota
- Department of Oral and Maxillofacial Surgery II, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan; Department of Oral and Maxillofacial Surgery, Itami City Hospital, Itami, Hyogo, Japan
| | - S Iwai
- Department of Oral and Maxillofacial Surgery II, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
| | - H Chisoku
- Department of Oral and Maxillofacial Surgery, Higashiosaka City Medical Centre, Higashiosaka, Osaka, Japan
| | - M Ohmae
- Department of Oral and Maxillofacial Surgery, Rinku General Medical Centre, Izumisano, Osaka, Japan
| | - T Sumi
- Department of Oral and Maxillofacial Surgery, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan
| | - M Nakazawa
- Department of Oral and Maxillofacial Surgery II, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
| | - N Uzawa
- Department of Oral and Maxillofacial Surgery II, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
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Sukegawa S, Kanno T, Masui M, Sukegawa-Takahashi Y, Kishimoto T, Sato A, Furuki Y. Which fixation methods are better between three-dimensional anatomical plate and two miniplates for the mandibular subcondylar fracture open treatment? J Craniomaxillofac Surg 2019; 47:771-777. [PMID: 30770259 DOI: 10.1016/j.jcms.2019.01.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 11/21/2018] [Accepted: 01/25/2019] [Indexed: 10/27/2022] Open
Abstract
PURPOSE To compare the clinical outcomes of a single three-dimensional (3-D) anatomical plate versus two conventional straight miniplates for the open treatment of mandibular subcondylar fractures. METHODS This retrospective clinical study included patients with mandibular subcondylar fractures treated by the retromandibular transparotid approach using a 3-D plate or two straight miniplates. Outcome variables included preoperative conditions of patients and fractures, extent of postoperative bone healing, and incidence of complications. Other variables included age, sex, fracture site, and follow-up duration. Variables were evaluated using descriptive statistics and compared between groups. RESULTS Twenty-eight fractures were analyzed: 13 fractures using 3-D plate and 15 fractures using two straight miniplates. None of the assessed variables showed significant differences between the two groups (p < 0.05). Unfortunately, in the 3-D plate group, reoperation was necessary for nonunion owing to plate breakage in one case with a bone defect around the fracture. CONCLUSION The 3-D plate and two straight miniplates were equally effective for the surgical management of mandibular subcondylar fractures. Although a 3-D plate is sufficient for a typical simple fracture, in cases with a bone defect around the fracture, selection of the plate fixation method should be carefully considered.
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Affiliation(s)
- Shintaro Sukegawa
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, Takamatsu, Kagawa, 760-8557, Japan.
| | - Takahiro Kanno
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Shimane, Japan.
| | - Masanori Masui
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, Kagawa, Japan.
| | - Yuka Sukegawa-Takahashi
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, Kagawa, Japan.
| | - Tsukasa Kishimoto
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, Kagawa, Japan.
| | - Ai Sato
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, Kagawa, Japan.
| | - Yoshihiko Furuki
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, Kagawa, Japan.
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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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Imai T, Nakazawa M, Uzawa N. Four-Step Chart of Percutaneous Approaches to the Mandibular Condyle: A Proposal of a Visualized System for Intuitive Comprehension. J Oral Maxillofac Surg 2018; 77:238-239. [PMID: 30342042 DOI: 10.1016/j.joms.2018.09.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 09/03/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Tomoaki Imai
- Assistant Professor, Department of Oral and Maxillofacial Surgery II, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan.
| | - Mitsuhiro Nakazawa
- Associate Professor, Department of Oral and Maxillofacial Surgery II, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
| | - Narikazu Uzawa
- Professor, Department of Oral and Maxillofacial Surgery II, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
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Moin A, Shetty AD, Archana TS, Kale SG. Facial Nerve Injury in Temporomandibular Joint Approaches. Ann Maxillofac Surg 2018; 8:51-55. [PMID: 29963424 PMCID: PMC6018270 DOI: 10.4103/ams.ams_200_17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Facial paralysis can be a devastating consequence resulting from blunt and penetrating trauma to the head and neck, as well as surgical injury, either accidental or due to involvement by tumor. In addition, the etiology can be attributed to a variety of other causes, ranging from infectious to metabolic, and is frequently idiopathic in nature. The incidence of facial nerve injury during temporomandibular joint (TMJ) surgeries varies among surgeons. There are many factors that could contribute to the injury of the temporal and zygomatic branches of the facial nerve. These nerves lie in a confluence of superficial fascia, temporalis fascia, and periosteum and may be injured by any dissection technique that attempts to violate the integrity of these regions. Excessive or heavy-handed retraction causes compression and/or stretching of nerve fibers resulting in neuropraxia. The facial nerve then enters the parotid gland, where the main trunk branches into the upper and lower divisions at the pes anserinus. The nerve further divides into five main branches: the temporal, zygomatic, buccal, marginal mandibular, and cervical. The temporal branch lies within the superficial muscular aponeurotic system at the level of the zygomatic arch. In this paper, we evaluate the facial nerve function based on the House–Brackmann grading index after the preauricular approach for the treatment of condylar fractures, pathologies, and TMJ ankylosis cases. The nerve functional regeneration postfacial nerve injury has been evaluated and reported in this retrospective study.
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Affiliation(s)
- Ayesha Moin
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences, Bengaluru, Karnataka, India
| | - Akshay D Shetty
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences, Bengaluru, Karnataka, India
| | - T S Archana
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences, Bengaluru, Karnataka, India
| | - Saurabh G Kale
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences, Bengaluru, Karnataka, India
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Shah AA, Dar N, Israr Ul Khaliq M, Hakeem T. Hypertonic saline solution for management of parotid fistula: A case report. J Oral Biol Craniofac Res 2016; 6:257-259. [PMID: 27761395 DOI: 10.1016/j.jobcr.2015.11.005] [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: 09/30/2015] [Accepted: 11/16/2015] [Indexed: 10/22/2022] Open
Abstract
The management of parotid fistulae has been unsatisfactory in the past, and numerous methods of treatment with varying success and morbidity have been described. A case of parotid fistula caused by damage to glandular elements during a transparotid approach for a subcondylar fracture reduction is reported. This paper presents a simple but effective and conservative method of treating this complication with the use of hot hypertonic saline.
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Affiliation(s)
- Ajaz A Shah
- Professor and Head, Department of Oral and Maxillofacial Surgery, Govt. Dental College & Hospital, Srinagar, India
| | - Nahida Dar
- Post Graduate Scholar, Department of Oral and Maxillofacial Surgery, SGT Dental College, Gurgaon, India
| | - Mohammed Israr Ul Khaliq
- Post Graduate Scholar, Department of Oral and Maxillofacial Surgery, Govt. Dental College & Hospital, Srinagar, India
| | - Tajamul Hakeem
- Post Graduate Scholar, Department of Oral and Maxillofacial Surgery, Govt. Dental College & Hospital, Srinagar, India
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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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Yang HM, Won SY, Kim HJ, Hu KS. Neurovascular structures of the mandibular angle and condyle: a comprehensive anatomical review. Surg Radiol Anat 2015; 37:1109-18. [PMID: 25956586 DOI: 10.1007/s00276-015-1482-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 04/27/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Various surgical interventions including esthetic surgery, salivary gland excision, and open reduction of fracture have been performed in the area around the mandibular angle and condyle. This study aimed to comprehensively review the anatomy of the neurovascular structures on the angle and condyle with recent anatomic and clinical research. METHODS AND RESULTS We provide detailed information about the branching and distributing patterns of the neurovascular structures at the mandibular angle and condyle, with reported data of measurements and proportions from previous anatomical and clinical research. Our report should serve to help practitioners gain a better understanding of the area in order or reduce potential complications during local procedures. Reckless manipulation during mandibular angle reduction could mutilate arterial branches, not only from the facial artery, but also from the external carotid artery. The transverse facial artery and superficial temporal artery could be damaged during approach and incision in the condylar area. The marginal mandibular branch of the facial nerve can be easily damaged during submandibular gland excision or facial rejuvenation treatment. The main trunk of the facial nerve and its upper and lower distinct divisions have been damaged during parotidectomy, rhytidectomy, and open reductions of condylar fractures. CONCLUSION By revisiting the information in the present study, surgeons will be able to more accurately prevent procedure-related complications, such as iatrogenic vascular accidents on the mandibular angle and condyle, complete and partial facial palsy, gustatory sweating (Frey syndrome), and traumatic neuroma after parotidectomy.
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Affiliation(s)
- Hun-Mu Yang
- Department of Anatomy, Dankook University College of Medicine, Cheonan, South Korea
| | - Sung-Yoon Won
- Department of Occupational Therapy, Semyung University, Jecheon, South Korea
| | - Hee-Jin Kim
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Yonsei University College of Dentistry, Seoul, South Korea
| | - Kyung-Seok Hu
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Yonsei University College of Dentistry, Seoul, South Korea.
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Shi D, Patil PM, Gupta R. Facial nerve injuries associated with the retromandibular transparotid approach for reduction and fixation of mandibular condyle fractures. J Craniomaxillofac Surg 2015; 43:402-7. [DOI: 10.1016/j.jcms.2014.12.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 12/10/2014] [Accepted: 12/11/2014] [Indexed: 11/16/2022] Open
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Kannadasan K, Shenoy K V, Kengagsubbiah S, V S, Priya V. Extra corporeal fixation of fractured mandibular condyle. J Clin Diagn Res 2014; 8:ZD41-3. [PMID: 25386546 DOI: 10.7860/jcdr/2014/10484.4914] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 07/31/2014] [Indexed: 11/24/2022]
Abstract
Condylar fracture is the second most common site in the mandibular fractures. Motor vehicle accident and fall are the major causes of such fractures. Because of the anatomical weakness of the condyle and the shape of the condylar head the antero-medial dislocation of the condyle is common. Open reduction and closed reduction is always debatable. The open reduction will bring back the normal function much earlier than closed reduction. Medially dislocated condylar fracture fragments are always managed with open method. In superior or high condylar fractures,exact reduction with conventional open reduction can be difficult due to the limited surgical and visual fields. In such cases extracorporeal fixation of condyle using vertical ramus osteotomy may be better choice to achieve perfect alignment and absolute maintaince of vertical height of the ramus and facial symmetry. We here present a case of extracorporeal fixation of unilateral left high condylar fracture.
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Affiliation(s)
- Kamal Kannadasan
- Professor and Head, Department of Oral and Maxillofacial Surgery, Thai Moogambigai Dental College and Hospital , Chennai, India
| | - Vandana Shenoy K
- Reader, Department of Oral and Maxillofacial Surgery, Thai Moogambigai Dental College and Hospital , Chennai,India
| | - Srivatsa Kengagsubbiah
- Professor, Department of Oral and Maxillofacial Surgery, Thai Moogambigai Dental College and Hospital , Chennai, India
| | - Sathyabhama V
- Reader, Department of Oral and Maxillofacial Surgery, Thai Moogambigai Dental College and Hospital , Chennai, India
| | - Vishnu Priya
- Reader, Department of Orthodontics, Thai Moogambigai Dental College and Hospital , Chennai, India
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Anatomy of the facial nerve at the condylar area: measurement study and clinical implications. ScientificWorldJournal 2014; 2014:473568. [PMID: 25379533 PMCID: PMC4212592 DOI: 10.1155/2014/473568] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 09/11/2014] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to elucidate the detailed anatomy of the facial nerve (FN) at the condylar area to helping physicians preventing the iatrogenic trauma on the nerve. We dissected 25 specimens of the embalmed Korean cadavers (13 males and 2 females; mean age 76.9 years). The FN course at the condylar was examined, and the location of the FN branches was measured with superficial standards. The trunks of the FN emerged in the condylar area as one trunk, two trunks, and a loop or plexiform in 36%, 12%, and 52% areas, respectively. The zygomatic branch (Zbr) of FN passed over the tragus-alar line 23 mm anterior to the tragus (Tg) in most of the cases. The Zbr passed over the vertical line 2 cm anterior to the Tg through the area about 6 to 20 mm inferior to the Tg. Regardless of careful approach techniques to the condylar area, the FN could be damaged by a careless manipulation. Any reference landmarks could not guarantee the safety during the approach to the condylar area because more than half of the cases present the complicated branching type in the front of the Tg.
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Candirli C, Taskesen F, Altintas N, Memis S. Novel Retromandibular Subparotideomasseteric Fascial Approach for Placement of a Temporomandibular Joint Prosthesis. J Oral Maxillofac Surg 2014; 72:1266.e1-5. [DOI: 10.1016/j.joms.2014.03.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 03/19/2014] [Accepted: 03/20/2014] [Indexed: 11/24/2022]
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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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Bhutia O, Kumar L, Jose A, Roychoudhury A, Trikha A. Evaluation of facial nerve following open reduction and internal fixation of subcondylar fracture through retromandibular transparotid approach. Br J Oral Maxillofac Surg 2013; 52:236-40. [PMID: 24370443 DOI: 10.1016/j.bjoms.2013.12.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 12/01/2013] [Indexed: 11/28/2022]
Abstract
The objective of this study was to evaluate any damage to the facial nerve after a retromandibular transparotid approach for open reduction and internal fixation (ORIF) of a subcondylar fracture. We studied 38 patients with 44 subcondylar fractures (3 bilateral and 38 unilateral) treated by ORIF through a retromandibular transparotid approach. All patients were followed up for 6 months. Postoperative function of the facial nerve was evaluated within 24h of operation, and at 1, 3, and 12 weeks, and 6 months. Variables including type of fracture, degree of mouth opening, postoperative occlusion, lateral excursion of the mandible, and aesthetic outcome were also monitored. Nine of the 44 fractures resulted in transient facial nerve palsy (20%). Branches of the facial nerve that were involved were the buccal (n=7), marginal mandibular (n=2), and zygomatic (n=1). In the group with lateral displacement, 2/15 showed signs of weakness, whereas when the fracture was medially displaced or dislocated 7/23 showed signs of weakness. Of the 9 sites affected, 7 had resolved within 3 months, and the remaining 2 resolved within 6 months. The mean (range) time to recovery of function was 12 weeks (3-6 months). There was no case of permanent nerve palsy. The retromandibular transparotid approach to ORIF does not permanently damage the branches of the facial nerve. Temporary palsy, though common, resolves in 3-6 months. Postoperative occlusion, mouth opening, and lateral excursion of the mandible were within the reference ranges. We had no infections, or fractured plates, or hypertrophic or keloid scars.
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Affiliation(s)
- Ongkila Bhutia
- Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi 110029, India.
| | - Lalit Kumar
- Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Anson Jose
- Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Ajoy Roychoudhury
- Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Anjan Trikha
- Department of Anaesthesia, All India Institute of Medical Sciences, New Delhi 110029, India
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Bowman J, O'Regan B, Bhopal S. Transmasseteric antero-parotid approach: a technique adaptation for ectopic subcondylar third molar removal and associated dentigerous cyst enucleation. Br J Oral Maxillofac Surg 2013; 52:e7-8. [PMID: 24268871 DOI: 10.1016/j.bjoms.2013.10.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 10/23/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Jonathan Bowman
- Department of Oral and Maxillofacial Surgery, Victoria Hospital, Hayfield Road, Kirkcaldy KY2 5AH, United Kingdom.
| | - Barry O'Regan
- Department of Oral and Maxillofacial Surgery, Victoria Hospital, Hayfield Road, Kirkcaldy KY2 5AH, United Kingdom.
| | - Sats Bhopal
- Department of Oral and Maxillofacial Surgery, Victoria Hospital, Hayfield Road, Kirkcaldy KY2 5AH, United Kingdom.
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40
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Balaji SM. Parotid fistula from transparotid approach for mandibular subcondylar fracture reduction. Ann Maxillofac Surg 2013; 3:182-4. [PMID: 24205480 PMCID: PMC3814669 DOI: 10.4103/2231-0746.119214] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Injury and/or damage to the parotid salivary glandular element during mandible condylar fracture approach is a rare event that leads to accumulation of saliva in the gland, leading to formation of a sialocele. Huge sialocele often seeks drain through the most dependent area through an extraoral wound. A case of parotid fistula (PF) caused by damage to glandular elements during a transparotid approach for a subcondylar fracture reduction is reported. The mechanism of damage and all possible sequels for the condition is being discussed. The method of surgical intervention for this condition is also discussed.
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Affiliation(s)
- S M Balaji
- Director, Balaji Dental and Craniofacial Hospital, Teynampet, Chennai, Tamil Nadu, India
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41
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Kisnisci R. Management of Fractures of the Condyle, Condylar Neck, and Coronoid Process. Oral Maxillofac Surg Clin North Am 2013; 25:573-90. [DOI: 10.1016/j.coms.2013.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Treatment of low subcondylar fractures--a 5-year retrospective study. Int J Oral Maxillofac Surg 2013; 42:716-20. [PMID: 23602278 DOI: 10.1016/j.ijom.2013.03.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 03/08/2013] [Accepted: 03/11/2013] [Indexed: 11/20/2022]
Abstract
The aim of the present study was to retrospectively review the treatment outcome of low subcondylar temporomandibular joint fractures. The retrospective analysis was performed on all patients treated for low subcondylar fractures (below the sigmoid notch) between 2006 and 2011. Patients were divided into two groups: the closed reduction group (maxillomandibular fixation, MMF) and the open reduction group (anteroparotid transmasseteric (APTM) approach). Out of 129 condylar fractures, a total of 37 patients met the inclusion criterion of a fracture below the sigmoid notch (low subcondylar). Ten patients (seven males and three females) were treated using the APTM approach, and 27 patients were treated conservatively by MMF. In the open reduction group, two patients (20%) had limited mouth opening that resolved following physiotherapy; the closed reduction group had a similar percentage (18.5%) of mouth opening limitation (below 35 mm). No facial nerve damage was noted. Adult patients suffering from low subcondylar fractures can be treated by open reduction and internal fixation using the APTM approach, which was found to be a safe and reproducible procedure with no facial nerve damage; however this is a surgical procedure with a shallow learning curve.
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Salgarelli A, Anesi A, Bellini P, Pollastri G, Tanza D, Barberini S, Chiarini L. How to improve retromandibular transmasseteric anteroparotid approach for mandibular condylar fractures: our clinical experience. Int J Oral Maxillofac Surg 2013; 42:464-9. [DOI: 10.1016/j.ijom.2012.12.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 10/31/2012] [Accepted: 12/01/2012] [Indexed: 11/27/2022]
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Analysis of the retroauricular transmeatal approach: a novel transfacial access to the mandibular skeleton. Br J Oral Maxillofac Surg 2012; 50:e22-6. [DOI: 10.1016/j.bjoms.2011.08.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 08/20/2011] [Indexed: 11/19/2022]
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46
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Girotto R, Mancini P, Balercia P. The retromandibular transparotid approach: Our clinical experience. J Craniomaxillofac Surg 2012; 40:78-81. [DOI: 10.1016/j.jcms.2011.01.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 11/18/2010] [Accepted: 01/03/2011] [Indexed: 10/18/2022] Open
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Subankylotic ostectomy for release of TMJ ankylosis using the transmasseteric anterior parotid approach. J Craniofac Surg 2011; 22:2300-3. [PMID: 22134263 DOI: 10.1097/scs.0b013e318232a59d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
Twelve patients with temporomandibular joint ankylosis (5 bilateral and 7 unilateral) with preoperative maximal mouth opening ranging from 0 to 11 mm (mean, 2.25 [SD, 3.19] mm) were treated with a subankylotic ostectomy. Inclusion criteria in the study were patients older than 18 years with restricted mouth opening of less than 30 mm and radiographic evidence of temporomandibular joint ankylosis. The mean maximal postoperative mouth opening was 38.92 (SD, 3.11) mm. All patients showed good functional rehabilitation in terms of movement and speech with no radiographic evidence of recurrence and no occurrences of temporary or permanent facial nerve palsy, sialoceles, or salivary fistulae. As this technique does not encroach upon the mass of ankylotic bone but creates a pseudarthrosis beneath it, chances of recurrences are minimized. The entire length and width of the right ramus from the condyle to the angle region can be accessed with this technique.
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Narayanan V, Ramadorai A, Ravi P, Nirvikalpa N. Transmasseteric anterior parotid approach for condylar fractures: experience of 129 cases. Br J Oral Maxillofac Surg 2011; 50:420-4. [PMID: 21982159 DOI: 10.1016/j.bjoms.2011.09.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2011] [Accepted: 09/07/2011] [Indexed: 11/17/2022]
Abstract
We have evaluated the transmasseteric anterior parotid (TMAP) approach in the treatment of 163 condylar fractures in 129 patients. Ninety-five patients presented with unilateral, and 34 with bilateral, fractures. The inclusion criteria were patient's choice for open reduction and internal fixation, displaced unilateral condylar fractures with occlusal derangement, and displaced bilateral condylar fractures with anterior open bite. Mean (SD) maximum interincisal opening after 3 months was 44(5)mm. There were no differences in lateral movements during the reviews 6 weeks and 3 months postoperatively. Protrusive movement at the end of 3 months was 7(2)mm. All patients achieved functional occlusion identical to the pretraumatic occlusion and good reduction of the condyles. No patient developed temporary or permanent facial palsy, sialocele, salivary fistula, or Frey syndrome. The mean (SD) operating time was 46(11)min. The TMAP approach avoids the complications of incision of the parotid gland, minimises the risk of facial nerve palsy, and offers excellent access to the fractured condyle.
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Affiliation(s)
- Vinod Narayanan
- Department of Oral & Maxillofacial Surgery, Saveetha Dental College & Hospital, Poonamalee High Road, Chennai 600077, Tamil Nadu, India
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Results of transmasseteric anteroparotid approach for mandibular condylar fractures. J Craniofac Surg 2011; 21:1882-3. [PMID: 21119445 DOI: 10.1097/scs.0b013e3181f4aef7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Management of condylar fractures has been the subject of much disagreement and debate. There is no general consensus for definitive treatment. Although there is a growing tendency for open reduction and internal fixation technique, risks and morbidity of the surgical procedure are still a point of concern for maxillofacial surgeons. To reduce potential complications and improve surgical exposure, the transmasseteric anteroparotid approach was introduced. Since 2008, we have operated on 6 patients (7 fractures) using this approach. The technique is easy to learn, provides adequate surgical exposure for open reduction internal fixation, and has few complication rates.
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50
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Retroauricular Transmeatal Approach to Manage Mandibular Condylar Head Fractures. J Craniofac Surg 2011; 22:641-7. [DOI: 10.1097/scs.0b013e318207f495] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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