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Alagarsamy R, Lal B, Arangaraju R, Roychoudhury A, Srivastava RK, Barathi A. Endoscopic-assisted intraoral approach for mandibular condyle fracture management: A systematic review and meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 136:537-553. [PMID: 37635009 DOI: 10.1016/j.oooo.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVE Surgical innovation led to an endoscopic-assisted intraoral approach for managing condyle fractures. The purpose of this systematic review is to purview the role of the endoscope and determine the range of information, summarizing the evidence for the benefit of surgeons on an endoscopic-assisted intraoral approach. STUDY DESIGN A literature search was conducted in PubMed, Google Scholar, Semantic Scholar, and Cochrane Library databases for studies mentioning the endoscopic intraoral approach for managing mandibular condylar fractures. Outcomes include the role of the endoscope, challenges, adjunct armamentarium, duration, and complications associated with the transoral and transbuccal approach for screw fixation. The meta-analysis was conducted with prevalence estimates and standardized means using STATA. RESULTS Thirty-nine studies were included. A 30° angulated, 4-mm-thick endoscope was the most commonly used endoscope. Two mini plates were most commonly used for fixation. Facial nerve weakness was higher in the transbuccal approach (1.24%) than in the transoral approach (0.8%). Pooled analysis (6 studies) showed that the duration of the surgical procedure was less in the transoral approach compared with the transbuccal approach for screw fixation. The bailout was 1.49%. CONCLUSIONS The endoscopic-assisted intraoral approach is reliable for condylar fracture management. The transoral and transbuccal approaches can be used for screw fixation with comparable outcomes.
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Affiliation(s)
- Ragavi Alagarsamy
- Department of Burns, Plastic and Maxillofacial Surgery, VMMC and Safdarjung Hospital, New Delhi, India
| | - Babu Lal
- Department of Trauma and Emergency Medicine, All India Institute of Medical Sciences, Bhopal, India
| | - Ramya Arangaraju
- Department of Oral and Maxillofacial Surgery, GDC Kottayam, Kerala, India
| | - Ajoy Roychoudhury
- Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Rakesh Kumar Srivastava
- Department of Burns, Plastic and Maxillofacial Surgery, VMMC and Safdarjung Hospital, New Delhi, India
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Nogami S, Yamauchi K, Izumita K, Kitamura J, Takeda Y, Otake Y, Koyama S, Okuyama K, Sasaki K, Takahashi T. Clinical course of masticatory function recovery following arthrocentesis in patients with unilateral mandibular condyle head fracture. J Craniomaxillofac Surg 2021; 50:225-229. [PMID: 34930666 DOI: 10.1016/j.jcms.2021.12.005] [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: 03/17/2021] [Revised: 12/01/2021] [Accepted: 12/10/2021] [Indexed: 11/18/2022] Open
Abstract
The aim of this study was to investigate the clinical course of masticatory function recovery following arthrocentesis. Patients with a unilateral condylar head fracture who underwent arthrocentesis for therapeutic reasons were evaluated and compared with patients with a unilateral condylar head fracture who did not undergo arthrocentesis. At 3 months after treatment, the occlusal contact area and maximum bite force in patients with a fracture treated with arthrocentesis were greater than in those who did not receive arthrocentesis at the same time points, although the differences were not significant. Moreover, at 1 and 3 months following arthrocentesis, mean (±SD) occlusal contact area (1 month: 1.99 ± 0.55 mm2, p = 0.01; 3 months: 2.90 ± 1.36 mm2, p = 0.03) and maximum bite force (1 month: 82.45 ± 15.04 N, p = 0.01; 3 months: 101.11 ± 14.53 N, p = 0.01) on the fractured side in patients who underwent that treatment were significantly reduced when compared with those on the non-fractured side. The authors conclude that if the priority is to avoid open reduction and internal fixation, then the arthrocentesis approach might be a less invasive alternative, albeit with the price of a prolonged healing interval.
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Affiliation(s)
- Shinnosuke Nogami
- Division of Oral and Maxillofacial Surgery, Department of Disease Management Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Miyagi, Japan.
| | - Kensuke Yamauchi
- Division of Oral and Maxillofacial Surgery, Department of Disease Management Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Miyagi, Japan
| | - Kuniyuki Izumita
- Joint Research Department of Next-Generation Dental Materials Engineering, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Miyagi, Japan
| | - Jun Kitamura
- Division of Oral and Maxillofacial Surgery, Department of Disease Management Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Miyagi, Japan
| | - Yuri Takeda
- Division of Oral and Maxillofacial Surgery, Department of Disease Management Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Miyagi, Japan
| | - Yoshio Otake
- Division of Oral and Maxillofacial Surgery, Department of Disease Management Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Miyagi, Japan
| | - Shinki Koyama
- Division of Oral and Maxillofacial Surgery, Department of Disease Management Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Miyagi, Japan
| | - Kyosuke Okuyama
- Division of Oral and Maxillofacial Surgery, Department of Disease Management Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Miyagi, Japan
| | - Keiichi Sasaki
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Miyagi, Japan
| | - Tetsu Takahashi
- Division of Oral and Maxillofacial Surgery, Department of Disease Management Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Miyagi, Japan
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Neuhaus MT, Zeller AN, Desch L, Dhawan A, Jehn P, Gellrich NC, Zimmerer R. Endoscopically Assisted Treatment of Condylar Base and Neck Fractures: A Single Institution Analysis of Outcomes and Complications. J Maxillofac Oral Surg 2021; 20:665-673. [PMID: 34776701 DOI: 10.1007/s12663-020-01398-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/19/2020] [Indexed: 11/26/2022] Open
Abstract
Background Conservative treatment, including observation and closed treatment, as well as open reduction and internal fixation are existing options for treating condylar process fractures. Extraoral approaches are widely preferred for open reduction and internal fixation. Transoral access for condylar base and neck fractures is not yet commonly used as it is technically demanding and requires special equipment. Purpose In this study, the transoral endoscopically assisted approach is described, and its outcomes and complications were investigated. Imaging data and clinical records of 187 patients with condylar process fractures, treated via endoscopically assisted transoral approach between 2007 and 2017 were analyzed. Parameters included diagnosis and fracture classification, treatment, osteosynthesis configuration and postoperative complications. Results Early complications, including infection, transient postoperative malocclusion, pain and limited mouth opening, occurred in 35 patients (18.7%). Late onset complications, such as screw loosening were documented in only 4 patients (2.1%). Revision surgery following postoperative 3D imaging was required in only 3 cases (1.6%). Fragment length ranged from 15.5 to 38.3 mm. In 57.7% of patients with condylar fragment length < 20 mm, a single osteosynthesis plate was used, with no elevated complication rate. Two osteosynthesis plates with 4 screws each was used as standard in longer fragments. Conclusion Endoscopically assisted transoral treatment of condylar process fractures is a reliable, yet technical demanding technique. It allows for reduction and fixation of fractures with a condylar fragment length of > 15 mm with low postoperative complication and revision rates.
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Affiliation(s)
- Michael-Tobias Neuhaus
- Department for Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Alexander-Nicolai Zeller
- Department for Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Lena Desch
- Department for Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Amit Dhawan
- Sri Guru Ram Das Institute of Dental Sciences and Research, Amritsar, India
| | - Philipp Jehn
- Department for Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Nils-Claudius Gellrich
- Department for Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Rüdiger Zimmerer
- Department for Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
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Cavalcanti SCSXB, Taufer B, Rodrigues ADF, Luz JGDC. Endoscopic surgery versus open reduction treatment of mandibular condyle fractures: A meta-analysis. J Craniomaxillofac Surg 2021; 49:749-757. [PMID: 33663963 DOI: 10.1016/j.jcms.2021.02.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 08/30/2020] [Accepted: 02/18/2021] [Indexed: 10/22/2022] Open
Abstract
The aim of the study was to compare open reduction with internal fixation (ORIF) and endoscopic open reduction with internal fixation (EORIF) of condylar fractures (CF) in adults in terms of reducing both needing of reoperation and/or facial nerve injury. An electronic search was undertaken (PubMed/MEDLINE, Web of Science, SCOPUS, and The Cochrane Library). The inclusion criteria were full text, published from their inception to June 2020, clinical trials, randomized or not, and retrospective studies, that compared ORIF and EORIF. The estimates of an intervention were expressed as the risk ratio (RR). From the 1338 articles found, 5 publications were included. There was no statistically significant difference between ORIF and EORIF regarding needing of reoperation (RR = 2.46, p = 0.42) or facial nerve injury (RR = 0.45, p = 0.14). Meta-analysis suggests that there is no difference between open reduction with internal fixation (ORIF) and endoscopic open reduction with internal fixation (EORIF) of condylar fractures (CF) regarding facial nerve injury risk or need for reoperation.
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Affiliation(s)
- Samantha Cristine Santos Xisto Braga Cavalcanti
- Department of Maxillofacial Surgery, Prosthetics and Traumatology, School of Dentistry, Universidade de São Paulo (USP), Sao Paulo, Brazil; School of Dentistry, Centro Universitário Das Faculdades Metropolitanas Unidas (FMU), Sao Paulo, Brazil.
| | - Bianca Taufer
- School of Dentistry, Centro Universitário Das Faculdades Metropolitanas Unidas (FMU), Sao Paulo, Brazil
| | - Alex de Freitas Rodrigues
- Department of Maxillofacial Surgery, Prosthetics and Traumatology, School of Dentistry, Universidade de São Paulo (USP), Sao Paulo, Brazil
| | - João Gualberto de Cerqueira Luz
- Department of Maxillofacial Surgery, Prosthetics and Traumatology, School of Dentistry, Universidade de São Paulo (USP), Sao Paulo, Brazil
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Change of body composition, physical strength, and nutritional status of patients with mandibular fractures. J Craniomaxillofac Surg 2021; 49:292-297. [PMID: 33589334 DOI: 10.1016/j.jcms.2021.01.023] [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: 04/08/2020] [Revised: 10/27/2020] [Accepted: 01/31/2021] [Indexed: 11/20/2022] Open
Abstract
The aim was to determine changes in various parameters indicating physical conditions and nutritional status of patients during surgical and conservative treatment of mandibular fractures. A round by a nutrition support team was done once postoperatively for the surgical treatment group. For the conservative treatment group, three rounds were performed during the period of intermaxillary fixation. Data obtained from the rounds were compared between the groups. There were 29 patients surgically and 30 patients conservatively treated. A significant weight loss was observed in both groups postoperatively. The mean weight loss of the surgical treatment group measured at the postoperative round was 1.73 kg (SD ± 1.78) (P < 0.001) and that of the conservative treatment group at the third round was 2.74 kg (SD ± 2.35) (P < 0.001). During the entire treatment period, weight loss, body fat percentage, skeletal muscle percentage, grip strength and parameters indicating body composition and nutritional status of the conservative treatment group did not substantially differ from those of the surgical group. The influence of the conservative procedure on the nutritional condition of the patients seems to be limited and reversible at the end of the treatment. The weight loss observed here suggests that systematic nutrition support is necessary during both surgical and conservative treatment.
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Kozakiewicz M, Zieliński R, Konieczny B, Krasowski M, Okulski J. Open Rigid Internal Fixation of Low-Neck Condylar Fractures of the Mandible: Mechanical Comparison of 16 Plate Designs. MATERIALS 2020; 13:ma13081953. [PMID: 32331209 PMCID: PMC7215721 DOI: 10.3390/ma13081953] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 04/06/2020] [Accepted: 04/18/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND In the literature, no information on plates for low-neck mandibular condylar osteosynthesis can be found, despite the fact that 30 plate designs have already been published. The aim of this study was to compare any dedicated plates for possible use in low-neck condylar fracture osteosynthesis. METHODS The force required for 1-mm displacement of the fixed fracture fragments and incidents of screw loosening were recorded on polyurethane mandibles among 16 designs of titanium plates fixed by 6-mm screws in a 2.0 system. RESULTS Double-straight plate fixation was the mechanical gold standard (15.2 ± 3.5 N), followed by A-shape Condylar Plates (14.9 ± 2.1 N), X-shape Condylar Plates (14.2 ± 1.3 N) and Auto Repositioning Plates (11.8 ± 2.4 N). Screw loosening was uncommon, as a minimum of three screws were placed into the condylar part. Fewer screws were lost from the ramus part of the fixation if the plate was attached to the condylar part by three screws. Often, the stability of the ramus screws was lost when there were only two fixing screws in the condyle (p < 0.001). CONCLUSIONS It is advisable to consider the mechanical advantages as one decides which plate to choose for open rigid internal fixation in low-neck condylar fractures, or to only be aware of the significant differences in mobility within the fracture line after fixation with different dedicated plates.
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Affiliation(s)
- Marcin Kozakiewicz
- Department of Maxillofacial Surgery, Medical University of Lodz, 1st Gen. J. Hallera Pl., 90-647 Lodz, Poland; (R.Z.); (J.O.)
- Correspondence:
| | - Rafał Zieliński
- Department of Maxillofacial Surgery, Medical University of Lodz, 1st Gen. J. Hallera Pl., 90-647 Lodz, Poland; (R.Z.); (J.O.)
| | - Bartłomiej Konieczny
- Material Science Laboratory, Medical University of Lodz, 251st Pomorska, 92-213 Lodz, Poland; (B.K.); (M.K.)
| | - Michał Krasowski
- Material Science Laboratory, Medical University of Lodz, 251st Pomorska, 92-213 Lodz, Poland; (B.K.); (M.K.)
| | - Jakub Okulski
- Department of Maxillofacial Surgery, Medical University of Lodz, 1st Gen. J. Hallera Pl., 90-647 Lodz, Poland; (R.Z.); (J.O.)
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