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Sasaki R, Watanabe Y, Miyamoto NS, Agawa K, Okamoto T. Innsbruck-style Retromandibular Anterior Trans-parotid Approach for Condylar Fractures: A Retrospective Review of 39 Fractures. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5091. [PMID: 37351120 PMCID: PMC10284331 DOI: 10.1097/gox.0000000000005091] [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: 03/13/2023] [Accepted: 05/05/2023] [Indexed: 06/24/2023]
Abstract
The retromandibular anterior trans-parotid (RAT) approach and a triangular-positioned double mini-plate osteosynthesis (TDO) technique have been reported from Innsbruck Medical University. This minimally invasive technique involves direct visualization of the condyle and is associated with lower incidence of facial palsy. Methods A retrospective review was performed on the RAT approach and TDO technique conducted by a surgeon and team at two hospitals in Tokyo during a period of 3 years and 10 months. Results This technique was performed on 35 patients with 39 condylar fractures. Sixty-nine percent of cases were due to accidental fall, 17% to traffic accidents, and 9% to sports. Furthermore, 92% cases were condylar base fractures. Nighty-seven percent of cases achieved good occlusion. The mean maximum mouth opening was 49 ± 1.3 mm. Postoperatively, facial palsy developed in three patients (7.7%), and two of them developed Frey syndrome at approximately 2.5 years postoperatively (5.1%). All patients completely recovered within 3 months postoperatively. One case each of salivary fistula, visible scar, and condylar resorption was found (2.6%). No case of massive bleeding during surgery, hematoma, or TMJ pain after surgery was found. Conclusion This technique could achieve good occlusion with low incidence of complications and could contribute to early social reintegration among patients.
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Affiliation(s)
- Ryo Sasaki
- From the Department of Oral and Maxillofacial Surgery, Tokyo Women’s Medical University, School of Medicine, Tokyo, Japan
- Department of Plastic and Reconstructive Surgery, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Yorikatsu Watanabe
- Department of Plastic and Reconstructive Surgery, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Noriko Sangu Miyamoto
- From the Department of Oral and Maxillofacial Surgery, Tokyo Women’s Medical University, School of Medicine, Tokyo, Japan
| | - Kaori Agawa
- Department of Plastic and Reconstructive Surgery, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Toshihiro Okamoto
- From the Department of Oral and Maxillofacial Surgery, Tokyo Women’s Medical University, School of Medicine, Tokyo, Japan
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Singh PK, Singh G, Vignesh U, Mohammad S, Singh RK, Mehrotra D. Comparative Evaluation of Modified Tragus Edge Approach and Retromandibular Approach to Mid- or Low-Level Mandibular Condylar Fractures. J Maxillofac Oral Surg 2022; 21:184-190. [PMID: 35400921 PMCID: PMC8934813 DOI: 10.1007/s12663-020-01356-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 03/25/2020] [Indexed: 11/25/2022] Open
Abstract
Objectives To compare and evaluate the modified tragus edge approach (MTEA) with retromandibular approach for surgical access to mid-level or low-level mandibular condylar fractures. Materials and Methods This study comprised of 22 patients with mid-level or low-level condylar fracture. Patients with clinical and radiological evidence of mid-level or low-level condylar fracture are included only in this study. Patients were randomly divided into two groups: group A includes 11 patients, in which modified tragus edge approach was used, and group B includes 11 patients treated with retromandibular approach. Patients were evaluated clinically after first week, second week, fourth week, third month, and sixth month radiographically. Results The mean age of the study subjects in group A was 32.45 ± 8.98 years, while in group B, the mean age was 26.91 ± 5.79 years. Post-operatively, no significant difference was seen in relation to pain, occlusal relationship, mouth opening, and deviation of jaw during opening and closing movements. In terms of post-operative complication, only significant difference found between two groups is post-operative scar visibility, which is higher in retromandibular incision group as compared to MTEA. Conclusion Thus, we can conclude that MTEA provides ease of operation as a good exposure of mandibular mid- or low-level condylar fracture as retromandibular approach but with less visibility of post-operative scar as compared to retromandibular approach.
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Affiliation(s)
- Praveen Kumar Singh
- Department of Oral and Maxillofacial Surgery, King George’s Medical University, Lucknow, India
| | - Geeta Singh
- Department of Oral and Maxillofacial Surgery, King George’s Medical University, Lucknow, India
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, King George’s Medical University, Lucknow, U.P. 226003 India
| | - U. Vignesh
- Department of Oral and Maxillofacial Surgery, King George’s Medical University, Lucknow, India
| | - Shadab Mohammad
- Department of Oral and Maxillofacial Surgery, King George’s Medical University, Lucknow, India
| | - R. K. Singh
- Department of Oral and Maxillofacial Surgery, King George’s Medical University, Lucknow, India
| | - Divya Mehrotra
- Department of Oral and Maxillofacial Surgery, King George’s Medical University, Lucknow, 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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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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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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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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Felix K, Singh M. The Retromandibular Transparotid Approach for Reduction and Internal Fixation of Mandibular Condylar Fractures. Ann Maxillofac Surg 2020; 10:168-177. [PMID: 32855935 PMCID: PMC7433982 DOI: 10.4103/ams.ams_193_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 01/12/2020] [Accepted: 03/30/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction: The retromandibular transparotid approach is most useful for condylar and subcondylar fractures and provides the best access to the joint and ascending ramus. The study aims at evaluating the ease of access and outcomes encountered on using the retromandibular transparotid approach to access the fracture site for the open reduction and internal fixation (ORIF) of condylar and sub-condylar fractures. Materials and Methods: An observational clinical study was carried out among 10 patients with unilateral and bilateral condylar fracture requiring ORIF. Maximal interincisal mouth opening, facial swelling, occlusal discrepancy, facial nerve injury, scar formation, and acceptability and complications including wound dehiscence, infection, and sialocele/salivary fistula were assessed and measured preoperatively and postoperatively. Results: There was a notable improvement in mouth opening and facial nerve weakness. Postoperative intermaxillary fixation was done with selective patients who had a discrepancy in their occlusion. Preoperatively, swelling was present in four patients (40%) out of 10 patients studied. There was no incidence of sialocele/salivary fistula in any of the cases studied. Conclusion: Retromandibular transparotid incision is technique sensitive and thorough knowledge about the retromandibular area is must for good results and minimal morbidity. The cosmetic results are good in this approach, as well as the facial nerve injury were less in this without any permanent damages.
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Affiliation(s)
- Kishore Felix
- Department of Oral and Maxillofacial Surgery, Rajarajeswari Dental College and Hospital, Bengaluru, Karnataka, India
| | - Madhumati Singh
- Department of Oral and Maxillofacial Surgery, Rajarajeswari Dental College and Hospital, Bengaluru, Karnataka, India
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Abdelwahab MA, Spataro EA, Elkholy NA, El-Degwi A, Most SP. Biportal transparotid dissection in the retromandibular approach for condylar fracture osteosynthesis: Efficacy of a novel technique. J Plast Reconstr Aesthet Surg 2020; 73:927-933. [DOI: 10.1016/j.bjps.2019.11.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 11/22/2019] [Indexed: 12/01/2022]
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Abstract
BACKGROUND Condylar fractures are considered the most controversial mandibular fractures, regarding both the diagnosis and the treatment. With the increase in surgical indications for handling this type of fracture, it is important to discuss about the advantages and disadvantages of the several surgical approaches available. This article describes the surgical details and postoperative results of the mini-retromandibular transparotid approach for treating extracapsular condylar fractures of the mandible. METHODS In a 1-year period, 16 patients affected by extracapsular condylar fractures with surgical indication were treated with the mini-retromandibular transparotid approach. All the surgeries were executed by the same surgeon. Preoperative and postoperative details of each patient were analyzed. RESULTS In the postoperatory, only 2 patients had purulent drainage in the associated fractures area and only 1 patient had paresis of the buccal branch of the facial nerve. No scar issues concerning the surgical wound were observed and reintervention was not necessary in any of the patients. CONCLUSION The mini-retromandibular transparotid approach offers advantages and should be included as an option for the open treatment of extracapsular condylar fractures of the mandible.
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Rozeboom A, Dubois L, Bos R, Spijker R, de Lange J. Open treatment of condylar fractures via extraoral approaches: A review of complications. J Craniomaxillofac Surg 2018; 46:1232-1240. [DOI: 10.1016/j.jcms.2018.04.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 03/24/2018] [Accepted: 04/19/2018] [Indexed: 12/21/2022] Open
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Al-Moraissi EA, Ellis E, Neff A. Does encountering the facial nerve during surgical management of mandibular condylar process fractures increase the risk of facial nerve weakness? A systematic review and meta-regression analysis. J Craniomaxillofac Surg 2018; 46:1223-1231. [PMID: 29929912 DOI: 10.1016/j.jcms.2018.04.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 03/20/2018] [Accepted: 04/10/2018] [Indexed: 12/01/2022] Open
Abstract
PURPOSE The purpose of this study was to identify whether the incidence of systematically identified or incidentally encountered facial nerve branches during dissection to approach condylar fractures increases risk of transient and/or permanent facial nerve weakness. METHODS A systematic review and meta-analysis were performed that included several databases with specific keywords, a reference search, and a manual search for suitable articles. The inclusion criteria were all clinical trials, with the aim of assessing the rate of facial nerve injuries when open reduction and internal fixation (ORIF) of condylar process fractures was performed using different surgical approaches. The articles had to have documented the number of encountered facial nerve branches during ORIF. The main outcome variable was transient and permanent facial nerve injury. The dependent variable was the event and/or number of encountered facial nerve branches during surgery, and how they were handled (i.e. dissected, retracted, etc.). RESULTS A total of 1202 mandibular condylar fractures were enrolled in 29 studies. Rate of transient facial nerve injury (TFNI) was 11.3 % (136/1202). The number of facial nerve branches encountered intraoperatively was 543, namely buccal, marginal mandibular, zygomatic and temporal nerve branches. There was a significant correlation suggesting that there is a strong positive linear relationship between TFNI and encountered facial nerve branches (Coef = 0.1916, P = 0.001). There was no significant relationship between permanent facial nerve injury and encountered facial nerve branches (P = 0.808). TFNI was 4.3% and 18.7% for those studies expressly reporting that facial nerve branches were encountered incidentally without dissection and with dissection, respectively. For studies reporting deliberate and systematic facial nerve dissection, TFNI was 20.9%. Finally, studies that did not report any encounters of facial nerve branches, TFNI was 7.9 %. CONCLUSION This meta-analysis demonstrated that manipulation of the facial nerve during different surgical approaches causes different incidences of facial nerve injury. The choice of surgical approach for a given fracture should take this into consideration.
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Affiliation(s)
- Essam Ahmed Al-Moraissi
- Dept. of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thamar University, Thamar, Yemen.
| | - Edward Ellis
- Dept. of Oral and Maxillofacial Surgery, University of Texas Health Science Center at San Antonio, USA
| | - Andreas Neff
- Dept. of Oral and Maxillofacial Surgery, University Hospital Marburg UKGM GmbH, Marburg, Germany
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Akdag O, Yildiran G, Abaci M, Tosun Z. Endoscopic-Assisted Treatment Combined With Transoral and Transbuccal Approach to Mandibular Subcondylar Fractures. J Oral Maxillofac Surg 2018; 76:831.e1-831.e5. [DOI: 10.1016/j.joms.2017.11.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 11/16/2017] [Accepted: 11/19/2017] [Indexed: 11/16/2022]
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Al-Moraissi EA, Louvrier A, Colletti G, Wolford LM, Biglioli F, Ragaey M, Meyer C, Ellis E. Does the surgical approach for treating mandibular condylar fractures affect the rate of seventh cranial nerve injuries? A systematic review and meta-analysis based on a new classification for surgical approaches. J Craniomaxillofac Surg 2018; 46:398-412. [DOI: 10.1016/j.jcms.2017.10.024] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 09/20/2017] [Accepted: 10/30/2017] [Indexed: 11/30/2022] Open
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Rozeboom A, Dubois L, Bos R, Spijker R, de Lange J. Open treatment of unilateral mandibular condyle fractures in adults: a systematic review. Int J Oral Maxillofac Surg 2017; 46:1257-1266. [DOI: 10.1016/j.ijom.2017.06.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 03/06/2017] [Accepted: 06/09/2017] [Indexed: 12/16/2022]
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Yang HM, Kim HJ, Park HW, Sohn HJ, Ok HT, Moon JH, Woo SH. Revisiting the Topographic Anatomy of the Marginal Mandibular Branch of Facial Nerve Relating to the Surgical Approach. Aesthet Surg J 2016; 36:977-82. [PMID: 27025245 DOI: 10.1093/asj/sjw045] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The marginal mandibular branch (Mbr) of the facial nerve is vulnerable to damage during rhytidoplasty, surgical reduction of the mandibular angle, parotidectomy, and excision of the submandibular gland. OBJECTIVES The authors sought to map the Mbr and determine the relationship between the number of Mbr offshoots and the course of the Mbr. METHODS The Mbr was examined in 29 hemifaces from 12 embalmed and 4 fresh cadavers (10 males, 6 females; mean age, 73.7 years). RESULTS The Mbr was located ≤5 mm from the gonion (Go) in 24 of 29 hemifaces (82.8%) and ≤10 mm from the intersection of the facial artery and mandible (ie, FM) in 26 hemifaces (89.7%). In 16 hemifaces (55.2%), offshoots arose from the Mbr inferior to the mandible. The Mbr ran below the Go in 14 hemifaces (48.3%) and ran below FM in 13 hemifaces (44.8%). Except for minute offshoots deep to the platysma, the Mbr was not found to pass >2 cm below the mandible. The mean (± standard deviation) quantity of Mbr offshoots was 1.5 (± 0.6). A greater number of offshoots was associated with a higher likelihood of an inferiorly located nerve. The Mbr proceeded under the lower border of the mandible in 13 hemifaces (44.8%) and reached the mandible at a mean distance of 33.1±5.2 mm anterior to the Go. CONCLUSIONS To avoid damaging the Mbr, surgical maneuvers should be positioned 4.5 cm anterior to the Go and 2 cm below the mandible.
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Affiliation(s)
- Hun-Mu Yang
- Dr Yang is an Assistant Professor, Department of Anatomy, Dankook University College of Medicine, Cheonan, Korea. Dr Kim is a Professor, Department of Oral Biology, Yonsei University College of Dentistry, Seoul, Korea. Dr Park is a Professor, Department of Anatomy, Yonsei University College of Medicine, Seoul, Korea. Dr Sohn is a Professor and Dr Ok is a Researcher, Department of Anatomy, School of Medicine, Chungbuk National University, Cheongju, Korea. Dr Moon is an Assistant Professor, Department of Otorhinolaryngology, Dankook University College of Medicine, Cheonan, Korea. Dr Woo is an Associate Professor, Department of Otolaryngology and Institution of Health Science, Gyeongsang National University, Jinju, Korea
| | - Hee-Jin Kim
- Dr Yang is an Assistant Professor, Department of Anatomy, Dankook University College of Medicine, Cheonan, Korea. Dr Kim is a Professor, Department of Oral Biology, Yonsei University College of Dentistry, Seoul, Korea. Dr Park is a Professor, Department of Anatomy, Yonsei University College of Medicine, Seoul, Korea. Dr Sohn is a Professor and Dr Ok is a Researcher, Department of Anatomy, School of Medicine, Chungbuk National University, Cheongju, Korea. Dr Moon is an Assistant Professor, Department of Otorhinolaryngology, Dankook University College of Medicine, Cheonan, Korea. Dr Woo is an Associate Professor, Department of Otolaryngology and Institution of Health Science, Gyeongsang National University, Jinju, Korea
| | - Hyung-Woo Park
- Dr Yang is an Assistant Professor, Department of Anatomy, Dankook University College of Medicine, Cheonan, Korea. Dr Kim is a Professor, Department of Oral Biology, Yonsei University College of Dentistry, Seoul, Korea. Dr Park is a Professor, Department of Anatomy, Yonsei University College of Medicine, Seoul, Korea. Dr Sohn is a Professor and Dr Ok is a Researcher, Department of Anatomy, School of Medicine, Chungbuk National University, Cheongju, Korea. Dr Moon is an Assistant Professor, Department of Otorhinolaryngology, Dankook University College of Medicine, Cheonan, Korea. Dr Woo is an Associate Professor, Department of Otolaryngology and Institution of Health Science, Gyeongsang National University, Jinju, Korea
| | - Hyun-Joon Sohn
- Dr Yang is an Assistant Professor, Department of Anatomy, Dankook University College of Medicine, Cheonan, Korea. Dr Kim is a Professor, Department of Oral Biology, Yonsei University College of Dentistry, Seoul, Korea. Dr Park is a Professor, Department of Anatomy, Yonsei University College of Medicine, Seoul, Korea. Dr Sohn is a Professor and Dr Ok is a Researcher, Department of Anatomy, School of Medicine, Chungbuk National University, Cheongju, Korea. Dr Moon is an Assistant Professor, Department of Otorhinolaryngology, Dankook University College of Medicine, Cheonan, Korea. Dr Woo is an Associate Professor, Department of Otolaryngology and Institution of Health Science, Gyeongsang National University, Jinju, Korea
| | - Hyun-Tae Ok
- Dr Yang is an Assistant Professor, Department of Anatomy, Dankook University College of Medicine, Cheonan, Korea. Dr Kim is a Professor, Department of Oral Biology, Yonsei University College of Dentistry, Seoul, Korea. Dr Park is a Professor, Department of Anatomy, Yonsei University College of Medicine, Seoul, Korea. Dr Sohn is a Professor and Dr Ok is a Researcher, Department of Anatomy, School of Medicine, Chungbuk National University, Cheongju, Korea. Dr Moon is an Assistant Professor, Department of Otorhinolaryngology, Dankook University College of Medicine, Cheonan, Korea. Dr Woo is an Associate Professor, Department of Otolaryngology and Institution of Health Science, Gyeongsang National University, Jinju, Korea
| | - Jung Hwan Moon
- Dr Yang is an Assistant Professor, Department of Anatomy, Dankook University College of Medicine, Cheonan, Korea. Dr Kim is a Professor, Department of Oral Biology, Yonsei University College of Dentistry, Seoul, Korea. Dr Park is a Professor, Department of Anatomy, Yonsei University College of Medicine, Seoul, Korea. Dr Sohn is a Professor and Dr Ok is a Researcher, Department of Anatomy, School of Medicine, Chungbuk National University, Cheongju, Korea. Dr Moon is an Assistant Professor, Department of Otorhinolaryngology, Dankook University College of Medicine, Cheonan, Korea. Dr Woo is an Associate Professor, Department of Otolaryngology and Institution of Health Science, Gyeongsang National University, Jinju, Korea
| | - Seung Hoon Woo
- Dr Yang is an Assistant Professor, Department of Anatomy, Dankook University College of Medicine, Cheonan, Korea. Dr Kim is a Professor, Department of Oral Biology, Yonsei University College of Dentistry, Seoul, Korea. Dr Park is a Professor, Department of Anatomy, Yonsei University College of Medicine, Seoul, Korea. Dr Sohn is a Professor and Dr Ok is a Researcher, Department of Anatomy, School of Medicine, Chungbuk National University, Cheongju, Korea. Dr Moon is an Assistant Professor, Department of Otorhinolaryngology, Dankook University College of Medicine, Cheonan, Korea. Dr Woo is an Associate Professor, Department of Otolaryngology and Institution of Health Science, Gyeongsang National University, Jinju, Korea
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Sikora M, Olszowski T, Sielski M, Stąpor A, Janiszewska-Olszowska J, Chlubek D. The use of the transparotid approach for surgical treatment of condylar fractures – Own experience. J Craniomaxillofac Surg 2015; 43:1961-5. [DOI: 10.1016/j.jcms.2015.10.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 09/17/2015] [Accepted: 10/01/2015] [Indexed: 11/28/2022] Open
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Surgical treatment of mandibular condyle fractures using the retromandibular anterior transparotid approach and a triangular-positioned double miniplate osteosynthesis technique: A clinical and radiological evaluation of 124 fractures. J Craniomaxillofac Surg 2015; 43:944-9. [PMID: 26027860 DOI: 10.1016/j.jcms.2015.04.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 03/27/2015] [Accepted: 04/22/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Different modalities have been described regarding the treatment of mandibular condyle fractures. The most advantageous and safest one is still a topic of discussion. The present analysis describes the combination of a retromandibular, transparotideal approach combined to a triangular-positioned double-miniplate osteosynthesis, with a special regard for the patients' long term outcomes. MATERIAL AND METHODS Clinical data of 102 patients with 124 condyle fractures treated with the mentioned surgical procedure were evaluated. Functional parameters such as the maximal interincisal distance, deviations/deflections, facial nerve function, occlusion as well as complications regarding the parotid gland, osteosynthesis, and esthetics were evaluated 1 week, 2 weeks, 3 months, and 6 months postoperatively. RESULTS The mean maximal interincisal distance ranged from 38 mm after 1 week to 45 mm after 6 months. Deviations/deflections were seen in 22.5% of the cases 1 week postoperatively and decreased to 2% at 6 months postoperatively. A temporary facial palsy was diagnosed in 3.9% during the first follow-up, whereas no impairment was recorded after 3 or 6 months. At the same time, no patient had occlusional disturbances or complications regarding the parotid gland or the osteosynthesis 6 months postoperatively. CONCLUSIONS Direct fracture visualization and a stable three-dimensional fracture stabilization are the main advantages of the presented combination of a surgical approach and osteosynthesis technique. Additionally, the absence of long-term complications confirms the safety of the procedure. Therefore, it may be considered as a successful treatment option for mandibular condyle fractures.
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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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Nam SM, Lee JH, Kim JH. The application of the Risdon approach for mandibular condyle fractures. BMC Surg 2013; 13:25. [PMID: 23829537 PMCID: PMC3708819 DOI: 10.1186/1471-2482-13-25] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 07/04/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many novel approaches to mandibular condyle fracture have been reported, but there is a relative lack of reports on the Risdon approach. In this study, the feasibility of the Risdon approach for condylar neck and subcondylar fractures of the mandible is demonstrated. METHODS A review of patients with mandibular condylar neck and subcondylar fractures was performed from March 2008 to June 2012. A total of 25 patients, 19 males and 6 females, had 14 condylar neck fractures and 11 subcondylar fractures. RESULTS All of the cases were reduced using the Risdon approach. For subcondylar fractures, reduction and fixation with plates was done under direct vision. For condylar neck fractures, reduction and fixation was done with the aid of a trochar in adults and a percutaneous threaded Kirschner wire in children. There were no malunions or nonunions revealed in follow-up care. Mild transient neuropraxia of the marginal mandibular nerve was seen in 4 patients, which was resolved within 1-2 months. CONCLUSIONS The Risdon approach is a technique for reducing the condylar neck and subcondylar fractures that is easy to perform and easy to learn. Its value in the reduction of mandibular condyle fractures should be emphasized.
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Preauricular Transparotid Approach to Mandibular Condylar Fractures Without Dissecting Facial Nerves. J Craniofac Surg 2013; 24:1365-7. [DOI: 10.1097/scs.0b013e318285d9a3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Zhou JH, Ren CQ. A preauricular long-corniform approach for open reduction and internal fixation of mandibular condylar fractures. J Craniomaxillofac Surg 2012; 41:359-66. [PMID: 23218871 DOI: 10.1016/j.jcms.2012.10.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 10/16/2012] [Accepted: 10/16/2012] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION We report functional and clinical outcomes following use of a preauricular long-corniform incision for open reduction and internal fixation (ORIF) of mandibular condylar fractures. MATERIALS AND METHODS Patients with mandibular condylar fractures who underwent ORIF via a 120° preauricular long-corniform incision were included in the study. A total of 78 patients (100 condyles) were included. Follow-up occurred 10 days and 1-6 months after surgery, and included assessments of clinical, functional outcome, complications, and bone fusion. RESULTS There were 38 high neck, 26 low base, and 35 diacapitular condylar fractures. All measures of functional outcome significantly improved over time after surgery regardless of fracture type (all P < 0.001). The vast majority of patients in all fracture type groups had good occlusion (≥ 88.5%), no pain (≥ 89.5%), and anatomical reduction 10 days after surgery (≥ 81.6%). Fracture healing was complete in all patients after 6 months. There were no long-term complications and all patients were satisfied with their postoperative appearance. CONCLUSIONS Our findings suggest that a preauricular long-corniform incision provides a good visual field during surgery, and allows for effective ORIF of mandibular high neck, low base, and diacapitular condylar fractures, with positive outcomes and minimal postoperative complications.
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Affiliation(s)
- Jian-Hong Zhou
- Department of Oral and Maxillofacial Surgery, 180th Hospital of PLA, Quanzhou 362000, Fujian Province, China.
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