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Franke A, Matschke JB, Weiland B, Schröder TA, McLeod NMH, Lauer G, Leonhardt H. A single-centre retrospective 10-year experience of the rhombic 3D condylar fracture plate for open reduction and internal fixation of condylar neck and base fractures. J Craniomaxillofac Surg 2024; 52:622-629. [PMID: 38582680 DOI: 10.1016/j.jcms.2024.03.001] [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: 10/28/2023] [Revised: 12/16/2023] [Accepted: 03/05/2024] [Indexed: 04/08/2024] Open
Abstract
Fractures of the mandibular condyle account for a significant proportion of mandibular fractures. The specific functional loads require particular specifications for the implant design used for open reduction and internal fixation of such fractures. The clinical and radiographic outcomes in patients treated using a single rhombic 3D condylar fracture plate for open reduction and internal fixation at a single institution, and who fulfilled the inclusion and exclusion criteria, are presented. The primary outcome variables were: occlusion, maximum interincisal distance and mandibular excursion at 1, 3, and 6 months postoperatively, and radiographic measurements for mandibular height and gonion angle. In total, 263 patients were included, of whom 173 (65.8%) were male and 90 (34.2%) female. The mean age was 40.4 ± 18.9 years. There was satisfactory occlusion in 98.9% of patients at the 6-month follow-up, and a significant improvement in all parameters for mandibular excursion (p < 0.001), with a reduced ramus height and an increase in the gonion angle on the fractured side. Excellent clinical and radiographic results were achieved using the rhombic-shaped implant, deeming it appropriate for the osteosynthesis of mandibular condyle fractures.
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Affiliation(s)
- Adrian Franke
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany.
| | - Jan Bernard Matschke
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
| | - Bernhard Weiland
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
| | - Tom Alexander Schröder
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany; Else Kröner Fresenius Center for Digital Health, Technische Universität Dresden, Dresden, Germany
| | - Niall M H McLeod
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Günter Lauer
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
| | - Henry Leonhardt
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
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Kostares E, Kostares M, Kostare G, Kantzanou M. Prevalence of Frey syndrome following extraoral surgical treatment for mandibular fractures: a systematic review and meta-analysis. F1000Res 2023; 12:1153. [PMID: 38106653 PMCID: PMC10721962 DOI: 10.12688/f1000research.140994.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2023] [Indexed: 12/19/2023] Open
Abstract
Our study aims to estimate the prevalence of Frey syndrome following open reduction and internal fixation (ORIF) for mandibular fractures. Two reviewers independently conducted a systematic literature search in the Medline and Scopus databases. The pooled prevalence with 95% confidence intervals (CI) was estimated, and quality assessment, outlier analysis, and influential analysis were performed. In total, fifteen eligible studies were included in this meta-analysis. One study was identified as critically influential. The overall prevalence of Frey syndrome following extraoral surgical treatment for mandibular fractures was estimated as 0.01% (95%CI 0%-0.7%) with moderate heterogeneity observed between studies. In the meta-regression analysis with continuous variables, no statistically significant association was observed. Despite the relatively low prevalence, the impact of Frey syndrome on affected individuals should not be underestimated. Additional research will provide a more comprehensive understanding of the underlying factors contributing to Frey syndrome, leading to improved preventive measures and treatment strategies. A better grasp of the prevalence and associated risk factors will aid in the development of guidelines to minimize the occurrence of this syndrome.
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Affiliation(s)
- Evangelos Kostares
- Microbiology, National and Kapodistrian University of Athens, Athens, Attica, 115 27, Greece
| | - Michael Kostares
- National and Kapodistrian University of Athens, Athens, Attica, 115 27, Greece
| | - Georgia Kostare
- National and Kapodistrian University of Athens, Athens, Attica, 115 27, Greece
| | - Maria Kantzanou
- Microbiology, National and Kapodistrian University of Athens, Athens, Attica, 115 27, Greece
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Tatsumi H, Matsuda Y, Toda E, Okui T, Okuma S, Kanno T. Postoperative Complications following Open Reduction and Rigid Internal Fixation of Mandibular Condylar Fracture Using the High Perimandibular Approach. Healthcare (Basel) 2023; 11:healthcare11091294. [PMID: 37174836 PMCID: PMC10178098 DOI: 10.3390/healthcare11091294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/21/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
The high perimandibular approach is a feasible surgical technique for treating mandibular condylar fractures with open reduction and internal fixation, followed by fewer complications. Temporary trismus is the only postoperative complication that may occur. This study evaluated postoperative complications following open reduction and rigid internal fixation (OR-IF) of mandibular condylar fractures using the high perimandibular approach. Twenty consecutive patients undergoing OR-IF were included in this study. They included 11 male and 9 female patients, of an average age of 58.5 years, all of whom responded to a follow-up call at least 12 months after the surgery. All patients were evaluated for range of mouth opening, postoperative complications, and radiological findings. A statistical analysis of the relationship between range of mouth opening and related clinical parameters at 6 months postoperative evaluation was conducted. The fracture of the condylar neck was associated with a limited range of mouth opening and longer operation time. However, longer operation time was not associated with a limited range of mouth opening. The high perimandibular approach with OR-IF in mandibular condylar fractures is a feasible and safe technique; however, prolonged surgery and mandibular condylar neck fractures could affect the postoperative range of mouth opening.
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Affiliation(s)
- Hiroto Tatsumi
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Shimane University, Izumo 693-8501, Japan
| | - Yuhei Matsuda
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Shimane University, Izumo 693-8501, Japan
| | - Erina Toda
- Department of Oral and Maxillofacial Surgery, National Hospital Organization Hamada Medical Center, Hamada 697-8511, Japan
| | - Tatsuo Okui
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Shimane University, Izumo 693-8501, Japan
| | - Satoe Okuma
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Shimane University, Izumo 693-8501, Japan
| | - Takahiro Kanno
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Shimane University, Izumo 693-8501, Japan
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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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A Novel Ultrasound-Guided Minimally Invasive Technique for the Treatment of Extracapsular Condylar Fractures. J Craniomaxillofac Surg 2022; 50:473-477. [DOI: 10.1016/j.jcms.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 04/26/2022] [Accepted: 05/26/2022] [Indexed: 11/23/2022] Open
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The Osteosynthesis of the Mandibular Head, Does the Way the Screws Are Positioned Matter? J Clin Med 2022; 11:jcm11072031. [PMID: 35407637 PMCID: PMC8999701 DOI: 10.3390/jcm11072031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/22/2022] [Accepted: 03/31/2022] [Indexed: 12/17/2022] Open
Abstract
Currently, an increasing number of medical centers are treating mandibular head fractures surgically. Dedicated screws for compression osteosynthesis have been developed. However, due to the very limited size of the fractured bones and the considerable technical difficulties accompanying the execution of the fixation, there is little room for correction of the positioning and reinsertion of the screws. Therefore, knowing the optimal position of the fixation material is crucial for therapeutic success. The aim of this study is the evaluation of fixation screw position on the mandibular ramus height obtained in the treatment of the condylar head fracture. A total of 57 patients were included in this study. The loss of mandibular ramus height on computed tomography twelve months after mandibular head osteosynthesis was evaluated in relation to the initial distance of the screws from the fracture line, the angle of insertion of the screw into the bone, and the size of the protrusion to the inner side of the condyle. The relationship of the proximity of the screw to the fracture line, angulation, and the size of the protrusion with the loss of ramus height was confirmed. Conclusions: the optimal location for the superior screw is approx. 4 mm below the fracture line (with any angulation), inferior screw is approx. 8 mm (with any angulation), and anterior screw position is approx. 4-5 mm distant from fracture line with the best angulation of 130 degrees to the lateral mandible ramus surface in the coronal plane.
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Mooney S, Gulati RD, Yusupov S, Butts SC. Mandibular Condylar Fractures. Facial Plast Surg Clin North Am 2021; 30:85-98. [PMID: 34809889 DOI: 10.1016/j.fsc.2021.08.007] [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: 11/16/2022]
Abstract
Mandibular condyle fractures can result in short-term and long-term morbidity. As a weak area of the mandible, the condyle is vulnerable to injury by a direct impact or an indirect force. Current treatment recommendations aim to better match the severity of the fracture with the choice of closed or open approach. Long-term follow-up of patients provides the best opportunity to monitor the degree of functional restoration after treatment. There is a growing consensus regarding the use of standardized fracture classification methods and outcomes measures that will allow better assessment of treatment results and strengthen the quality of outcomes research.
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Affiliation(s)
- Sean Mooney
- Department of Otolaryngology, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Box 126, Brooklyn, NY 11203, USA
| | - Rahul D Gulati
- Department of Otolaryngology, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Box 126, Brooklyn, NY 11203, USA
| | - Steve Yusupov
- Staten Island University Hospital/Northwell Health, 256-C Mason Avenue, Staten Island, NY 10305, USA
| | - Sydney C Butts
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, SUNY Downstate Health Sciences University, Kings County Hospital Center, 450 Clarkson Avenue, Box 126, Brooklyn, NY 11203, USA.
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Sikora M, Chęciński M, Nowak Z, Chęcińska K, Olszowski T, Chlubek D. The Use of Titanium 3D Mini-Plates in the Surgical Treatment of Fractures of the Mandibular Condyle: A Systematic Review and Meta-Analysis of Clinical Trials. J Clin Med 2021; 10:jcm10163604. [PMID: 34441900 PMCID: PMC8396911 DOI: 10.3390/jcm10163604] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/25/2021] [Accepted: 08/14/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction: Fixing fractures of the base and neck of mandibular condyles is demanding due to the difficulties in surgical access and the various shapes of bone fragments. Classic fixation techniques assume the use of straight mini-plates, utilized for other craniofacial bone fractures. Three dimensional mini-plates may provide a reasonable alternative due to their ease of use and steadily improved mechanical properties. The multitude of different shapes of 3D mini-plates proves the need for their evaluation. Aim: This paper aims to summarize the clinical trials regarding the use of various types of 3D condylar mini-plates in terms of need for reoperation and the incidence of loosening and damage to the osteosynthetic material. Materials and Methods: A systematic review was conducted in accordance with PICOS criteria and PRISMA protocol. The risk of bias was assessed using ROBINS-I and RoB 2 Cochrane protocols. The obtained data series was analyzed for correlations (Pearson’s r) respecting statistical significance (Student’s t-test p > 0.05) and visualized using OriginLab. Results: 13 clinical trials with low overall risk of bias regarding 6 shapes of 3D mini-plates were included in the synthesis. The number of reoperations correlates with the number of fixations (r = 0.53; p = 0.015) and the total number of screw holes in the mini-plate (r = −0.45; p = 0.006). There is a strong correlation between the number of loosened osteosynthetic screws and the total number of fractures treated with 3D mini-plates (r = 0.79; p = 0.001 for each study and r = 0.99; p = 0.015 for each mini-plate shape). A correlation between the percentage of lost screws and the number of distal screw holes is weak regarding individual studies (r = −0.27; p = 0.000) and strong regarding individual mini-plate shape (r = −0.82; p = 0.001). Three cases of 3D mini-plate fractures are noted, which account for 0.7% of all analyzed fixation cases. Discussion: The reasons for reoperations indicated by the authors of the analyzed articles were: mispositioning of the bone fragments, lack of bone fragment union, secondary dislocation, and hematoma. The known screw loosening factors were poor bone quality, bilateral condylar fractures, difficulties in the correct positioning of the osteosynthetic material due to the limitations of the surgical approach, fracture line pattern, including the presence of intermediate fragments, and mechanical overload. Fractures of the straight mini-plates fixing the mandibular condyles amounts for up to 16% of cases in the reference articles. Conclusions: There is no convincing data that the number of reoperations depends on the type of 3D mini-plate used. The frequency of osteosynthetic screw loosening does not seem to depend on the 3D mini-plate’s shape. Clinical fractures of 3D mini-plates are extremely rare.
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Affiliation(s)
- Maciej Sikora
- Department of Maxillofacial Surgery, Hospital of the Ministry of Interior, Wojska Polskiego 51, 25-375 Kielce, Poland;
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland
| | - Maciej Chęciński
- Preventive Medicine Center, Komorowskiego 12, 30-106 Kraków, Poland;
- StomaDent Non-Public Healthcare Institution, Dental Clinic, Kościuszki 32, 46-320 Praszka, Poland;
| | - Zuzanna Nowak
- StomaDent Non-Public Healthcare Institution, Dental Clinic, Kościuszki 32, 46-320 Praszka, Poland;
| | - Kamila Chęcińska
- Department of Glass Technology and Amorphous Coatings, Faculty of Materials Science and Ceramics, AGH University of Science and Technology, ul. Mickiewicza 30, 30-059 Kraków, Poland;
| | - Tomasz Olszowski
- Department of Hygiene and Epidemiology, Pomeranian Medical University, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland;
| | - Dariusz Chlubek
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland
- Correspondence:
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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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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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The Use of 3D Titanium Miniplates in Surgical Treatment of Patients with Condylar Fractures. J Clin Med 2020; 9:jcm9092923. [PMID: 32927799 PMCID: PMC7563735 DOI: 10.3390/jcm9092923] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 12/20/2022] Open
Abstract
The aim of this study was to evaluate the effectiveness of open treatment of mandibular condyle fractures using 3D miniplates. A group of 113 patients has been chosen for evaluation, including 100 men and 13 women. After hospitalization, each patient underwent a 6-month postoperative follow-up. The material chosen for the analysis consisted of data collected during the patient’s stay in the hospital as well as the postoperative outpatient care. A single 4-hole Delta Condyle Compression Plate (4-DCCP) was used in 90 out of 113 (79.6%) cases. In 16 out of 113 (14.2%) patients, the Trapezoid Condyle Plate (4-TCP or 9-TCP) was used. The remaining cases required more than one miniplate. No 3D miniplate fractures were found in the study subjects during the analyzed observation period. Loosening of one or more osteosynthesis screws was observed in 4 out of 113 (3.5%) patients. Screw loosening was a complication that did not affect bone healing in any of the patient cases. The conducted research confirms that titanium 3D mini-plates are easy to adjust and take up little space, therefore they can easily be used in cases of mandibular condyle base and lower condyle neck fractures. The stability of the three-dimensional miniplates for osteosynthesis gives very good reliability for the rigid fixation of the fractured mandibular condyle.
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12
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Burkhard JPM, Koba S, Schlittler F, Iizuka T, Schaller B. Clinical results of two different three-dimensional titanium plates in the treatment of condylar neck and base fractures: A retrospective study. J Craniomaxillofac Surg 2020; 48:756-764. [DOI: 10.1016/j.jcms.2020.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 05/12/2020] [Accepted: 06/07/2020] [Indexed: 12/19/2022] Open
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Ibrahim MH, Ali S, Abdelaziz O, Galal N. Will Closed Treatment Provide Better Mandibular Motion Than Open Reduction and Internal Fixation in Cases of Unilateral Displaced Subcondylar Fracture? A Systematic Review and Meta-Analysis. J Oral Maxillofac Surg 2020; 78:1795-1810. [PMID: 32554064 DOI: 10.1016/j.joms.2020.05.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 05/08/2020] [Accepted: 05/08/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of the present systematic review was to determine whether closed treatment (CLT) with intermaxillary fixation (IMF) is superior or equivalent to open reduction and internal fixation (ORIF) in the management of unilateral displaced subcondylar fractures regarding the range of mandibular motion. MATERIALS AND METHODS To address our question, we conducted a systematic review and meta-analysis of the reported data after a comprehensive manual and electronic database search of studies reported up to 2017 in the English language that had compared CLT and ORIF of mandibular condyle fractures in adults. The following outcomes were recorded: maximum interincisal opening (MIO), protrusive movement (PM), lateral excursion toward the fractured side (LEFS), and lateral excursion toward the nonfractured side (LENFS). RESULTS The search resulted in 8 studies, 4 of which were included in the meta-analysis. The MIO and PM showed no statistically significant differences, with an effect size of -0.823 (P = .112) and -0.633 (P = .079), respectively. However, the LEFS and LENFS were superior after CLT, with an effect size of -0.710 (P = .031) and -0.682 (P = .017), respectively. CONCLUSIONS The findings from the present review suggest that both ORIF and CLT can provide comparable MIO and PM in subjects with unilateral displaced subcondylar fractures. However, CLT was superior to ORIF for both LEFS and LENFS.
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Affiliation(s)
- Mohamed H Ibrahim
- Master's Degree Candidate, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Cairo University, Cairo, Egypt.
| | - Sherif Ali
- Lecturer, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Omniya Abdelaziz
- Lecturer, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Nadia Galal
- Associate Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Cairo University, Cairo, Egypt
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Marwan H, Sawatari Y. What Is the Most Stable Fixation Technique for Mandibular Condyle Fracture? J Oral Maxillofac Surg 2019; 77:2522.e1-2522.e12. [DOI: 10.1016/j.joms.2019.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 07/22/2019] [Accepted: 07/23/2019] [Indexed: 10/26/2022]
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15
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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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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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17
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Ahuja SA, Galinde J, Asnani U, Mistry YA. Comparative Evaluation of Clinical Outcomes Using Delta Plates and Conventional Miniplates for Internal Fixation of Mandibular Condylar Fractures in Adults. J Oral Maxillofac Surg 2018; 76:1255-1266. [DOI: 10.1016/j.joms.2017.12.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 12/20/2017] [Accepted: 12/20/2017] [Indexed: 11/17/2022]
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Abstract
Avulsions of mandible are among the most devastating lesions observed in cranio-maxillofacial traumas. They present an important health problem because of the high risk of morbidity related to deformities that cause functional limitations and esthetic changes. The avulsions commonly result from high-energy effects, which cause complete or partial separation of the mandibular bone of the face. As a result of the intense aggression, the skin and subcutaneous tissues of the bone are usually removed, affecting muscles, fascia, blood vessels, and the surrounding nerves. This article aimed to present a case of partial avulsion of mandible caused by car accident. Here, we emphasize the importance of correctly performing patient stabilization and maintenance of the airways, damage control, and facial reconstruction. Finally, we proceeded with a literature review to discuss standard protocols and controversies in the treatment of these lesions.
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Albogha MH, Mori Y, Takahashi I. Three-dimensional titanium miniplates for fixation of subcondylar mandibular fractures: Comparison of five designs using patient-specific finite element analysis. J Craniomaxillofac Surg 2018; 46:391-397. [DOI: 10.1016/j.jcms.2017.12.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 12/12/2017] [Accepted: 12/18/2017] [Indexed: 10/18/2022] Open
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20
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Complications in the treatment of mandibular condylar fractures: Surgical versus conservative treatment. Ann Anat 2018; 216:60-68. [DOI: 10.1016/j.aanat.2017.10.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 10/07/2017] [Accepted: 10/11/2017] [Indexed: 12/15/2022]
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21
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de Souza GM, Rodrigues DC, Celegatti Filho TS, Moreira RWF, Falci SGM. In-vitro comparison of mechanical resistance between two straight plates and a Y-plate for fixation of mandibular condyle fractures. J Craniomaxillofac Surg 2017; 46:168-172. [PMID: 29208487 DOI: 10.1016/j.jcms.2017.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 10/08/2017] [Accepted: 11/02/2017] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To compare the mechanical resistance of conventional plates with a modified Y-plate in mandibular condyle fracture. MATERIALS AND METHODS 40 synthetic hemi-mandibular polyurethane replicates were used. Two groups of fixing materials were included: 20 mandibles fixed with 40 straight plates with four roles each (2.0 mm system) and 20 mandibles fixed with 20 Y-shaped plates (2.0 mm system and 1.5 mm thickness). The samples were submitted to linear loading in the following directions: 10 mandibles from each group from lateral to medial and 10 mandibles from each group from anterior to posterior. A universal loading machine, Instron Universal 4411, was used to performed the tests, and the resistance of each fixed mandible was assessed at displacements of 1 mm, 3 mm, and 5 mm. The t-test for independent samples was performed. The p value was set at <0.05. RESULTS The worst mechanical resistance was found in the Y-plates loaded from anterior to posterior. The best mechanical resistance was in two straight hole plates loaded from lateral to medial. The Y-plates and two straight hole plates showed similar resistance when a lateral to medial load was applied. CONCLUSION There was no difference between the plates when lateral to medial loading was tested.
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Affiliation(s)
- Glaciele Maria de Souza
- Oral and Maxillofacial Surgery Section, Department of Dentistry, Federal University of Vales do Jequitinhonha e Mucuri (UFVJM), Rua da Glória, 187 - Diamantina -MG, 39100-000, Brazil
| | - Danillo Costa Rodrigues
- Oral and Maxillofacial Surgery Section, Department of Dentistry, Federal University of Vales do Jequitinhonha e Mucuri (UFVJM), Rua da Glória, 187 - Diamantina -MG, 39100-000, Brazil
| | - Tóride Sebastião Celegatti Filho
- Oral and Maxillofacial Surgery Section, Department of Dentistry, Federal University of Vales do Jequitinhonha e Mucuri (UFVJM), Rua da Glória, 187 - Diamantina -MG, 39100-000, Brazil
| | - Roger William Fernandes Moreira
- Oral and Maxillofacial Surgery Section, Department of Dentistry, Federal University of Vales do Jequitinhonha e Mucuri (UFVJM), Rua da Glória, 187 - Diamantina -MG, 39100-000, Brazil
| | - Saulo Gabriel Moreira Falci
- Oral and Maxillofacial Surgery Section, Department of Dentistry, Federal University of Vales do Jequitinhonha e Mucuri (UFVJM), Rua da Glória, 187 - Diamantina -MG, 39100-000, Brazil.
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22
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Current Management of Subcondylar Fractures of the Mandible, Including Endoscopic Repair. Facial Plast Surg Clin North Am 2017; 25:577-580. [DOI: 10.1016/j.fsc.2017.06.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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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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24
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Thapa S, Wang J, Hu HT, Zhang FG, Ji P. Epidemiology of Surgically Managed Mandibular Condylar Fractures at a Tertiary Referral Hospital in Urban Southwest China. Open Dent J 2017; 11:294-300. [PMID: 28839478 PMCID: PMC5543664 DOI: 10.2174/1874210601711010294] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 03/31/2017] [Accepted: 05/15/2017] [Indexed: 12/02/2022] Open
Abstract
Background: Mandibular condylar fracture is one of the commonest maxillofacial fractures treated by maxillofacial surgeons. Demography of the patients, causation, and characteristics of the fracture depends on various socio-economic factors. Hence, maxillofacial surgeons should be familiar with epidemiology of mandibular condylar fracture. Objective: This study retrospectively describes the demography, etiology, fracture characteristics, and hospital utilization of surgically treated mandibular condylar fractures in a tertiary referral hospital in urban China in past five years. Methods: Data of all patients who underwent surgical management between 2011 and 2015 were collected. This included aetiology, characteristics of fracture, time, age, sex, associated injuries, and hospital utilization of 166 patients with 208 mandibular condylar fractures. These patients had undergone open reduction and internal fixation with either miniplates or lag screws. Among the fracture of head of mandibular condyle, 21.28% of the patients had the fracture segments removed. These data were statistically analyzed to describe the epidemiology of mandibular condylar fracture. Results: Most of the patients had unilateral mandibular condylar fractures (74.7%). Male patients (76.51%) outnumbered female patients (23.49%) in this cohort. The average age of the patients was 37 years. The fractures were mostly caused by fall from height (60.84%) and were located at the condylar neck (53.61%). Most of the patients had other associated maxillofacial injuries (71.08%) which were mostly located at symphysis and parasymphysis (44.59%). It took 12.58 +/- 0.35 days of hospitalization for the treatment. Conclusion: Fall from height was the most prevalent cause of mandibular condylar injury in mountainous urban China. The people at highest risk were middle-aged men. Mandibular condylar fracture was mostly located at the condylar neck and was usually associated with fracture at the symphysis and parasymphysis.
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Affiliation(s)
- Swosti Thapa
- Department of Oral and Maxillofacial Surgery, Chongqing Medical University, Chongqing 401147, China
| | - Jun Wang
- Department of Oral and Maxillofacial Surgery, Chongqing Medical University, Chongqing 401147, China
| | - Hong-Tao Hu
- Department of Oral and Maxillofacial Surgery, Chongqing Medical University, Chongqing 401147, China
| | - Fu-Gui Zhang
- Department of Oral and Maxillofacial Surgery, Chongqing Medical University, Chongqing 401147, China
| | - Ping Ji
- Department of Oral and Maxillofacial Surgery, Chongqing Medical University, Chongqing 401147, China
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25
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Adnot J, Feuss A, Duparc F, Trost O. Retraction force necessary to expose the mandibular neck in Risdon and high cervical anteroparotid transmasseteric approaches: an anatomic comparative study. Surg Radiol Anat 2017; 39:1079-1084. [PMID: 28429040 DOI: 10.1007/s00276-017-1853-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 04/06/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this anatomic study was to compare the retraction force necessary to expose the mandibular neck in the Risdon and the high cervical anteroparotid transmasseteric (HAT) approaches. METHODS An anatomic study was performed on 18 formalin-embalmed cadavers. We performed a Risdon approach on the left side, and an HAT approach on the right side in all the cases. The subjects were placed in a normative frame and the force necessary to maintain a satisfactory exposure of the condyle was measured with a system of cables, pulleys, and mechanical dynamometer. The statistical comparison between the two sides was carried out using the Wilcoxon signed-rank test for paired series. RESULTS In all the cases, the region of interest was exposed as in the operating room. In the Risdon approach, the mean force was 32 Newtons (4-47). In the HAT approach, the mean force was 19 Newtons (4-33). The difference was statistically significant (p < 0.001). The age, gender, and duration of conservation had no influence on the retraction force. CONCLUSION In the HAT approach, the retraction of the soft tissues was significantly lower than in the Risdon approach. This study gave an additional explanation to the remarkable safety of the HAT approach. Our results were in favor of the generalization of this technique.
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Affiliation(s)
- Jérôme Adnot
- Department of Oral and Maxillofacial Surgery, Charles-Nicolle Hospital, University Hospital of Rouen, 1 rue de Germont, 76031, Rouen, France
| | - Aliosha Feuss
- Department of Oral and Maxillofacial Surgery, Charles-Nicolle Hospital, University Hospital of Rouen, 1 rue de Germont, 76031, Rouen, France
| | - Fabrice Duparc
- Laboratory of Anatomy, Rouen Faculty of Medicine, 22 boulevard Gambetta, 76000, Rouen, France
| | - Olivier Trost
- Department of Oral and Maxillofacial Surgery, Charles-Nicolle Hospital, University Hospital of Rouen, 1 rue de Germont, 76031, Rouen, France. .,Laboratory of Anatomy, Rouen Faculty of Medicine, 22 boulevard Gambetta, 76000, Rouen, France.
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Sikora M, Sielski M, Stąpor A, Chlubek D. Use of the Delta plate for surgical treatment of patients with condylar fractures. J Craniomaxillofac Surg 2016; 44:770-4. [DOI: 10.1016/j.jcms.2016.04.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/08/2016] [Accepted: 04/07/2016] [Indexed: 10/21/2022] Open
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27
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Guo SS, Zhou WN, Wan LZ, Yuan H, Yuan Y, Du YF, Jiang HB. Computer-aided design-based preoperative planning of screw osteosynthesis for type B condylar head fractures: A preliminary study. J Craniomaxillofac Surg 2016; 44:167-76. [DOI: 10.1016/j.jcms.2015.11.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 10/15/2015] [Accepted: 11/23/2015] [Indexed: 10/22/2022] Open
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28
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Bewley AF, Farwell DG. Management of Mandible Fractures. CURRENT OTORHINOLARYNGOLOGY REPORTS 2015. [DOI: 10.1007/s40136-015-0095-8] [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]
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29
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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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30
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Soleimani T, Greathouse ST, Sood R, Tahiri YH, Tholpady SS. Epidemiology and resource utilization in pediatric facial fractures. J Surg Res 2015; 200:648-54. [PMID: 26541684 DOI: 10.1016/j.jss.2015.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 08/21/2015] [Accepted: 10/01/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pediatric facial fractures, although uncommon, have a significant impact on public health and the US economy by the coexistence of other injuries and developmental deformities. Violence is one of the most frequent mechanisms leading to facial fracture. Teaching hospitals, while educating future medical professionals, have been linked to greater resource utilization in differing scenarios. This study was designed to compare the differences in patient characteristics and outcomes between teaching and non-teaching hospitals for violence-related pediatric facial fractures. METHODS Using the 2000-2009 Kids' Inpatient Database, 3881 patients younger than 18 years were identified with facial fracture and external cause of injury code for assault, fight, or abuse. Patients admitted at teaching hospitals were compared to those admitted at non-teaching hospitals in terms of demographics, injuries, and outcomes. RESULTS Overall, 76.2% of patients had been treated at teaching hospitals. Compared to those treated at non-teaching hospitals, these patients were more likely to be younger, non-white, covered by Medicaid, from lower income zip codes, and have thoracic injuries; but mortality rate was not significantly different. After adjusting for potential confounders, teaching status of the hospital was not found as a predictor of either longer lengths of stay (LOS) or charges. CONCLUSIONS There is an insignificant difference between LOS and charges at teaching and non-teaching hospitals after controlling for patient demographics. This suggests that the longer LOS observed at teaching hospitals is related to these institutions being more often involved in the care of underserved populations and patients with more severe injuries.
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Affiliation(s)
- Tahereh Soleimani
- Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Rajiv Sood
- Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Youssef H Tahiri
- Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Sunil S Tholpady
- Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
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Development plates for stable internal fixation: Study of mechanical resistance in simulated fractures of the mandibular condyle. J Craniomaxillofac Surg 2015; 43:158-61. [DOI: 10.1016/j.jcms.2014.10.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 08/28/2014] [Accepted: 10/22/2014] [Indexed: 11/20/2022] Open
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