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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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Louvrier A, Bertin E, Lutz JC, Meyer C. The modified Risdon approach is not only a high sub-mandibular skin incision. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e839-e840. [PMID: 35700950 DOI: 10.1016/j.jormas.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Aurélien Louvrier
- Chirurgie Maxillo-Faciale, Stomatologie et Odontologie Hospitalière, CHU Besançon, Besançon 25000, France; Laboratoire Nano Médecine, Imagerie, Thérapeutique, University Bourgogne Franche-Comté, EA 4662, Besançon 25000, France..
| | - Eugénie Bertin
- Chirurgie Maxillo-Faciale, Stomatologie et Odontologie Hospitalière, CHU Besançon, Besançon 25000, France
| | - Jean-Christophe Lutz
- Service de Chirurgie Maxillofaciale et Stomatologie, Centre Hospitalier Universitaire de Strasbourg; Faculté de Médecine, Université de Strasbourg, Strasbourg, France
| | - Christophe Meyer
- Chirurgie Maxillo-Faciale, Stomatologie et Odontologie Hospitalière, CHU Besançon, Besançon 25000, France; Laboratoire Nano Médecine, Imagerie, Thérapeutique, University Bourgogne Franche-Comté, EA 4662, Besançon 25000, France
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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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Nowair IM, Essa EF, Eid MK. A comparative evaluation of retromandibular versus Modified Risdon approach in surgical treatment of condylar fracture. J Craniomaxillofac Surg 2021; 50:237-245. [PMID: 34974959 DOI: 10.1016/j.jcms.2021.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 10/17/2021] [Accepted: 12/22/2021] [Indexed: 10/19/2022] Open
Abstract
The purpose of this study was aimed to compare the efficiency and safety of retromandibular versus modified Risdon approach using periangular incision for open reduction and internal fixation of low subcondylar mandibular fracture. Open reduction and internal fixation with different plating systems were utilized via retromandibular approach (group I) and via modified Risdon approach with periangular incision (group II). Twenty four (n= 24) condylar fractures in 21 adult patients were divided randomly into two equal groups (12 each) according to the cutaneous incision (approach) utilized. The evaluation score for scarring in group I it was excellent in 9 patients, good in 2 patients and acceptable in only one patient (Mean 2.4 ± SD 3.38). While in group II was excellent in 10 patients and good in 2 patients (Mean 2.4 ± SD 3.87) and the p value was 0.591. Symptoms of transient facial nerve weakness were noted in only 3 patients in group I with slight to moderate dysfunction (Mean 2 ± SD 3.21), while only one patient had facial nerve weakness in group II with House - Brackman score of 2 immediate postoperatively and this got resolved in 6 weeks (Mean 2 ± SD 4.04) and the p value was 0.00022. Within the limitations of the study it seems that a modified Risdon approach using periangular incision for reduction and fixation of low subcondylar fracture should be preferred whenever possible because it yields better outcomes.
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Affiliation(s)
- Ibrahim Mohamed Nowair
- Associate Professor of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tanta University, Egypt.
| | - Emad Fahim Essa
- Associate Professor of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tanta University, Egypt; Associate Professor of Oral and Maxillofacial Surgery, Faculty of Dentistry, Taibah University, KSA, Saudi Arabia.
| | - Mohamed Kamal Eid
- Associate Professor of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tanta University, Egypt.
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Neuhaus MT, Zeller AN, Desch L, Dhawan A, Jehn P, Gellrich NC, Zimmerer R. Endoscopically Assisted Treatment of Condylar Base and Neck Fractures: A Single Institution Analysis of Outcomes and Complications. J Maxillofac Oral Surg 2021; 20:665-673. [PMID: 34776701 DOI: 10.1007/s12663-020-01398-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/19/2020] [Indexed: 11/26/2022] Open
Abstract
Background Conservative treatment, including observation and closed treatment, as well as open reduction and internal fixation are existing options for treating condylar process fractures. Extraoral approaches are widely preferred for open reduction and internal fixation. Transoral access for condylar base and neck fractures is not yet commonly used as it is technically demanding and requires special equipment. Purpose In this study, the transoral endoscopically assisted approach is described, and its outcomes and complications were investigated. Imaging data and clinical records of 187 patients with condylar process fractures, treated via endoscopically assisted transoral approach between 2007 and 2017 were analyzed. Parameters included diagnosis and fracture classification, treatment, osteosynthesis configuration and postoperative complications. Results Early complications, including infection, transient postoperative malocclusion, pain and limited mouth opening, occurred in 35 patients (18.7%). Late onset complications, such as screw loosening were documented in only 4 patients (2.1%). Revision surgery following postoperative 3D imaging was required in only 3 cases (1.6%). Fragment length ranged from 15.5 to 38.3 mm. In 57.7% of patients with condylar fragment length < 20 mm, a single osteosynthesis plate was used, with no elevated complication rate. Two osteosynthesis plates with 4 screws each was used as standard in longer fragments. Conclusion Endoscopically assisted transoral treatment of condylar process fractures is a reliable, yet technical demanding technique. It allows for reduction and fixation of fractures with a condylar fragment length of > 15 mm with low postoperative complication and revision rates.
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Affiliation(s)
- Michael-Tobias Neuhaus
- Department for Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Alexander-Nicolai Zeller
- Department for Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Lena Desch
- Department for Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Amit Dhawan
- Sri Guru Ram Das Institute of Dental Sciences and Research, Amritsar, India
| | - Philipp Jehn
- Department for Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Nils-Claudius Gellrich
- Department for Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Rüdiger Zimmerer
- Department for Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
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Bhargava D, Sharma Y, Beena S. Infinitesimal Peri-angular Pterygomasseteric Transectioning Approach (IPPTA) for the Base Fractures of the Mandibular Condyle: A Preliminary Study. J Maxillofac Oral Surg 2021; 20:657-664. [PMID: 34776700 DOI: 10.1007/s12663-020-01446-4] [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: 07/15/2020] [Accepted: 09/04/2020] [Indexed: 10/23/2022] Open
Abstract
Purpose To investigate a reliable and safe surgical access to the condylar base region with minimal surgical trauma to the surrounding anatomic structures. In an attempt to do so, to describe Infinitesimal Peri-angular Pterygomasseteric Transectioning Approach (IPPTA) for the management of base fractures of the mandibular condyle. Materials and Method A preliminary clinical study involving 20 patients was undertaken to treat patients with unilateral condylar base fracture of the mandible using IPPTA under general anaesthesia (GA). Various parameters assessed were adequacy of surgical access, wound healing at the incision site, marginal mandibular nerve injury, diet intake and complications post-operatively. Result This method provided adequate exposure to fractured condylar base for open reduction and internal fixation (ORIF) with uneventful post-operative recovery phase. There was no limitation to function which was identified by restoration of normal pre-trauma diet intake by 14th post-operative day in more than 50% of the study patients. No complications were observed in any patients among the study population. Discussion The peri-angular approach has been discussed in the literature. The IPPTA highlights the use of a smaller incision providing an adequate exposure to the condylar base region for ORIF.
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Affiliation(s)
- Darpan Bhargava
- Department of Oral and Maxillofacial Surgery, People's College of Dental Sciences and Research Center, People's University, Bhanpur, Bhopal, Madhya Pradesh 462037 India.,TMJ Consultancy Services (South East Asia), H-3/2, B.D.A Colony, Nayapura, Lalghati, Airport Road, Bhopal, Madhya Pradesh 462 001 India
| | - Yogesh Sharma
- Department of Dentistry, Netaj Subhash Chandra Bose Medical College, Tilwara Road, Doctors Colony, Medical College Colony, Jabalpur, Madhya Pradesh 482003 India
| | - Sivakumar Beena
- TMJ Consultancy Services (South East Asia), H-3/2, B.D.A Colony, Nayapura, Lalghati, Airport Road, Bhopal, Madhya Pradesh 462 001 India
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Hasegawa K, Sukegawa S, Ono S, Ando M, Shibata A, Sukegawa-Takahashi Y, Fujimura A, Matsuyama T, Ibaragi S, Nagatsuka H, Mizobuchi K, Sasaki A, Furuki Y. Endoscopic-assisted resection of pleomorphic adenoma in the accessory parotid gland. THE JOURNAL OF MEDICAL INVESTIGATION 2021; 68:376-380. [PMID: 34759162 DOI: 10.2152/jmi.68.376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Background : An accessory parotid gland (APG) is a common anatomical structure that occurs in 10%-56% of individuals. Pleomorphic adenomas are the most common benign tumors of the APG, and their ideal treatment is surgical excision, although there is a risk for aesthetic disorders and facial nerve damage due to the site of origin. Moreover, despite being benign, these tumors are known to recur. Therefore, it is necessary to achieve both reliable excision and avoidance of facial nerve damage. Case presentation : We report a case of a 49-year-old Japanese man with a mass in his left cheek. The lesion was diagnosed as a benign salivary gland tumor derived from the APG by computed tomography imaging, magnetic resonance imaging and fine needle aspiration cytology. We resected the tumor using modified high submandibular incision under the endoscopic-assisted field of view. Discussion and Conclusions : The tumor was less invasive and reliably resected using an endoscope. In surgical treatment, the endoscopic-assisted technique is very useful to achieve complete tumor resection and prevent relapse while avoiding serious complications due to surgical procedures. J. Med. Invest. 68 : 376-380, August, 2021.
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Affiliation(s)
- Kazuaki Hasegawa
- Department of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, Takamatsu, Kagawa 760-8557, Japan
| | - Shintaro Sukegawa
- Department of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Sawako Ono
- Department of Pathology, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa, Japan
| | - Midori Ando
- Department of Pathology, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa, Japan
| | - Akane Shibata
- Department of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, Takamatsu, Kagawa 760-8557, Japan
| | - Yuka Sukegawa-Takahashi
- Department of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, Takamatsu, Kagawa 760-8557, Japan
| | - Ai Fujimura
- Department of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, Takamatsu, Kagawa 760-8557, Japan
| | - Tamamo Matsuyama
- Department of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, Takamatsu, Kagawa 760-8557, Japan
| | - Soichiro Ibaragi
- Departments of Oral and Maxillofacial Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Hitoshi Nagatsuka
- Department of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Koichi Mizobuchi
- Department of Pathology, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa, Japan
| | - Akira Sasaki
- Departments of Oral and Maxillofacial Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Yoshihiko Furuki
- Department of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, Takamatsu, Kagawa 760-8557, Japan
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Kaouani A, Kerdoud O, Aloua R, Sabr A, Slimani F. The high subangulomandibular approach for condylar fractures of the mandible. Int J Surg Case Rep 2021; 85:106146. [PMID: 34252645 PMCID: PMC8369289 DOI: 10.1016/j.ijscr.2021.106146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/20/2021] [Accepted: 06/24/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction The approaches to mandibular condyle fractures are described in the literature in an abbreviated manner. Their complications, especially facial nerve damage, have limited the surgical indication. Presentation of case Through this clinical case, we reported the way and the interest of using a twisted steel wire to increase the visibility of the fracture site and facilitate the reduction of even the highest localized fractures. Discussion The high subangulomandibular approach remains a safe approach, with less risk of facial nerve injury if the planes are respected and the facial nerve is avoided if encountered. Nevertheless, this approach is indicated in low condylar and some neck fractures. Conclusion Given the benefits of this approach compared to other techniques, we recommend its use. The high subangulomandibular approach has been proven to be superior to other approaches for mandibular condyle fractures. The majority of surgeons practice this route only for low condylar fractures and using 3D plates. With the help of traction of the ramus by a twisted steel wire, this route can be used for all subcondylar fractures, even the most difficult and highest.
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Affiliation(s)
- Amine Kaouani
- Department of Stomatology and Maxillofacial Surgery, 20 August 1953 Hospital, Ibn Rochd, B.P 2698, Casablanca, Morocco.
| | - Ouassime Kerdoud
- Department of Stomatology and Maxillofacial Surgery, 20 August 1953 Hospital, Ibn Rochd, B.P 2698, Casablanca, Morocco
| | - Rachid Aloua
- Department of Stomatology and Maxillofacial Surgery, 20 August 1953 Hospital, Ibn Rochd, B.P 2698, Casablanca, Morocco
| | - Ayoub Sabr
- Department of Stomatology and Maxillofacial Surgery, 20 August 1953 Hospital, Ibn Rochd, B.P 2698, Casablanca, Morocco
| | - Faical Slimani
- Department of Stomatology and Maxillofacial Surgery, 20 August 1953 Hospital, Ibn Rochd, B.P 2698, Casablanca, Morocco; Faculty of Medicine and Pharmacy of Casablanca, Hassan II University of Casablanca, B.P 5696, Casablanca, Morocco
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Algorithm for Management of Mandibular Condylar Base Fractures. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3145. [PMID: 33133982 PMCID: PMC7544252 DOI: 10.1097/gox.0000000000003145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/31/2020] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Increasing evidence suggests that open reduction and internal fixation of condylar base fractures in adults results in improved outcomes in regard to interincisal opening, jaw movement, pain, and malocclusion. However, most of the condylar fractures are managed by maxillomandibular fixation alone due to the need for specialized training and equipment. Our aim was to present an algorithm for condylar base fractures to simplify surgical management. Methods: A retrospective review was performed of patients (n = 22) with condylar base fractures treated from 2016 to 2020. Patients who presented with operative fractures that require open treatment underwent 1 of 2 different techniques depending on the fracture type: a preauricular approach with a transoral approach if the condyle was dislocated (n = 2) or a transoral only approach (n = 20) in nondislocated cases. Operative time, occlusion, range of motion, and postoperative complications were assessed. Results: Condylar base fractures were combined with other mandibular fractures in 16 of 22 patients. Patients with condylar dislocation were managed with a preauricular approach with a secondary transoral incision (n = 2, median 147 minutes). Those without dislocation were treated with a transoral approach (n = 20, median 159 minutes). Most patients were restored to their preoperative occlusion without long-term complications. Conclusions: We present a simplified algorithm for treating condylar base fractures. Our case series suggests that reduction in operative time and clinical success can be achieved with open reduction and internal fixation using a transoral approach alone or in combination with a preauricular approach for dislocated fractures.
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Sukegawa S, Masui M, Kanno T, Miki M, Nakamoto H, Furuki Y. Evaluation of Open Reduction and Internal Fixation of Mandibular Condyle Fracture by Intraoperative Cone-Beam Computed Tomography in a Hybrid Operating Room. J Craniofac Surg 2020; 31:762-765. [PMID: 31856135 PMCID: PMC7329199 DOI: 10.1097/scs.0000000000006101] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Condylar fractures are the most common fractures of the mandible, and treatment of mandibular condylar fractures by maxillofacial surgeons is a very important procedure. However, the surgical approaches have anatomical limitations. Therefore, it is difficult to evaluate the reduction achieved in open reduction and internal fixation because of the uncertainty in securing a sufficient operative field. As a potential solution, the authors evaluated the benefits of intraoperative cone-beam computed tomography (CBCT) with high image quality performed in a hybrid operating room. Intraoperative CBCT is easy to perform in a hybrid operating room, and it is possible to quickly evaluate high-quality CT images, including 3D images. Because the state of reduction of mandibular condylar fractures also affects the prognosis of treatment, more precise reduction and fixation should improve prognoses. The use of CBCT in a hybrid operating room also avoids re-operation, and patients benefit from minimum invasive surgery. Intraoperative CBCT is a very useful strategy for evaluation of mandibular condylar fracture surgical treatment.
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Affiliation(s)
- Shintaro Sukegawa
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, Takamatsu
| | - Masanori Masui
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, Takamatsu
| | - Takahiro Kanno
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Shimane
| | - Masayuki Miki
- Division of Radiological Technology, Kagawa Prefectural Central Hospital, Kagawa, Japan
| | - Hitoshi Nakamoto
- Division of Radiological Technology, Kagawa Prefectural Central Hospital, Kagawa, Japan
| | - Yoshihiko Furuki
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, Takamatsu
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12
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Modified Tragus Edge and Transmasseteric Anteroparotid Approach for Intracapsular and Condylar Neck Fractures. J Craniofac Surg 2020; 31:1822-1826. [PMID: 32371706 DOI: 10.1097/scs.0000000000006470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to evaluate the effects of protecting the facial nerve and reducing the scar visibility using a modified tragus edge and transmasseteric anteroparotid approach compared to classic preauricular approach for intracapsular and condylar neck fractures. This retrospective study included 64 patients (78 sides) who underwent surgical treatment for intracapsular or condylar neck fractures from January 2014 to June 2018. Patients were divided into the experimental group (treated via a modified tragus edge and transmasseteric anteroparotid approach), and the control group (treated via the classical preauricular approach). Therapeutic outcome assessment parameters included facial nerve injury, salivary fistulae, wound infection, restricted mouth opening, postoperative occlusion disorders, and scar visibility. In the control group, there were 3 cases of facial nerve injuries and 2 cases of salivary fistulae. One case of temporary facial nerve injury occurred in the experimental group, with complete recovery within 1 month. The scars were less visible in the experimental group than in the control group. These results suggest that a modified tragus edge and transmasseteric anteroparotid approach reduced the incidences of facial nerve injuries, minimized the scar visibility, improved exposure of the operative site and fixation of titanium screws or plates, and did not increase the frequency of other complications.
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Louvrier A, Barrabé A, Weber E, Chatelain B, Sigaux N, Meyer C. The high sub-mandibular approach: Our experience about 496 procedures. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 121:626-633. [PMID: 32205300 DOI: 10.1016/j.jormas.2020.03.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 03/06/2020] [Accepted: 03/13/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The potential drawbacks of surgical approaches to neck and base fractures of the mandibular condyle (visible scare, facial nerve injury) are still considered by many surgeons as a brake for open reduction and internal fixation. The aim of our study was to analyze the results in terms of access, scare quality and complications that could be noticed in a 12 years period of time with the use of the high sub-mandibular approach (HSMA) we first described in 2006 for the surgical treatment of neck and base fractures. MATERIAL AND METHOD All the files of patients operated on for condylar neck and base fractures approached by mean of a HSMA between January 2006 and December 2018 in our department and containing information concerning age, sex, type of fracture, kind of osteosynthesis material, operating time, name of the surgeon, postoperative complication linked to the approach, scare quality at 6 months follow-up at least were included. The skin incision and the dissection planes followed the original publication of Meyer et al. in 2006. RESULTS 434 patients (sex ratio: 2.06, mean age: 32, 496 approaches) met the inclusion criteria. Following the AO classification, 21.2% of the fractures were classified as neck fractures and 78.8% as base fractures. 97.6% of all fractures were stabilized by mean of a 3D plate (TCP® plate, Medartis, Basel-CH), the remaining ones by mean of a combination of 1.2, 1.5 and 2.0 straight plates. Mean operating time was 40minutes per side. Patients were operated on by senior surgeons in 71.7% of the cases and by trainees under supervision for the others. Concerning the complications linked to the approach, we noticed 11 (2.2%) temporary (0 definitive) paresis of the facial nerve, 1 (0.2%) hematoma and 1 (0.2%) abscess that both needed revision. Scare was hypertrophic or considered as unaesthetic by the patient in 5 cases (1%). DISCUSSION The HSMA, if performed as initially described, is a safe and quick procedure compared to other cutaneous approaches. It gives access to all base fractures and to most of neck fractures. The very low rate of facial nerve complications is mainly explained by the plane by plane dissection making it very easy to avoid the facial nerve branches or to check them when encountered. The HSMA is particularly suited to the use of TCP plates as the upper holes of these plates, placed horizontally, are easy to reach from below. The HSMA is therefore still our preferred cutaneous approach to the condylar process.
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Affiliation(s)
- A Louvrier
- Department of Oral and Maxillofacial Surgery, University Hospital of Besançon, 3, boulevard Fleming, 25030 Besançon cedex, France; Host-Graft Interactions Lab-Tumor - Cell and Tissue engineering (UMR 1098 INSERM/UFC/EFS), University of Franche-Comté, 1, boulevard Fleming, 25020 Besançon cedex, France.
| | - A Barrabé
- Department of Oral and Maxillofacial Surgery, University Hospital of Besançon, 3, boulevard Fleming, 25030 Besançon cedex, France
| | - E Weber
- Department of Oral and Maxillofacial Surgery, University Hospital of Besançon, 3, boulevard Fleming, 25030 Besançon cedex, France
| | - B Chatelain
- Department of Oral and Maxillofacial Surgery, University Hospital of Besançon, 3, boulevard Fleming, 25030 Besançon cedex, France
| | - N Sigaux
- Department of Maxillofacial Surgery and Plastic Facial Surgery, Lyon Sud Hospital, Hospices Civils de Lyon, Claude-Bernard Lyon 1 University, 69310 Pierre-Bénite, France
| | - C Meyer
- Department of Oral and Maxillofacial Surgery, University Hospital of Besançon, 3, boulevard Fleming, 25030 Besançon cedex, France; Nanomedicine Lab Imagery and Therapeutics (EA 4662), University of Franche-Comté, 19, rue Ambroise-Paré, 25000 Besançon, France.
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Ricciardi L, Sturiale CL, Izzo A, Pucci R, Valentini V, Montano N, Polli FM, Visocchi M, Vivas-Buitrago T, Chaichana KL, Quinones-Hinojosa A, Olivi A, Chen S. Submandibular Approach for Single-Stage Craniovertebral Junction Ventral Decompression and Stabilization: A Preliminary Cadaveric Study of Technical Feasibility. World Neurosurg 2019; 127:206-212. [DOI: 10.1016/j.wneu.2019.04.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 04/02/2019] [Accepted: 04/03/2019] [Indexed: 11/30/2022]
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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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Algan S, Kara M, Cakmak MA, Tan O, Cinal H, Barin EZ, Inaloz A. Experiences with a modified preauricular mini incision with subdermally dissection in condylar and subcondylar fractures of the mandible. J Craniomaxillofac Surg 2018. [PMID: 29526414 DOI: 10.1016/j.jcms.2018.01.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Condylar and subcondylar fractures (CSFs) are among the most common mandible fractures. If reduction of these fractures is not carried out correctly, serious complications can result, including infection, damage to temporomandibular joint (TMJ) function, malocclusion, nonunion, malunion, and ankylosis of the TMJ. METHODS We used a preauricular, mini-incision, open technique (PMIOT) for CSF of the mandible. 66 patients (48 males, 18 females), with a total of 72 CSFs of the mandible, were repaired with PMIOT between 2011 and 2016. Average age was 37.8 years (range: 8-78). CSFs were located on the right side, left side, and bilaterally in 21, 27 and six patients, respectively. We used only one mini incision of length 2 cm for non-displaced subcondylar fractures. However, we had to perform a second mini incision for condylar fractures displaced by more than 45°, where subcondylar fractures overlapped, or where there was deep surgical exposure and difficulty with reduction. RESULTS No early complications, such as bleeding, hematoma, seroma, infection, or parotid fistula, were seen in any patients. Temporary facial nerve paresis was reported in three patients, but these recovered spontaneously with conservative treatment within 15 days. Permanent facial nerve paralysis occurred in none of the patients. CONCLUSION We believe that PMIOT is an effective, reliable, and feasible method for repair of CSF. It does not need any expensive and sophisticated tools, and has low complication rates. The mini incision used in our technique results in both a hidden scar and protection of essential structures in the region.
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Affiliation(s)
- Said Algan
- Medical Park Hospital, Plastic and Reconstructive and Aesthetic Surgery Clinic, Batman, Turkey.
| | - Murat Kara
- Regional Training and Research Hospital, Plastic and Reconstructive Surgery Clinic, Erzurum, Turkey
| | - Mehmet Akif Cakmak
- Ataturk University, Faculty of Medicine, Department of Plastic Reconstructive and Aesthetic Surgery, Erzurum, Turkey
| | - Onder Tan
- Ataturk University, Faculty of Medicine, Department of Plastic Reconstructive and Aesthetic Surgery, Erzurum, Turkey
| | - Hakan Cinal
- Ataturk University, Faculty of Medicine, Department of Plastic Reconstructive and Aesthetic Surgery, Erzurum, Turkey
| | - Ensar Zafer Barin
- Ataturk University, Faculty of Medicine, Department of Plastic Reconstructive and Aesthetic Surgery, Erzurum, Turkey
| | - Akin Inaloz
- Regional Training and Research Hospital, Plastic and Reconstructive Surgery Clinic, Erzurum, Turkey
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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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Kudva A, Kamath AT, Rajan J, D'Souza C. A Modified Peri-Angular Approach for Exposure of Condylar Fractures. J Oral Maxillofac Surg 2018; 76:1504-1508. [PMID: 29452070 DOI: 10.1016/j.joms.2018.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 12/29/2017] [Accepted: 01/02/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE To describe a modified peri-angular approach to address subcondylar and condylar neck fractures. MATERIALS AND METHODS A modified peri-angular incision is used to approach a fractured condyle through the anteroparotid transmasseteric approach. RESULTS In the authors' experience, this method provides quick and clean exposure to the fractured condylar base and neck fractures for open reduction and internal fixation. CONCLUSION Although the peri-angular approach has been discussed in the literature, the authors' modification lessens the chance of complications, such as marginal nerve injury and parotid fistula formation, because the nerve is visualized and kept isolated throughout.
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Affiliation(s)
- Adarsh Kudva
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal, Udupi, Karnataka, India.
| | - Abhay T Kamath
- Professor and Head, Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal, Udupi, Karnataka, India
| | - Jyotsna Rajan
- Final-Year Junior Resident, Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal, Udupi, Karnataka, India
| | - Charlene D'Souza
- Second-Year Junior Resident, Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal, Udupi, Karnataka, India
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