1
|
Emmerling MR, LaVigne M, Warburton G, Caccamese JF, Ord RA. Extracorporealization of the Mandibular Condyle: Effects on Viability and Function. Craniomaxillofac Trauma Reconstr 2023; 16:130-137. [PMID: 37222979 PMCID: PMC10201190 DOI: 10.1177/19433875221095989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023] Open
Abstract
Study Design For certain condylar fractures, extracorporealization of the condylar segment may be performed via extra-oral vertical ramus osteotomy (EVRO) to facilitate reduction and fixation. This approach can similarly be used for condyle-sparing resection of osteochondromas of the condyle. Due to controversy regarding long-term health of the condyle after extracorporealization, we conducted a retrospective analysis of surgical outcomes. Objective For certain condylar fractures, extracorporealization of the condylar segment may be performed via extra-oral vertical ramus osteotomy (EVRO) to facilitate reduction and fixation. This approach can similarly be used for condyle-sparing resection of osteochondromas of the condyle. Due to controversy regarding long-term health of the condyle after extracorporealization, we investigated the viability of this technique through a retrospective analysis of outcomes. Methods Twenty-six patients were treated using EVRO with extracorporealization of the condyle for both condylar fractures (18 patients) and osteochondroma (8 patients). Of the 18 trauma patients, 4 were excluded due to limited follow-up. Clinical outcomes were measured, including occlusion, maximum interincisal opening (MIO), facial asymmetry, incidence of infection, and temporomandibular joint (TMJ) pain. Radiographic signs of condylar resorption were investigated, quantified, and categorized using panoramic imaging. Results Average follow-up was 15.9 months. Average maximum interincisal opening was 36.8 mm. Four patients demonstrated mild resorption and one patient demonstrated moderate resorption. Two cases of malocclusion were attributed to failed repairs of other concurrent facial fractures. Three patients reported TMJ pain. Conclusions Extracorporealization of the condylar segment with EVRO to facilitate open treatment of condylar fractures is a viable treatment option when more conventional approaches prove unsuccessful.
Collapse
Affiliation(s)
- Max R. Emmerling
- Division of Oral and Maxillofacial
Surgery, Cook County Health, Chicago, IL, USA
| | - Meghan LaVigne
- Department of Oral and
Maxillofacial Surgery, University of Maryland Medical
Center, Baltimore, MD, USA
| | - Gary Warburton
- Department of Oral and
Maxillofacial Surgery, University of Maryland
Baltimore, Baltimore, MD, USA
| | - John F. Caccamese
- Department of Oral and
Maxillofacial Surgery, University of Maryland
Baltimore, Baltimore, MD, USA
| | - Robert A. Ord
- Department of Oral and
Maxillofacial Surgery, University of Maryland
Baltimore, Baltimore, MD, USA
| |
Collapse
|
2
|
Muacevic A, Adler JR, Rajiah D, Kamalakaran A, Thirunavukkarasu R, Palani T. Evaluation of Mini-Preauricular Incision in the Surgical Management of Condylar Fracture. Cureus 2022; 14:e31725. [PMID: 36569739 PMCID: PMC9769360 DOI: 10.7759/cureus.31725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Mandibular fractures have the highest incidence next to nasal bone fractures of which condylar fractures account for one-third of it. Various approaches for condylar fracture include intraoral and extraoral approaches such as coronal, preauricular, postauricular, endaural, endoscopic, rhytidectomy, transparotid, submandibular, and retromandibular approaches. The purpose of this study was to evaluate the mini-preauricular incision in open reduction and internal fixation of condylar and subcondylar fractures of the mandible. Materials and methods Twenty patients with condylar fracture underwent open reduction and internal fixation under general anesthesia using a modified mini-preauricular incision and subdermal dissection approach. Parameters assessed were pain, mouth opening, occlusal derangement, accessibility of fracture site, duration of surgery, neurosensory deficit (facial nerve), postoperative edema, wound infection, wound dehiscence, and scar. Patients were followed up at an interval of one week, one month, three months, and six months. Results On comparing the parameters preoperatively and postoperatively, occlusal derangement, mouth opening, and pain showed statistical significance with a p-value of 0.01, while nerve weakness and scar assessment showed a high level of statistical significance with a p-value of 0.001. The anatomical reduction of the condyle and internal fixation with miniplates was easy when this approach was used. Patients showed transient facial nerve paralysis only. No permanent damage was noted. The resultant scar was aesthetically acceptable. Discussion The mini-preauricular approach is an effective and safe technique for open reduction and internal fixation of condylar and subcondylar fractures. This approach provided good access, good cosmetic results, and patient satisfaction. This approach resulted in very less morbidity to the facial nerve.
Collapse
|
3
|
Extraoral versus endoscopic-assisted transoral treatment modalities for mandibular condylar fractures: a current opinion. Arch Plast Surg 2021; 48:720-722. [PMID: 34818723 PMCID: PMC8627939 DOI: 10.5999/aps.2021.00731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/30/2021] [Indexed: 11/25/2022] Open
|
4
|
Buller J, Noetzel N, Kröger N, Zöller JE, Zirk M. Outcomes of the Nonendoscopic Transoral Approach to Subcondylar Mandible Fractures. J Oral Maxillofac Surg 2021; 80:114-120. [PMID: 34453908 DOI: 10.1016/j.joms.2021.07.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 07/23/2021] [Accepted: 07/23/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The transoral approach (TRA) to subcondylar fractures without any endoscopic or transbuccal assistance is not a common technique. The purpose of this study was to measure and compare the quality of open reduction and internal fixation (ORIF) between the TRA and the retromandibular approach (RMB), including types and frequencies of postoperative complications. METHODS In our retrospective cohort study, we enrolled a sample of patients with displaced subcondylar mandible fractures treated by ORIF. The predictor was the approach mode: TRA or RMB. In postoperative computed tomography (CT) data sets, we measured the angles of the condylar process in relation to references: 1) midline, 2) lateral ramus border, and 3) posterior ramus border. The primary outcome variable was the reduction outcome, which was calculated as the difference between the total of all angles of the operated side and the non-affected side. Secondary outcomes were postoperative complications extracted from patients' files. Other variables were age, gender, number of plates, operation time and a modified AO trauma score. In bivariate analysis, we compared the outcome between both groups. RESULTS Sixty-four patients were included in total, with TRA performed in 50%. Patients with TRA were younger (31 vs 41, P = .003), and the trauma score was lower (1.9 vs 3.3, P < .001). Reduction outcome remained comparable between both techniques (mean 3.7° for both, P = .92). Complication rates were similar, although facial nerve palsy was absent for TRA (0 vs 4, P = .039). CONCLUSION We suggest TRA for selected patients with displaced, single fragmented subcondylar fractures. Reduction outcome shows a comparable exactness to RMB, while TRA is safer for the facial nerve.
Collapse
Affiliation(s)
- Johannes Buller
- Consultant, Department of Oral and Craniomaxillofacial and Plastic Surgery; Received from University of Cologne, Cologne, Germany.
| | - Nicolas Noetzel
- Resident, Department of Oral and Craniomaxillofacial and Plastic Surgery; Received from University of Cologne, Cologne, Germany
| | - Nadja Kröger
- Resident, Department of Oral and Craniomaxillofacial and Plastic Surgery; Received from University of Cologne, Cologne, Germany
| | - Joachim E Zöller
- Professor and Head, Department of Oral and Craniomaxillofacial and Plastic Surgery; Received from University of Cologne, Cologne, Germany
| | - Matthias Zirk
- Consultant, Department of Oral and Craniomaxillofacial and Plastic Surgery
| |
Collapse
|
5
|
Johner JP, Essig H, Neff A, Wagner MEH, Blumer M, Gander T. Volumetric Evaluated Bone Resorption After Open Reduction and Internal Fixation of Condylar Head Fractures of the Mandible. J Oral Maxillofac Surg 2021; 79:1902-1913. [PMID: 34062130 DOI: 10.1016/j.joms.2021.04.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/15/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Decision making in the management of condylar head fractures remains difficult due to its dependency on multiple factors like fracture type, degree of dislocation, patient`s age and dental condition. As open reduction and internal fixation (ORIF) of condylar head fractures (CHFs) becomes more popular, the question of osteosynthesis removal is controversial. So far, information on volumetric changes after ORIF are available for a short-term period (<6 months) only. This study, therefore, was performed to assess bone resorption after condylar head fractures and to follow-up intermediate-term (>1 year) remodelling after removal of metallic osteosynthesis material. Furthermore clinical outcome was measured using Helkimo Index and put in relation with bone resorption. MATERIALS AND METHODS A retrospective analysis of 19 patients who underwent open reduction and internal fixation of condylar head fractures at the University Hospital of Zürich between January 2016 and April 2018 using intraoperative cone-beam computed tomography repositioning control was conducted. The bone resorption on the condylar head was measured in the course after removal of osteosynthesis material by segmenting and superimposing of the postoperative 3D radiologic follow-up exam (T2) over the initial intraoperative cone-beam computed tomography (T1) using iPlan-CMF software. Complementary Helkimo index was assessed to put resorption rate in relation to clinical outcome. RESULTS A total of 19 patients fulfilled the inclusion criteria. The mean follow-up time was 15.6 months and the mean bone resorption on the condylar head was -0.348cm3 or -15.29% of segmented condylar head. There was no correlation of clinical outcome and bone resorption. CONCLUSIONS Helkimo index showed satisfying results; therefore, ORIF of condylar head fracture proves as a feasible treatment option. The mean bone resorption rate of -15.29% in the intermediate-term follow-up time (mean 15.6 months) is comparable to findings of other studies with short-term follow-up time (< 6 months). Thus, postinterventional remodeling activity and resorption seems highest in the first 4 to 6 postoperative months with little further resorption. In prevention of negative sequelae of protruding implants, timing of osteosynthesis material removal after this period of high bone remodeling activity is recommended. The resorption rate showed no correlation to clinical outcome.
Collapse
Affiliation(s)
- Jean-Pierre Johner
- Resident, Department of Craniomaxillofacial Surgery, University Hospital Zürich, Switzerland.
| | - Harald Essig
- Senior physician, Department of Craniomaxillofacial Surgery, University Hospital Zürich, Switzerland
| | - Andreas Neff
- Professor, Department of Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg, Germany
| | - Maximilian E H Wagner
- Attending physician, Department of Craniomaxillofacial Surgery, University Hospital Zürich, Switzerland
| | - Michael Blumer
- Attending physician, Department of Craniomaxillofacial Surgery, University Hospital Zürich, Switzerland
| | - Thomas Gander
- Senior physician, Department of Craniomaxillofacial Surgery, University Hospital Zürich, Switzerland
| |
Collapse
|
6
|
Cavalcanti SCSXB, Taufer B, Rodrigues ADF, Luz JGDC. Endoscopic surgery versus open reduction treatment of mandibular condyle fractures: A meta-analysis. J Craniomaxillofac Surg 2021; 49:749-757. [PMID: 33663963 DOI: 10.1016/j.jcms.2021.02.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 08/30/2020] [Accepted: 02/18/2021] [Indexed: 10/22/2022] Open
Abstract
The aim of the study was to compare open reduction with internal fixation (ORIF) and endoscopic open reduction with internal fixation (EORIF) of condylar fractures (CF) in adults in terms of reducing both needing of reoperation and/or facial nerve injury. An electronic search was undertaken (PubMed/MEDLINE, Web of Science, SCOPUS, and The Cochrane Library). The inclusion criteria were full text, published from their inception to June 2020, clinical trials, randomized or not, and retrospective studies, that compared ORIF and EORIF. The estimates of an intervention were expressed as the risk ratio (RR). From the 1338 articles found, 5 publications were included. There was no statistically significant difference between ORIF and EORIF regarding needing of reoperation (RR = 2.46, p = 0.42) or facial nerve injury (RR = 0.45, p = 0.14). Meta-analysis suggests that there is no difference between open reduction with internal fixation (ORIF) and endoscopic open reduction with internal fixation (EORIF) of condylar fractures (CF) regarding facial nerve injury risk or need for reoperation.
Collapse
Affiliation(s)
- Samantha Cristine Santos Xisto Braga Cavalcanti
- Department of Maxillofacial Surgery, Prosthetics and Traumatology, School of Dentistry, Universidade de São Paulo (USP), Sao Paulo, Brazil; School of Dentistry, Centro Universitário Das Faculdades Metropolitanas Unidas (FMU), Sao Paulo, Brazil.
| | - Bianca Taufer
- School of Dentistry, Centro Universitário Das Faculdades Metropolitanas Unidas (FMU), Sao Paulo, Brazil
| | - Alex de Freitas Rodrigues
- Department of Maxillofacial Surgery, Prosthetics and Traumatology, School of Dentistry, Universidade de São Paulo (USP), Sao Paulo, Brazil
| | - João Gualberto de Cerqueira Luz
- Department of Maxillofacial Surgery, Prosthetics and Traumatology, School of Dentistry, Universidade de São Paulo (USP), Sao Paulo, Brazil
| |
Collapse
|
7
|
Ghezta NK, Ram R, Bhardwaj Y, Sreevidya Sasidhar, Sharma M, Bhatt R. Operator Experience and Fracture Location Affects the Rate of Facial Nerve Injury in Condylar Fractures: An Analysis of 89 Cases. J Oral Maxillofac Surg 2020; 79:1104.e1-1104.e9. [PMID: 33515504 DOI: 10.1016/j.joms.2020.12.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 12/23/2020] [Accepted: 12/24/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study was to measure the frequency and identify risk factors for facial nerve injury (FNI) in the open treatment of condylar neck and subcondylar fractures. MATERIALS AND METHODS A prospective cohort study was conducted over 5 years on patients who were treated surgically for mandibular condylar fractures using the retomandibular transparotid approach (RMTA). The primary result was FNI occurrence (yes/no). The predictor variables were demographic, fracture location, and pattern (dislocation, present or not), as well as surgeon experience. Post-treatment functional facial nerve changes were initially assessed in the operating room as the patient regained consciousness and documented thereafter within, the 1st and 3rd weeks, and 3rd and 6th months. Appropriate statistics were computed and, SPSS version 16 was used to analyze the data. χ2 test and Fisher exact test were used to assess significance (P ≤ 0.05). RESULTS Eighty-nine patients with 102 condylar fractures (63 subcondylar and 26 condylar neck), with a mean age of 28.5±7.5 years and 91% men were evaluated. There were 15 subjects (16.8%) with FNI and among them 6 subjects had persistent facial weakness for 6-8 weeks that completely resolved within 3 months, with no permanent facial nerve paralysis. The marginal mandibular (n = 7), buccal (n = 6), and zygomatic (n = 2) were the facial nerve branches involved. Risk factors for FNI were operator' inexperience, fracture-dislocation, and condylar neck fracture to the site and location of the fracture. Multivariate logistic regression showed that the location of the fracture at neck level (0.030∗), fracture dislocation (<0.001∗), and operator's inexperience (0.003∗) were significant risk factors for postoperative facial nerve injury (P ≤ 0.05). CONCLUSIONS If conducted properly, the RMTA is a safe method for treating condylar fractures with rare major complications; however, fracture dislocation, fractured condylar neck, and operator' in-experience were significantly associated with increased risk of developing transient postoperative FNI.
Collapse
Affiliation(s)
- Narotam Kumar Ghezta
- Assistant Professor, Department of Oral & Maxillofacial Surgery, H.P.Govt. Dental College & Hospital, Shimla, Himachal Pradesh, India.
| | - Rangila Ram
- Professor, Department of Oral & Maxillofacial Surgery, H.P.Govt. Dental College & Hospital, Shimla, Himachal Pradesh, India
| | - Yogesh Bhardwaj
- Professor and Head, Department of Oral & Maxillofacial Surgery, H.P.Govt. Dental College & Hospital, Shimla, Himachal Pradesh, India
| | - Sreevidya Sasidhar
- Postgraduate residents, Department of Oral & Maxillofacial Surgery, H.P.Govt. Dental College & Hospital, Shimla, Himachal Pradesh, India
| | - Manish Sharma
- Postgraduate residents, Department of Oral & Maxillofacial Surgery, H.P.Govt. Dental College & Hospital, Shimla, Himachal Pradesh, India
| | - Ravi Bhatt
- Postgraduate residents, Department of Oral & Maxillofacial Surgery, H.P.Govt. Dental College & Hospital, Shimla, Himachal Pradesh, India
| |
Collapse
|
8
|
Does Dynamic Intermaxillary Fixation With Elastics Improve Outcomes Following Unilateral Condylar Fracture? J Oral Maxillofac Surg 2020; 79:192-199. [PMID: 33011163 DOI: 10.1016/j.joms.2020.08.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/28/2020] [Accepted: 08/28/2020] [Indexed: 11/23/2022]
Abstract
PURPOSE The use of rigid versus semi-rigid intermaxillary fixation (IMF) following subcondylar fractures is controversial. This study aims to investigate whether the "dynamic" elastic fixation technique improves the outcomes, compared to the rigid fixation technique for the treatment of displaced subcondylar fractures in adults. MATERIALS AND METHODS This nonblinded randomized clinical trial was performed on adult patients with unilateral displaced mandibular subcondylar fractures. Patients were randomly allocated into two groups (n = 17). The primary predictor variable was wire versus elastic IMF. Changes in primary (mouth opening) and secondary (other clinical and radiological) outcomes were recorded. Data were analyzed with the t test and Mann-Whitney test with SPSS software version 20. P-value < .05 considered as significant. RESULTS In this study 34 patients (with mean age of 33.03 ± 1.79, 23.5% females & 76.5% males) in two groups (Elastics & Wire) followed up to 6 months. The Elastics group showed significant improvement in mouth opening (primary outcome) after 1 month of follow-up, but the differences were not significant at the end of the study. In terms of secondary outcomes, the ramus height shortening compared to the opposite side revealed favorable improvement in the Elastics group in the period of study. The differences between the two groups in the lateral movement and protrusive movement were significant in favor of the Elastics group. The differences in pain, fracture displacement, and midline deviation between study groups were not significant at the end of the study. Just 1 case with malocclusion was observed in the Wire group. Patients were more satisfied with dynamic nonrigid IMF with elastics. CONCLUSIONS The results of this study showed that using the dynamic IMF technique is more tolerable, and patients have better functional and clinical outcomes during and at the end treatment.
Collapse
|
9
|
Sinha A, Natarajan S. Comparative Evaluation of Clinical and Radiological Outcomes of Retromandibular Transparotid and Transoral Endoscopic-Assisted Approach for Surgical Management of Mandibular Subcondylar Fractures. Craniomaxillofac Trauma Reconstr 2020; 14:90-99. [PMID: 33995829 DOI: 10.1177/1943387520949099] [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] [Indexed: 11/16/2022] Open
Abstract
Study Design A prospective randomized comparative study was conducted to evaluate the clinical and radiological outcomes of the retromandibular transparotid (RMT) approach with endoscopic-assisted transoral (ENDO) approach used for open reduction and internal fixation (ORIF) of adult mandibular subcondylar fractures. Objectives To evaluate and compare the primary functional outcome using the Helkimo's dysfunction index, the surgical ease, the incidence of facial nerve weakness, the cosmetic outcomes and the number of complications following ORIF of mandibular subcodylar fractures using the RMT and ENDO approaches. Methods In this prospective study, 20 patients with unilateral/bilateral subcondylay fractures requiring ORIF were recruited between 2017 and 2018. Patients were randomly divided into RMT and ENDO group, 10 patients in each. Clinical and radiological assessment was done preoperatively and in postoperative period it was done at different intervals over the period of 6 months. The intraoperative parameter time taken during surgery was correlated for association with the time elasped since day of trauma and with the fracture severity. Similarly, the presence of multiple fractures of the mandible and postoperative occlusion were evaluated for the association. Results Comparable functional results were noted in both groups without any statistical significance. ORIF in ENDO group proved to be more time-consuming. For the RMT group, visible scars were rated best or close to best at the end of 6 months but a greater number of facial nerve injuries were reported in the RMT group. Conclusions Superiority of one approach over others cannot be established since the outcomes were not statistically different. However, the ENDO approach appears to be safer. Therefore, there is a need for the development of innovative armamentarium which would improve the dexterity and ease of the surgeon and hence the total time taken for this minimally invasive approach for the management of subcondylar fracture.
Collapse
Affiliation(s)
- Ajit Sinha
- Department of Oral and Maxillofacial Surgery, MGM Dental College and Hospital, Navi Mumbai, Maharashtra, India
| | - Srivalli Natarajan
- Department of Oral and Maxillofacial Surgery, MGM Dental College and Hospital, Navi Mumbai, Maharashtra, India
| |
Collapse
|
10
|
Endoscopically Assisted Open Reduction and Internal Fixation of Sub-Condylar Fractures: Debunking Some of the Myths. J Craniofac Surg 2020; 31:1727-1730. [PMID: 32371709 DOI: 10.1097/scs.0000000000006480] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Endoscopically assisted open reduction and internal fixation has cumulate advantages over both open and closed techniques. Even though, this approach had not become popular. The study intended to summarize the outcomes and complications from the first 12 consecutive cases of sub condylar fractures that treated by endoscope and trans-buccal trocar. All patients experienced improvement in mouth opening. No postoperative malocclusion was noticed. The learning curve was assessed subjectively regarding the use of the endoscope and objectively by operating time reduction. The significant decrease in operating time and the ease of handling the endoscope were already noticed after the 5th operation. The mean time for endoscopically assisted open reduction and internal fixation in our study was 180 minutes, which was the same as for external approaches open reduction and internal fixation for sub-condylar fracture cases. No special designed instruments except an endoscope and a trans-buccal trocar were used. We can conclude that the learning curve for this technique is not as steep as it was thought to be, and it can be mastered after a relatively small number of operations. There is no difference in mean operation time comparing to external approaches. No need for special designed instruments.
Collapse
|
11
|
Ambrose E, Sokoya M, Eustaquio M. Pseudoaneurysm Following Endoscopic-Assisted Repair of Subcondylar Fracture. Craniomaxillofac Trauma Reconstr 2018; 11:302-304. [PMID: 30574274 DOI: 10.1055/s-0037-1607064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 06/17/2017] [Indexed: 10/18/2022] Open
Abstract
Pseudoaneurysms are a known complication following facial trauma and orthognathic surgery. Few reports exist of this clinical entity following traditional open techniques of repair, and none have been associated with endoscopic-assisted open reduction and internal fixation (ORIF) of a subcondylar fracture. We present a case of a 33-year-old man who developed pseudoaneurysm after endoscopic-assisted ORIF as well as a review of the literature on this topic. While uncommon, this is a potential complication that should be recognized with the use of endoscopic-assisted repair of mandibular fractures.
Collapse
Affiliation(s)
- Emily Ambrose
- Department of Otolaryngology, University of Colorado, Aurora, Colorado
| | | | - Marcia Eustaquio
- Department of Otolaryngology, Denver Health and Hospital Authority, Denver, Colorado
| |
Collapse
|
12
|
Anehosur V, Joshi A, Rajendiran S. Endoscopic-Assisted Intraoral Open Reduction Internal Fixation of Mandibular Subcondylar Fractures: Initial Experiences from a Tertiary-Care Maxillofacial Center in India. Craniomaxillofac Trauma Reconstr 2018; 11:183-191. [PMID: 30087747 DOI: 10.1055/s-0037-1603457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 02/18/2017] [Indexed: 01/20/2023] Open
Abstract
Management of condylar fractures is a highly controversial and debatable area. Open reduction and internal fixation (ORIF) using an extraoral approach has certain benefits over the nonsurgical treatment. Risk of damage to the facial nerve and an extraoral scar remains constant deterrents. An endoscopic-assisted ORIF offers an intraoral approach, thus eliminating consequences such as scarring. Though this technique offers unparalleled advantages, it is associated with a steep learning curve. Surgical results improve only with patience and experience. Patients with condylar fractures reported to SDM Craniofacial Unit, Dharwad, India, from 2013 to 2015 are included. Patients were treated with endoscopic-assisted ORIF and were evaluated for functional outcomes that included occlusion, maximal interincisal opening, and deviation of mouth and complications such as facial nerve pareses, postsurgical infection, and morbidity. Fifteen patients included in the study: 4 left sided and 11 right sided fractures. Nine patients had associated other mandibular fracture. Mean age of the patients was 28.2 years. Mean mouth opening at the end of 1 week, 6 weeks, and 6 months was 32.6, 37.8, and 40.5 mm, respectively. Transient facial nerve pareses were noted in one patient, and an extraoral draining sinus was noted in another. Endoscopic-assisted ORIF has a definite scope in management of condylar fractures. Results are more predictable with appropriate case selection due to a steep learning curve and intraoperative technical challenges. An initial experience in ORIF using extraoral approaches would greatly benefit a surgeon in utilizing this novel and alternate tool.
Collapse
Affiliation(s)
- Venkatesh Anehosur
- SDM Craniofacial Unit, SDM College of Dental Sciences and Hospital, Dharwad, Karnataka, India
| | - Abhijit Joshi
- SDM Craniofacial Unit, SDM College of Dental Sciences and Hospital, Dharwad, Karnataka, India
| | - Saravanan Rajendiran
- Department of Dentistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Gorimedu, Puducherry, India
| |
Collapse
|
13
|
Wagner F, Strasz M, Traxler H, Schicho K, Seemann R. Evaluation of an experimental oblique plate for osteosynthesis of mandibular condyle fractures. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 124:537-541. [PMID: 29056288 DOI: 10.1016/j.oooo.2017.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 08/04/2017] [Accepted: 09/14/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aim of this study was to test the bone thickness and potential screw length for osteosynthesis of condylar base fractures (according to the Loukota classification) with an experimental titanium plate, placed in an ideal position against 2 types of conventional plates. STUDY DESIGN After exclusion of completely edentulous mandibles, 28 dentate macerated mandibles available at the time of the study were included. Linear regression models 1 and 2 compared the sums of the 2 cranial bone thicknesses and the 3 caudal thicknesses among the 3 different plate designs, and linear models 3 and 4 tested the bone thickness in the 2 most cranial screw axes. RESULTS Linear models 1 and 2 revealed significantly higher potential screw lengths for the experimental oblique plate. Equally, linear models 3 and 4 indicated significantly higher bone thickness for the novel oblique plate. CONCLUSION The novel proposed oblique plate allows for favorable plate positioning in a biomechanically ideal location with sufficient amounts of local bone for stable plate fixation. When plates with 15-degree angulated screw holes are used, stable bicortical plate fixation can be achieved.
Collapse
Affiliation(s)
- Florian Wagner
- University Clinic for Cranio- and Maxillofacial Surgery, Medical University of Vienna, Vienna, Austria.
| | - Martin Strasz
- University Clinic for Cranio- and Maxillofacial Surgery, Medical University of Vienna, Vienna, Austria
| | - Hannes Traxler
- Department for Systematic Anatomy, Medical University of Vienna, Vienna, Austria
| | - Kurt Schicho
- University Clinic for Cranio- and Maxillofacial Surgery, Medical University of Vienna, Vienna, Austria
| | - Rudolf Seemann
- University Clinic for Cranio- and Maxillofacial Surgery, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
14
|
Kommers SC, Boffano P, Forouzanfar T. Consensus or controversy? The classification and treatment decision-making by 491 maxillofacial surgeons from around the world in three cases of a unilateral mandibular condyle fracture. J Craniomaxillofac Surg 2015; 43:1952-60. [DOI: 10.1016/j.jcms.2015.08.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 08/07/2015] [Accepted: 08/31/2015] [Indexed: 10/23/2022] Open
|
15
|
|
16
|
Cortelazzi R, Altacera M, Turco M, Antonicelli V, De Benedittis M. Development and Clinical Evaluation of MatrixMANDIBLE Subcondylar Plates System (Synthes). Craniomaxillofac Trauma Reconstr 2015; 8:94-9. [PMID: 26000078 PMCID: PMC4428734 DOI: 10.1055/s-0034-1395382] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 07/09/2014] [Indexed: 01/24/2023] Open
Abstract
In this article, authors report the different steps of development and clinical validation of MatrixMANDIBLE Subcondylar Plates (Synthes, Soletta, Switzerland), a specialized osteosynthesis system developed by Synthes during the past 4 years. Between 2009 and 2013, a total of 62 patients were treated for subcondylar and condylar neck fractures via a preauricular or retromandibular/transparotid approach. The MatrixMANDIBLE Subcondylar Plates System consists of a Trapezoidal Plate, a three-dimensional (3D) 4-hole 1.0-mm plate for smaller fracture areas, the Lambda Plate, a 7-hole 1.0-mm linear plate which mimics the two miniplates technique, and the Strut Plate, a 3D 1.0-mm plate with great versatility of employment. All devices satisfy the principles of a functionally stable osteosynthesis as stated by Champy et al. None of the plates broke and no macroscopic condylar displacement was noted on radiological follow-up. Clinical and functional parameters assessed at 6 months postoperative (mandibular range of motion, pain, dental occlusion) were almost restored. MatrixMANDIBLE Subcondylar Plates System (Synthes) has proved to provide sufficient mechanical stiffness and anatomically accurate fracture reduction to avoid major postoperative drawbacks of subcondylar and condylar neck fractures.
Collapse
Affiliation(s)
- Roberto Cortelazzi
- Department of Maxillo-facial Surgery, General Regional Hospital “F. Miulli,” Bari, Italy
- Gradute School of Maxillo-facial Surgery, University of Bari, Bari, Italy
| | - Mario Altacera
- Department of Maxillo-facial Surgery, General Regional Hospital “F. Miulli,” Bari, Italy
| | - Monica Turco
- Department of Maxillo-facial Surgery, General Regional Hospital “F. Miulli,” Bari, Italy
| | | | | |
Collapse
|
17
|
Shi D, Patil PM, Gupta R. Facial nerve injuries associated with the retromandibular transparotid approach for reduction and fixation of mandibular condyle fractures. J Craniomaxillofac Surg 2015; 43:402-7. [DOI: 10.1016/j.jcms.2014.12.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 12/10/2014] [Accepted: 12/11/2014] [Indexed: 11/16/2022] Open
|
18
|
Position paper from the IBRA Symposium on Surgery of the Head – The 2nd International Symposium for Condylar Fracture Osteosynthesis, Marseille, France 2012. J Craniomaxillofac Surg 2014; 42:1234-49. [DOI: 10.1016/j.jcms.2014.03.005] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 12/20/2013] [Accepted: 03/10/2014] [Indexed: 11/18/2022] Open
|
19
|
Bhutia O, Kumar L, Jose A, Roychoudhury A, Trikha A. Evaluation of facial nerve following open reduction and internal fixation of subcondylar fracture through retromandibular transparotid approach. Br J Oral Maxillofac Surg 2013; 52:236-40. [PMID: 24370443 DOI: 10.1016/j.bjoms.2013.12.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 12/01/2013] [Indexed: 11/28/2022]
Abstract
The objective of this study was to evaluate any damage to the facial nerve after a retromandibular transparotid approach for open reduction and internal fixation (ORIF) of a subcondylar fracture. We studied 38 patients with 44 subcondylar fractures (3 bilateral and 38 unilateral) treated by ORIF through a retromandibular transparotid approach. All patients were followed up for 6 months. Postoperative function of the facial nerve was evaluated within 24h of operation, and at 1, 3, and 12 weeks, and 6 months. Variables including type of fracture, degree of mouth opening, postoperative occlusion, lateral excursion of the mandible, and aesthetic outcome were also monitored. Nine of the 44 fractures resulted in transient facial nerve palsy (20%). Branches of the facial nerve that were involved were the buccal (n=7), marginal mandibular (n=2), and zygomatic (n=1). In the group with lateral displacement, 2/15 showed signs of weakness, whereas when the fracture was medially displaced or dislocated 7/23 showed signs of weakness. Of the 9 sites affected, 7 had resolved within 3 months, and the remaining 2 resolved within 6 months. The mean (range) time to recovery of function was 12 weeks (3-6 months). There was no case of permanent nerve palsy. The retromandibular transparotid approach to ORIF does not permanently damage the branches of the facial nerve. Temporary palsy, though common, resolves in 3-6 months. Postoperative occlusion, mouth opening, and lateral excursion of the mandible were within the reference ranges. We had no infections, or fractured plates, or hypertrophic or keloid scars.
Collapse
Affiliation(s)
- Ongkila Bhutia
- Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi 110029, India.
| | - Lalit Kumar
- Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Anson Jose
- Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Ajoy Roychoudhury
- Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Anjan Trikha
- Department of Anaesthesia, All India Institute of Medical Sciences, New Delhi 110029, India
| |
Collapse
|
20
|
Analysis of Complications Following Endoscopically Assisted Treatment of Mandibular Condylar Fractures. J Craniofac Surg 2012; 23:e196-8. [DOI: 10.1097/scs.0b013e31824de328] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
21
|
|
22
|
Biomechanical Study of the Delta Plate and the TriLock Delta Condyle Trauma Plate. J Oral Maxillofac Surg 2011; 69:2619-25. [DOI: 10.1016/j.joms.2011.01.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2009] [Revised: 11/29/2010] [Accepted: 01/04/2011] [Indexed: 11/20/2022]
|
23
|
Park JM, Jang YW, Kim SG, Park YW, Rotaru H, Baciut G, Hurubeanu L. Comparative Study of the Prognosis of an Extracorporeal Reduction and a Closed Treatment in Mandibular Condyle Head and/or Neck Fractures. J Oral Maxillofac Surg 2010; 68:2986-93. [DOI: 10.1016/j.joms.2010.02.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Revised: 11/07/2009] [Accepted: 02/23/2010] [Indexed: 10/19/2022]
|
24
|
Meng F, Hu K, Kong L, Zhao Y, Liu Y, Zhou S. Veterinary and radiological evaluations of open and closed treatment of type B diacapitular (intracapsular) fractures of the mandibular condyle in sheep. Br J Oral Maxillofac Surg 2010; 48:448-52. [DOI: 10.1016/j.bjoms.2009.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2008] [Accepted: 08/02/2009] [Indexed: 10/20/2022]
|
25
|
Gerbino G, Boffano P, Tosco P, Berrone S. Long-term clinical and radiological outcomes for the surgical treatment of mandibular condylar fractures. J Oral Maxillofac Surg 2009; 67:1009-14. [PMID: 19375010 DOI: 10.1016/j.joms.2008.06.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2008] [Accepted: 06/02/2008] [Indexed: 10/20/2022]
Abstract
PURPOSE This retrospective study evaluated the long-term results and complications of open reduction and internal fixation of displaced and dislocated fractures of the condylar process. PATIENTS AND METHODS Two hundred four patients were treated via various surgical approaches between 1991 and 2005. Fifty patients with a total of 57 treated condylar fractures who underwent complete clinical and radiological documentation were included in this study. Follow-up clinical and radiological evaluations were carried out after an average period of 88 months. RESULTS We found that 12% of our patients reported temporary weakness of the facial nerve and 4% had mild permanent facial nerve palsy. Clinical and radiological assessment showed satisfactory recovery of facial symmetry. Excellent recovery of function was observed, and very few patients complained of temporomandibular joint-related symptoms. Severe condylar remodeling was observed in 8% of the patients, 47% showed slight or moderate remodeling, and 45% showed no remodeling. A statistically significant association was observed between the presence of condylar remodeling and poor mouth opening at the follow-up examination. CONCLUSIONS Surgical treatment of condylar fractures, in association with postoperative functional therapy, promotes the recovery of function, occlusion, and facial symmetry with few complications. However, some difficulties remain related to the surgeon, the patient, and the objective complexity of this pathology.
Collapse
Affiliation(s)
- Giovanni Gerbino
- Division of Maxillofacial Surgery, Head and Neck Department, San Giovanni Battista Hospital, University of Turin, Turin, Italy
| | | | | | | |
Collapse
|
26
|
Abstract
Management of condylar fractures remains a source of ongoing controversy. While it appears that many condylar fractures can be managed nonsurgically, recognition of cases that require surgical intervention and selection of an appropriate procedure are paramount to success in treating these injuries. There are a variety of special considerations that are peculiar to the condylar region. This article discusses anatomic considerations, classification of condylar fractures, indications for surgery, treatment options, and complications. The goals of treatment include restoration of function and esthetics. Careful consideration and attention to the principles of fracture management, and the role of the condyle as an articulating unit and growth center, must be taken into account for the successful management of these injuries.
Collapse
Affiliation(s)
- André H Montazem
- Division of Oral and Maxillofacial Surgery, Mount Sinai School of Medicine, New York, NY 10022, USA.
| | | |
Collapse
|
27
|
Transoral endoscopic-assisted management of subcondylar fractures in 17 patients: An alternative to open reduction with rigid internal fixation and closed reduction with maxillomandibular fixation. Int J Oral Maxillofac Surg 2009; 38:19-25. [DOI: 10.1016/j.ijom.2008.11.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2007] [Revised: 05/06/2008] [Accepted: 11/13/2008] [Indexed: 11/24/2022]
|
28
|
Veras RB, Kriwalsky MS, Eckert AW, Schubert J, Maurer P. Long-Term Outcomes After Treatment of Condylar Fracture by Intraoral Access: A Functional and Radiologic Assessment. J Oral Maxillofac Surg 2007; 65:1470-6. [PMID: 17656270 DOI: 10.1016/j.joms.2006.07.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2006] [Accepted: 07/20/2006] [Indexed: 11/16/2022]
Abstract
PURPOSE The aim of the present study was to investigate radiographic and functional long-term results after condylar fractures have been reduced by an exclusively intraoral surgical approach. PATIENTS AND METHODS A total of 25 (21 male, 4 female) consecutive patients with 30 condylar process fractures were retrospectively investigated. Clinical follow-up was performed in 19 patients (16 male, 3 female) with a total of 24 fractures. Median postoperative follow-up time was 19.7 months. Surgical indications followed specific parameters of fracture localization, dislocation, and ramus shortening. All patients were examined in accordance with the Research Diagnostic Criteria for Temporomandibular Dysfunction (RDC/TMD) and the Helkimo Index. Orthopantomograms (OPGs) were analyzed with use of the condylar morphologic scale (CMS), and mandibular ramus position and height were measured. RESULTS Fractures were classified as condylar neck (n = 2) and basis fractures (n = 28), according to criteria of the Strasbourg Osteosynthesis Research Group (SORG). Mean age of patients was 33 years (standard deviation [SD], 13 yr). RDC/TMD measurements at follow-up showed a mean mouth opening of 48 mm (SD, 9), mandibular laterotrusion right of 11 mm (SD, 3.8), laterotrusion left of 10 mm (SD, 4.5), and protrusion with a mean of 5.83 mm (SD, 3). No joint clicking, weakness of the facial nerve, or joint or muscular pain was observed. Statistical analysis of the CMS showed significantly better postoperative ramus height (P < .05). CONCLUSION Reduction achieved by this technique allows reconstruction of anatomic ramus height in combination with excellent functional results.
Collapse
Affiliation(s)
- Rafael Block Veras
- Department of Oral and Plastic Maxillofacial Surgery, Martin Luther University Halle-Wittenberg, Halle, Germany.
| | | | | | | | | |
Collapse
|
29
|
Meyer C, Zink S, Wilk A. La voie d’abord sous-angulo-mandibulaire haute (voie de Risdon modifiée) pour le traitement des fractures sous-condyliennes de la mandibule. ACTA ACUST UNITED AC 2006; 107:449-54. [PMID: 17194998 DOI: 10.1016/s0035-1768(06)77086-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- C Meyer
- Service de Stomatologie et de Chirurgie Maxillo-faciale, CHU de Besançon, France.
| | | | | |
Collapse
|
30
|
Meningaud JP, Pitak-Arnnop P, Bertrand JC. Endoscope-assisted submandibular sialoadenectomy: a pilot study. J Oral Maxillofac Surg 2006; 64:1366-70. [PMID: 16916670 DOI: 10.1016/j.joms.2006.05.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2005] [Indexed: 11/22/2022]
Abstract
PURPOSE To describe an endoscopic technique for submandibular sialoadenectomy in humans, as well as the equipment, instrumentation, and pertinent anatomy. MATERIALS AND METHODS Six submandibular sialoadenectomies were carried out in 5 patients (3 women, 2 men; mean age, 26.6 years; range, 16 to 42 years) via a 15 to 20 mm neck incision for insertion of the endoscopic camera and surgical instruments. RESULTS All operations were successful without conversion to an open surgery. Operative time was 20 to 120 minutes (mean, 65 minutes). All patients were discharged the day after surgery. There were no postoperative complications (hematoma, nerve injury, infection). All patients experienced a mild degree of edema, which had resolved totally at the 6-month follow-up visit. All patients were satisfied with the outcome and especially the cosmetic result. CONCLUSIONS Absence of extensive scars, nontraumatic dissection, and magnification of anatomic structures are the most obvious advantages of this innovative technique.
Collapse
Affiliation(s)
- Jean-Paul Meningaud
- Department of Maxillofacial Surgery, Pitié-Salpêtrière Hospital, Paris, France.
| | | | | |
Collapse
|
31
|
|
32
|
Abstract
In 1948, Dr Kurt H Thoma, a leading authority of the day, published a paper on new methods for immobilization of the mandible in the first issue of this Journal. He reviewed the state of the art for management of patients with fractures of the mandible. By reviewing the paper now we can see how difficult to treat some of the injuries he saw were. This paper assesses his patient management in light of today's knowledge and experience. It discusses changes in therapy that have occurred during this over fifty-year time span. Although many things have changed since then, what has not changed is our desire to provide the best care for our patients using currently available scientific knowledge and clinical evidence.
Collapse
Affiliation(s)
- Joseph E Van Sickels
- Oral and Maxillofacial Surgery, University of Kentucky College of Dentistry, Lexington 40536-0297, USA.
| |
Collapse
|