Closed reduction of mandibular condyle fractures using C-arm fluoroscopy: a technical note

Use of intraoperative C-arm fluoroscopy in open reduction and internal fixation of mandibular condyle fracture - A case report

The Rationale:

Condyle fractures are a common type of mandibular fracture that can result in malocclusion. Open reduction and internal fixation (ORIF) in condylar fracture is considered as the most acceptable treatment modality.

Patient Concerns:

The patient complained of pain and difficulty in the jaw while chewing.

Diagnosis:

An orthopantomogram and reverse Towne’s view can lead to diagnosis of the condylar fracture.

Treatment:

Open reduction and internal fixation using intraoperative real-time visualisation of subcondylar fracture reduction utilising the C-arm fluoroscopic approach were used to allow for adequate anatomical repositioning and fast restoration of function to meet the patient’s concerns.

Outcomes:

We were able to achieve correct reduction of the fracture fragments with restoration of function and occlusion.

Take-away Lessons:

When this procedure is used to treat condylar fractures, surgeons can get a better view of the fracture segments while eliminating the need for postoperative intermaxillary fixation and also reduces the complications from inappropriate reduction and fixation.

Evaluation of Open Reduction and Internal Fixation of Mandibular Condyle Fracture by Intraoperative Cone-Beam Computed Tomography in a Hybrid Operating Room

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.

Reduction of Nasal Bone Fracture using Ultrasound Imaging during Surgery

Background

Most nasal bone fractures are corrected using non-invasive methods. Often, patients are dissatisfied with surgical outcomes following such closed approach. In this study, we compare surgical outcomes following blind closed reduction to that of ultrasound-guided reduction.

Methods

A single-institutional prospective study was performed for all nasal fracture patients (n=28) presenting between May 2013 and November 2013. Upon research consent, patients were randomly assigned to either the control group (n=14, blind reduction) or the experimental group (n=14, ultrasound-guided reduction). Surgical outcomes were evaluated using preoperative and 3-month postoperative X-ray images by two independent surgeons. Patient satisfaction was evaluated using a questionnaire survey.

Results

The experimental group consisted of 4 patients with Plane I fracture and 10 patients with Plane II fracture. The control group consisted of 3 patients with Plane I fracture and 11 patients with Plane II fracture. The mean surgical outcomes score and the mean patient dissatisfaction score were found not to differ between the experimental and the control group in Plane I fracture (p=0.755, 0.578, respectively). In a subgroup analysis consisting of Plane II fractures only, surgeons graded outcomes for ultrasound-guided reduction higher than that for the control group (p=0.007). Likewise, among the Plane II fracture patients, those who underwent ultrasound-guided reduction were less dissatisfied than those who underwent blind reduction (p=0.043).

Conclusion

Our study result suggests that ultrasound-guided closed reduction is superior to blind closed reduction in those patients with Plane II nasal fractures.

C-arm fluoroscopy: a reliable modality for retrieval of foreign bodies in the maxillofacial region

The anatomic complexity of the maxillofacial region makes the retrieval of foreign bodies a daunting task for the maxillofacial Surgeon. Moreover the inability of 2-dimensional imaging to precisely locate foreign bodies makes it challenging. The anatomic proximity of critical structures and esthetic considerations limits the access and thus poses a greater challenge for the surgeon in cases of foreign body retrieval. Hereby we propose a simple technique and a case report to support, the retrieval of small (<5 mm greatest dimension) objects from the maxillofacial region. The present technique uses a 2 dimensional mobile C arm Fluoroscopy and a needle triangulation method to precisely locate a loosened miniplate screw in the mandibular angle region.