1
|
Shah A, Perez-Otero S, Tran D, Aponte HA, Oh C, Agrawal N. Infection Rates of an Intraoral Versus Extraoral Approach to Mandibular Fracture Repairs are Equal: A Systematic Review and Meta-Analysis. J Oral Maxillofac Surg 2024; 82:449-460. [PMID: 38336352 DOI: 10.1016/j.joms.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/06/2024] [Accepted: 01/15/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE This study investigates whether the intraoral approach to mandibular open reduction and internal fixation, through exposure to the oral cavity's microbiome, results in higher infection rates compared to the extraoral approach, thus addressing a critical public health concern, potentially offering an opportunity to reduce health-care costs, and aiming to guide effective clinical practice. METHODS In this systematic review with meta-analyses, a review of the literature was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. A comprehensive literature search was conducted using Embase and PubMed for articles published between 1989 and 2023. Inclusion criteria targeted studies on open reduction and internal fixation mandibular fractures comparing intraoral and extraoral approaches and reporting infection rates. Exclusion criteria eliminated non-English articles, case reports, and studies with insufficient approach-specific data. The primary outcome was the postoperative infection rate, with surgical approach as the predictor. Covariates such as age, sex, diabetes, and smoking status were included when reported. Data were analyzed using R software, employing random-effects models due to anticipated heterogeneity (I2 statistics). RESULTS From 61 studies, 11 provided direct comparisons involving 1,317 patients-937 intraoral and 380 extraoral. Infection rates were 5.9% for intraoral and 10% for extraoral approaches. Pooled relative risk was 0.94 [95% confidence interval, 0.63, 1.39], suggesting no significant risk difference. Prevalence of infections was estimated at 9% for intraoral and 6.1% for extraoral procedures, with significant heterogeneity (I2 = 84% for intraoral and 56% for extraoral). CONCLUSION Our meta-analysis found no significant difference in infection rates between the two approaches. There is opportunity to expand on reporting complication rates comparing the various approaches to mandibular fixation. Until these data are presented, surgeon preference may dictate the operative approach to expose the mandible for reduction and fixation.
Collapse
Affiliation(s)
- Alay Shah
- Post-Doctoral Research Fellow, Medical Student, Clinical Assistant Professor, Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY.
| | - Sofia Perez-Otero
- Post-Doctoral Research Fellow, Medical Student, Clinical Assistant Professor, Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY
| | - David Tran
- Post-Doctoral Research Fellow, Medical Student, Clinical Assistant Professor, Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY
| | - Hermes A Aponte
- Post-Doctoral Research Assistant, Department of Surgery, University of Puerto Rico School of Medicine, San Juan, PR
| | - Cheongeun Oh
- Clinical Assistant Professor, Biostatistics Division, Department of Population Health (Biostatistics), New York University Grossman School of Medicine, New York, NY
| | - Nikhil Agrawal
- Post-Doctoral Research Fellow, Medical Student, Clinical Assistant Professor, Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY
| |
Collapse
|
2
|
Shikara M, Bridgham K, Ludeman E, Vakharia K, Justicz N. Current Management of Subcondylar Fractures: A Systematic Review. Otolaryngol Head Neck Surg 2023; 168:956-969. [PMID: 36939481 DOI: 10.1002/ohn.185] [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: 06/22/2022] [Revised: 09/21/2022] [Accepted: 10/08/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The aim of this study is to review the current literature on treatment of subcondylar fractures using traditional open reduction internal fixation (ORIF), closed reduction with maxillomandibular fixation (MMF), and endoscopic open approaches. DATA SOURCES PubMed, Embase, Cochrane CENTRAL, Clinicaltrials.gov, and WHO ICTRP. REVIEW METHODS A comprehensive database search was performed in accordance with PRISMA guidelines. All English-only texts published in the last 20 years with ≥10 patients were included. Studies that included patients <16 years old were excluded. RESULTS Thirty-two studies met the final inclusion criteria. Nine studies compared ORIF with closed reduction using MMF, 12 studies evaluated ORIF via different approaches, and 10 studies evaluated outcomes after endoscopic approaches. Five studies reported significant improvement in mouth opening with ORIF compared to closed reduction. In 1 study that recorded patient-reported outcomes measure (FACE-Q scale), quality of life scores and patient satisfaction were significantly higher in the ORIF group. Among the 10 studies that used the endoscopic approach, transient facial nerve injury ranged from 0% to 10%. CONCLUSION Several studies report better mouth opening, dental occlusion, and functional outcomes after ORIF compared to closed reduction, while some found no significant difference. Endoscopic approaches provide ease of access to the condyle with a low incidence of facial nerve injury. However, limitations include special equipment, longer operative times, and a steep learning curve using an endoscope. This review provides surgeons with an overview of the current literature on subcondylar fractures to allow for an individualized management approach for each patient.
Collapse
Affiliation(s)
- Meryam Shikara
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland Medical System, Baltimore, Maryland, USA
| | - Kelly Bridgham
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Department of Otorhinolaryngology-Head and Neck Surgery, Jefferson University, Philadelphia, Pennsylvania, USA
| | - Emilie Ludeman
- Health Sciences and Human Services Library, University of Maryland Graduate School, Baltimore, Maryland, USA
| | - Kalpesh Vakharia
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland Medical System, Baltimore, Maryland, USA.,Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Natalie Justicz
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland Medical System, Baltimore, Maryland, USA.,Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
3
|
Medial Epicanthoplasty With the Classic and Modified Skin Redraping Method: A Retrospective Case Control Study. J Craniofac Surg 2022; 33:1987-1990. [PMID: 35184114 DOI: 10.1097/scs.0000000000008585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 01/30/2022] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT The skin redraping method for medial epicanthoplasty is characterized by some shortcomings which warrants modification. In this study, clinical data of 193 patients who underwent medial epichanthoplasty by the modified skin redraping technique or the classic skin redraping technique were reviewed retrospectively. The patients underwent operation between May 2018 and June 2020 and were followed up for not less than 6 months. Interepicanthal distance , interpupillary distance, patient satisfaction, and postoperative complications were evaluated. In terms of interepicanthal distance/interpupillary distance ratio (P > 0.05) and satisfaction score (P = 0.759), the modified skin redraping technique and the classic skin redraping technique were similar. In the classic skin redraping group, there were 3 cases of visible scarring in the lower eyelid, corresponding to significantly more cases than in the modified skin redraping group (n = 0, P < 0.001). There were more out-fold cases in the modified skin redraping group (76/90) than in the classic skin redraping group (17/88) (P < 0.001). Utilizing the modified skin redraping medial epicanthoplasty can prevent medial hooding of the upper eyelid, reduce the probability of visible scarring, and produce more out-fold with concurrent double eyelidplasty compared with classic skin redraping epicanthoplasty.Level of evidence: IV.
Collapse
|
4
|
Management of Medially Displaced Sub-Condylar Mandibular Fractures in Pediatric Population Using Novel Atraumatic Approach. J Craniofac Surg 2021; 32:851-854. [PMID: 32897973 DOI: 10.1097/scs.0000000000006993] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT The appropriate treatment of pediatric mandibular condyle fractures is subject to much debate and concern among surgeons, with improper treatment potentially resulting in a number of adverse outcomes. Such outcomes include the disruption of mandible growth, decreased posterior facial height, facial asymmetry, and temporomandibular joint ankylosis. Several surgical and nonsurgical approaches to these fractures have been described in the literature; however, each one carries its own risk of various complications. In this study, the authors illustrate a new atraumatic approach for mild to moderately displaced subcondylar fractures, with least possible complications and unexpected outcomes. In this study, 6 patients (2 female and 4 male) with unilateral medially displaced condylar base and neck fractures, angulated between 30 and 45 degrees, were treated using a novel intraoral approach. The follow-up period varied from 12 to 18 months. All patients achieved normal occlusion and had painless functioning of the temporomandibular joint with proper mouth opening (>35 mm) without any recurrence at long term follow up. This minimally invasive approach could eliminate the possibility of major complications and be considered a safe and feasible surgical technique for certain cases of pediatric mandibular condyle fracture.
Collapse
|
5
|
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
|
6
|
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.
Collapse
|
7
|
Burkhard JPM, Koba S, Schlittler F, Iizuka T, Schaller B. Clinical results of two different three-dimensional titanium plates in the treatment of condylar neck and base fractures: A retrospective study. J Craniomaxillofac Surg 2020; 48:756-764. [DOI: 10.1016/j.jcms.2020.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 05/12/2020] [Accepted: 06/07/2020] [Indexed: 12/19/2022] Open
|
8
|
Zhang L, Wang Y, Shao X, Chen J. Open reduction and internal fixation obtains favorable clinical and radiographic outcomes for pediatric mandibular condylar fractures. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 122:18-23. [PMID: 32428602 DOI: 10.1016/j.jormas.2020.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Surgery with open reduction internal fixation (ORIF) for pediatric mandibular condylar fractures (MCF) is controversial. This study aims to evaluate the clinical and radiographic outcomes of the children with MCF treated surgically with ORIF. METHODS This retrospective study included 9 children diagnosed with MCF and treated surgically with ORIF. Imaging examinations were performed preoperatively and postoperatively. Patients underwent follow-up clinical observations and objective measurements for over 5 years. RESULTS All children recovered well in facial features, facial nerve functions, occlusions, joint movements, maximal incisal opening, and midline deviation postoperatively. The temporomandibular joint (TMJ) pain and click were found in 2 of 9 (22.2%) cases 1 year after surgery and disappeared 2 years later. Mandibular retrusion was always observed in a child (11.1%) postoperatively. The condylar surface appeared unsmooth in panoramic radiographs of 2 (22.2%) cases. Objective measurements showed that a patent (11.1%) had an opening deflection and a limited laterotrusion at the return visits. SNB angles of all cases were within the normal range 5 years after the operation. CONCLUSION Surgery with ORIF is a relatively safe and effective method for pediatric MCF. The future growth of the mandibular condyle and the long-term TMJ function are lightly influenced in patients postoperatively.
Collapse
Affiliation(s)
- L Zhang
- Shanghai Minhang District Dental Clinic, Shanghai, China; Department of Stomatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Y Wang
- Department of Stomatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - X Shao
- Department of Stomatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - J Chen
- Department of Otolaryngology, Head and Neck Surgery, Affiliated Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, China.
| |
Collapse
|
9
|
Nam SM, Kim YB, Lee SJ, Park ES, Lee JH. A comparative study of intraoral versus retromandibular approach in the management of subcondylar fracture. BMC Surg 2019; 19:28. [PMID: 30832641 PMCID: PMC6399831 DOI: 10.1186/s12893-019-0487-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 02/14/2019] [Indexed: 12/05/2022] Open
Abstract
Background The purpose of this study was to compare the outcomes and effectiveness between intraoral approach and retromandibular approach for treatment of subcondylar fracture of mandible. Methods Between March 2011 and October 2013, 24 patients with subcondylar fractures of the mandible were treated by a single surgeon with an intraoral approach using an angulated screwdriver (n = 14) or by another surgeon using a retromandibular approach (n = 10). The interincisal distance was measured 1 week (T0), 6 weeks (T1), 3 months (T2), and 6 months (T3) postoperatively. We also compare the average operation time and the cost of operation between the two groups. Results At 6 months postoperatively, all 24 patients achieved satisfactory ranges of temporomandibular joint movement, with an interincisal distance > 40 mm without deviation and with stable centric occlusion. The intraoral group had the median interincisal distance of 14 mm at T0, 38 mm at T1, 42.5 mm at T2, and 43 mm at T3, while the retromandibular group had that of 15, 29, 35, and 42.5 mm respectively. There was no statistically significant difference between the intraoral and the retromandibular group at T0 and T4. However, significant differences were noted T1 and T2 (p < 0.01). The differences of average operation time between the intraoral (81 min) and retromandibular group (45 min) were statistically significant (p < 0.01). The cost of an operation was 369.96 ± 8.14 (United States dollar [USD]) in intraoral group and was 345.48 ± 0.0 (USD) in retromandibular group. The differences between the two groups were statistically significant (p < 0.01). Conclusion In open reduction of a subcondylar fracture of the mandible, a intraoral approach using an angulated screwdriver is superior to the retromandibular approach in terms of interincisal distance, although the operation time is longer.
Collapse
Affiliation(s)
- Seung Min Nam
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, 170 Jomaru-ro, Bucheon, 14584, Republic of Korea
| | - Yong Bae Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, 170 Jomaru-ro, Bucheon, 14584, Republic of Korea.
| | - Sun Jae Lee
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, 170 Jomaru-ro, Bucheon, 14584, Republic of Korea
| | - Eun Soo Park
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, 170 Jomaru-ro, Bucheon, 14584, Republic of Korea
| | - Jang Hyun Lee
- Department of Plastic and Reconstructive Surgery, Hanyang University, College of Medicine, 153, Gyeongchun-ro, Guri, 11923, Republic of Korea
| |
Collapse
|
10
|
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
|
11
|
Weiss JP, Sawhney R. Update on mandibular condylar fracture management. Curr Opin Otolaryngol Head Neck Surg 2016; 24:273-8. [DOI: 10.1097/moo.0000000000000272] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
12
|
Abstract
Facial trauma is a significant cause of morbidity in the United States. Despite the large volume of trauma surgeries at most academic institutions, there is still controversy regarding management of many traumatic injuries. The literature lacks clear-cut best practices for most fractures. In orbital trauma, there is debate about the optimal timing of repair, preferred biomaterial to be used, and the utility of evaluation afterward with intraoperative computed tomographic scan. In repair of mandible fractures, there is debate regarding open versus closed reduction of subcondylar fractures, or alternatively, endoscopic repair.
Collapse
|
13
|
You HJ, Moon KC, Yoon ES, Lee BI, Park SH. Clinical and radiological outcomes of transoral endoscope-assisted treatment of mandibular condylar fractures. Int J Oral Maxillofac Surg 2016; 45:284-91. [DOI: 10.1016/j.ijom.2015.11.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 09/10/2015] [Accepted: 11/03/2015] [Indexed: 11/25/2022]
|
14
|
|