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Liu X, Shao S, Lou H, Xia Y. Application of Crus of Helix Incision Through the Posterior Parotid Gland Approach in the Mid-Level or High-Level Mandibular Condylar Fractures. J Craniofac Surg 2024:00001665-990000000-01479. [PMID: 38688015 DOI: 10.1097/scs.0000000000010167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVE This study is to explore the clinical effect of crus of helix incision through the posterior parotid gland approach in the treatment of Mid-or High-Level mandibular condylar fractures. METHODS From September 2020 to June 2023, we performed incision reduction internal fixation of 23 patients with mid-level or high-level fractures of the mandibular condylar through the approach of the posterior parotid gland, and observed the effect of the operation. RESULTS After a follow-up period of 6 to 12 months, all patients showed no signs of postoperative facial paralysis or salivary gland fistula. In addition, satisfactory scars were observed in the operation area, and the occlusion function had recovered well. CONCLUSION The approach of using a crus of helix incision through the posterior parotid gland proved to be an effective method for treating mid-level or high-level fractures of the condylar fractures. This technique offers several advantages, including adequate exposure, minimal facial nerve injury, ease of incision and reduction, inconspicuous scarring, and a more concealed incision.
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Affiliation(s)
- Xiang Liu
- Department of Oral and Maxillofacial Surgery, The First People's Hospital of Yunnan Province
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Shengjie Shao
- Department of Oral and Maxillofacial Surgery, The First People's Hospital of Yunnan Province
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Huiquan Lou
- Department of Oral and Maxillofacial Surgery, The First People's Hospital of Yunnan Province
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Yichao Xia
- Department of Oral and Maxillofacial Surgery, The First People's Hospital of Yunnan Province
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
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Banerjee A, Rana M, Chakraborty A, Biswas JK, Chowdhury AR. In-silico study of type 'B' condylar head fractures and evaluating the influence of two positional screw distance in two-screw osteosynthesis construct. Proc Inst Mech Eng H 2023; 237:1297-1305. [PMID: 37924244 DOI: 10.1177/09544119231201782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2023]
Abstract
Clinical fixation screws are common in clinical practices to fix mandibular condyle fractures. Evidence suggests significance of 'working length' that is, distance between proximal and distal fixation screws in proximity to the fracture in orthopaedic implant design. In pursuit of stable implant-bone construct, this study aims to investigate the biomechanical performance of each configuration considered in the study and provide an optimal working length between the screws for clinical reference. Finite element models of virtually designed broken condyle as type 'B' were simulated and analysed in ANSYS Workbench. Screws are implanted according to previous literature at five varied distances 'd' maintaining five different ratios with the fracture length 'D'. Based on a literature review, boundary conditions, muscle traction forces and non-linear contacts were assigned to obtain precise results. Each case is considered an individual configuration and von Mises distribution, microstrain in bone, screw-bone interface micromotion and fracture dislocation were evaluated for all these configurations. Stress-shielding phenomenon is observed for maximum von Mises stresses in bone. Microstrain concentration was significant in cancellous bone in the vicinity of the screw around the fracture line. Configurations were compared based on the stress-strain along with micromotion to support the required amount of osseointegration between implant and bone. Presented data from all five conditions supported the assumption that under physiological loading conditions, the D3 configuration provided stability for fracture healing. Further research on screw shapes, diameters and material properties, or investigating the direction of forces within the screws could provide further insight into this topic.
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Affiliation(s)
- Anik Banerjee
- Department of Aerospace Engineering and Applied Mechanics, Indian Institute of Engineering Science and Technology, Shibpur, Howrah, West Bengal, India
| | - Masud Rana
- Department of Aerospace Engineering and Applied Mechanics, Indian Institute of Engineering Science and Technology, Shibpur, Howrah, West Bengal, India
| | - Arindam Chakraborty
- Department of Aerospace Engineering and Applied Mechanics, Indian Institute of Engineering Science and Technology, Shibpur, Howrah, West Bengal, India
| | - Jayanta Kumar Biswas
- Department of Mechanical Engineering, National Institute of Technology, Patna, Bihar, India
| | - Amit Roy Chowdhury
- Department of Aerospace Engineering and Applied Mechanics, Indian Institute of Engineering Science and Technology, Shibpur, Howrah, West Bengal, India
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Ho Nguyen CT, Lam PH. Endoscopic-Assisted Intraoral Approach for Osteosynthesis of Mandibular Subcondylar Fractures. J Craniofac Surg 2022; 33:e754-e758. [PMID: 36201692 PMCID: PMC9518962 DOI: 10.1097/scs.0000000000008734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/22/2022] [Indexed: 11/25/2022] Open
Abstract
The aim of this study is to follow-up and evaluate the treatment result of mandibular subcondylar (MSC) fractures by osteosynthesis via endoscopy-assisted intraoral approach.
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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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Abdelwahab MA, Spataro EA, Elkholy NA, El-Degwi A, Most SP. Biportal transparotid dissection in the retromandibular approach for condylar fracture osteosynthesis: Efficacy of a novel technique. J Plast Reconstr Aesthet Surg 2020; 73:927-933. [DOI: 10.1016/j.bjps.2019.11.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 11/22/2019] [Indexed: 12/01/2022]
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Rozeboom A, Dubois L, Bos R, Spijker R, de Lange J. Open treatment of condylar fractures via extraoral approaches: A review of complications. J Craniomaxillofac Surg 2018; 46:1232-1240. [DOI: 10.1016/j.jcms.2018.04.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 03/24/2018] [Accepted: 04/19/2018] [Indexed: 12/21/2022] Open
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In Vitro Effect of 3D Plates Used for Surgical Treatment of Condylar Fractures on Prostaglandin E₂ (PGE₂) and Thromboxane B₂ (TXB₂) Concentration in THP-1 Macrophages. Int J Mol Sci 2017; 18:ijms18122638. [PMID: 29292766 PMCID: PMC5751241 DOI: 10.3390/ijms18122638] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 11/29/2017] [Accepted: 12/02/2017] [Indexed: 12/14/2022] Open
Abstract
Recent studies have shown promising results concerning the effectiveness of 3D plates in terms of stabilization of condylar fractures. Despite the use of new techniques and new materials, we can still observe certain side effects, including the immune reaction of the body, which may lead to the excessive inflammation. The aim of this paper was to determine how the production of prostaglandin E₂ (PGE₂) and thromboxane B₂ (TXB₂) in THP-1 monocytes/macrophages is influenced by the titanium 3D plates and dedicated screws. The experiments were conducted on THP-1 monocytic cell line and macrophages derived from a THP-1cells. The concentrations of PGE₂ and TXB₂ released were measured by using immunoassay kit. Verification of plate-induced activation of THP-1 monocytes and macrophages and initiation of inflammatory reaction was conducted by flow cytometry. Despite some differences in the content of the implant devices our results showed that these plates did not statistically significantly increase the production of these prostanoids. Osteosynthesis of condylar fractures using 3D titanium mini-plates seems to be a good alternative to traditional plates due to their lack of stimulating the cyclooxygenase-dependent production of prostanoids; limiting the development of inflammatory reactions.
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Rozeboom A, Dubois L, Bos R, Spijker R, de Lange J. Open treatment of unilateral mandibular condyle fractures in adults: a systematic review. Int J Oral Maxillofac Surg 2017; 46:1257-1266. [DOI: 10.1016/j.ijom.2017.06.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 03/06/2017] [Accepted: 06/09/2017] [Indexed: 12/16/2022]
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Temporomandibular joint reconstruction after condylar fracture complication related to osteosynthesis material. Int J Oral Maxillofac Surg 2017; 47:137-139. [PMID: 28844337 DOI: 10.1016/j.ijom.2017.07.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 06/11/2017] [Accepted: 07/20/2017] [Indexed: 11/23/2022]
Abstract
Total condylar resorption and the failure of bone synthesis material as postoperative complications of condyle fracture are seldom reported in the literature. When these occur, they may severely limit temporomandibular joint (TMJ) function. In such cases, a reconstruction of the joint is indicated, which can be achieved by means of an alloplastic prosthesis. This article reports a rare case of impaction of osteosynthesis material in the region of the base of the skull associated with a mandibular condyle fracture treated with rigid internal fixation, which resulted in complications. There was progression to condylar resorption, requiring an alloplastic TMJ reconstruction, which was performed in a single surgical session.
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Sikora M, Sielski M, Stąpor A, Chlubek D. Use of the Delta plate for surgical treatment of patients with condylar fractures. J Craniomaxillofac Surg 2016; 44:770-4. [DOI: 10.1016/j.jcms.2016.04.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/08/2016] [Accepted: 04/07/2016] [Indexed: 10/21/2022] Open
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Sikora M, Olszowski T, Sielski M, Stąpor A, Janiszewska-Olszowska J, Chlubek D. The use of the transparotid approach for surgical treatment of condylar fractures – Own experience. J Craniomaxillofac Surg 2015; 43:1961-5. [DOI: 10.1016/j.jcms.2015.10.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 09/17/2015] [Accepted: 10/01/2015] [Indexed: 11/28/2022] Open
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12
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Correlation of Plates’ Number With Complications of Osteosynthesis in Mandibular Fractures. J Craniofac Surg 2014; 25:e526-9. [DOI: 10.1097/scs.0000000000001038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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13
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de Jesus G, Vaz L, Gabrielli M, Passeri L, V. Oliveira T, Noritomi P, Jürgens P. Finite element evaluation of three methods of stable fixation of condyle base fractures. Int J Oral Maxillofac Surg 2014; 43:1251-6. [DOI: 10.1016/j.ijom.2014.07.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 04/07/2014] [Accepted: 07/21/2014] [Indexed: 10/24/2022]
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Xiang GL, Long X, Deng MH, Han QC, Meng QG, Li B. A retrospective study of temporomandibular joint ankylosis secondary to surgical treatment of mandibular condylar fractures. Br J Oral Maxillofac Surg 2014; 52:270-4. [PMID: 24485809 DOI: 10.1016/j.bjoms.2014.01.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 01/03/2014] [Indexed: 10/25/2022]
Abstract
We investigated the incidence of ankylosis of the temporomandibular joint (TMJ) after open operations for fractures of the mandibular condyle, and analysed possible risk factors in a total of 385 patients with 492 condylar fractures who had been operated on in our department from 2001 to 2010. Sixteen patients developed postoperative ankylosis of the TMJ with 26 joints (5%) affected during a follow-up of 6 months-10 years. Of the 492 condylar fractures, the most common ones that were associated with postoperative ankylosis were those of the condylar head (20/248), followed by the condylar neck (6/193). Subcondylar fractures did not cause postoperative ankylosis (0/51). Among the 16 patients with postoperative ankylosis, 13 had associated anterior mandibular fractures. Long-screw (bicortical screw) fixation of fractures of the condylar head seemed to be associated with a lower incidence of postoperative ankylosis than fixation by miniplate and wire or removal of the fractured fragment. The articular discs were damaged in all ankylosed joints, and the remaining fractured fragment was found in 10 ankylosed joints after fractures of the condylar head. The results suggest that fractures of the condylar head are more prone to lead to postoperative ankylosis of the TMJ, and that the possible risk factors seem to include the technique used for fixation and damage to the disc, together with an anterior mandibular fracture with the fractured fragment remaining.
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Affiliation(s)
- Guo-lin Xiang
- Department of Oral and Maxillofacial Surgery, Puai Hospital of Tongji Medical College, Huazhong University of Science and Technology, Hanzheng Street 473, Wuhan 430033, PR China; The State Key Laboratory Breeding Base of Basic Science of Stomatology & Key Laboratory of Oral Biomedicine, Ministry of Education, Department of Oral and Maxillofacial Surgery, School & Hospital of Stomatology, Wuhan University, Luoyu Road 237, Wuhan 430079, PR China
| | - Xing Long
- The State Key Laboratory Breeding Base of Basic Science of Stomatology & Key Laboratory of Oral Biomedicine, Ministry of Education, Department of Oral and Maxillofacial Surgery, School & Hospital of Stomatology, Wuhan University, Luoyu Road 237, Wuhan 430079, PR China.
| | - Mo-hong Deng
- The State Key Laboratory Breeding Base of Basic Science of Stomatology & Key Laboratory of Oral Biomedicine, Ministry of Education, Department of Oral and Maxillofacial Surgery, School & Hospital of Stomatology, Wuhan University, Luoyu Road 237, Wuhan 430079, PR China
| | - Qian-chao Han
- Department of Oral and Maxillofacial Surgery, Puai Hospital of Tongji Medical College, Huazhong University of Science and Technology, Hanzheng Street 473, Wuhan 430033, PR China
| | - Qing-gong Meng
- The State Key Laboratory Breeding Base of Basic Science of Stomatology & Key Laboratory of Oral Biomedicine, Ministry of Education, Department of Oral and Maxillofacial Surgery, School & Hospital of Stomatology, Wuhan University, Luoyu Road 237, Wuhan 430079, PR China
| | - Bo Li
- The State Key Laboratory Breeding Base of Basic Science of Stomatology & Key Laboratory of Oral Biomedicine, Ministry of Education, Department of Oral and Maxillofacial Surgery, School & Hospital of Stomatology, Wuhan University, Luoyu Road 237, Wuhan 430079, PR China
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Wang WH, Deng JY, Zhu J, Li M, Xia B, Xu B. Computer-assisted virtual technology in intracapsular condylar fracture with two resorbable long-screws. Br J Oral Maxillofac Surg 2012; 51:138-43. [PMID: 22546281 DOI: 10.1016/j.bjoms.2012.04.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 04/09/2012] [Indexed: 11/19/2022]
Abstract
Our aim was to fix intracapsular condylar fractures (ICF) with two resorbable long screws using preoperative computer-assisted virtual technology. From February 2008 to July 2011, 19 patients with ICF were treated with two resorbable long screws. Preoperatively we took panoramic radiographs and spiral computed tomography (CT). Depending on their digital imaging and communications in medicine (DICOM) data, the dislocated condylar segments were restored using the SimPlant Pro™ software, version 11.04. The mean (SD) widths of the condylar head and neck from lateral to medial were 19.01 (1.28)mm and 13.84 (1.13)mm, respectively. In all patients, the mandibles and the ICF seen intraoperatively corresponded with the preoperative three-dimensional and virtual reposition. All patients were followed up for 6-46 months (mean 21). Occlusion and mouth opening had been restored completely in all but one patient, and absolute anatomical reduction was also achieved in most cases. Computer-assisted virtual technology plays an important part in the diagnosis of ICF, as well as in its preoperative design. Fixation with only two resorbable long screws is an effective and reliable method for fixing ICF.
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Affiliation(s)
- W H Wang
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatological Hospital of Kunming Medical College, No. 193 Renmingxi Road, Kunming, Yunnan 650031, China
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