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Agarwal SS, Khandelwal E, Rao S, Raghani MJ. Electromyographic Study of Facial Nerve Function Using Two Different Surgical Approaches in Low Condylar Fractures of the Mandible: A Randomized Controlled Clinical Trial. J Oral Maxillofac Surg 2024:S0278-2391(24)00334-3. [PMID: 38878797 DOI: 10.1016/j.joms.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 05/20/2024] [Accepted: 05/20/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND Facial nerve (FN) dysfunction is a potential complication during open reduction of mandibular condylar fractures. PURPOSE The purpose of this study was to measure and compare the postoperative FN function following transparotid (TP) and transmasseteric anterior parotid (TMAP) operative approaches in open reduction and internal fixation of condylar fractures using electromyogram. STUDY DESIGN, SETTING, SAMPLE A randomized controlled clinical trial was designed. The study was conducted in a single tertiary-care hospital in the inpatient setting. Patients aged above 18 years with unilateral condylar fracture of the jaw or bilateral condylar fractures undergoing surgery on only 1 side were included. Patients were excluded if they had fractures of the head, bilateral condylar fractures with surgery planned on both sides, a previous history of surgery in the retromandibular area, existing lacerations to approach condyle, preoperative signs of FN weakness, or a history of parotid surgery. PREDICTOR VARIABLE The predictor variable was the operative approach and the subjects were allocated randomly to TMAP and TP. MAIN OUTCOME VARIABLE(S) The primary outcome variable was postoperative FN function in the surgical approach employed using the House-Brackmann scale and electromyography (EMG) to record any subtle weakness in nerve function. The FN function is recorded at 3 time intervals postoperatively 1 week (T1), 1 month (T2), and 3 months (T3). The secondary outcomes studied were operating time and any other complications recorded. COVARIATES Age, sex, fracture pattern with classification of condylar fractures into condylar neck or base fractures according to Loukata et al.4 Any associated fracture of mandible describing the anatomical location viz symphysis and parasymphysis (anterior mandible), body, contralateral condyle or greater than 1 associated fracture were recorded. Similarly, the presence or absence of any associated midface fracture was also recorded to suggest that the study participants were homogenous in all aspects. ANALYSES Analytical statistics included χ2 test, t-test, and repeated measures ANOVA followed by post hoc test to compare EMG data (mean power and mean amplitude) between 2 operative approaches (TP vs TMAP) for facial muscles including frontalis, oculi, and buccinator at different time intervals (T0, T1, T2, T3). Patients within each group were also analyzed to check for nerve recovery occurring during the follow-up period. The level of significance was set at P < .05. RESULTS The study sample was composed of 22 patients with a mean age of 32.82 ± 11.21 years in TMAP and 27.82 ± 8.54 years in the TP group respectively (P = .26); male predominance of 81.8 and 90.9% in TMAP and TP group respectively (P = .53) was noted. The FN deficit as assessed by the House-Brackmann scale clinically, was at 54% (T1), 36.4% (T2), and 9.1% (T3) for the TP group and 27% (T1),9% (T2), and 0% (T3) for TMAP group; however, the results were statistically insignificant (P = .31). In surface EMG evaluation, the mean power for the frontalis muscle was significantly higher in the TMAP approach at the T3 time (105.03 ± 9.7 vs 89.56 ± 10; 95% confidence interval -24.28 to -6.65 with P value = .002). TP approach was faster with a mean exposure time of 9.9 minutes. CONCLUSION AND RELEVANCE The results show that both approaches give comparable long-term results with the TMAP group showing better frontalis muscle activity.
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Affiliation(s)
- Subham S Agarwal
- Senior Resident, Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, Raipur
| | - Ekta Khandelwal
- Professor, Department of Physiology, All India Institute of Medical Sciences, Raipur
| | - Santhosh Rao
- Professor, Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, Raipur.
| | - Manish J Raghani
- Professor, Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, Raipur
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Kostares E, Kostare G, Kostares M, Kantzanou M. Prevalence of surgical site infections after open reduction and internal fixation for mandibular fractures: a systematic review and meta-analysis. Sci Rep 2023; 13:11174. [PMID: 37430033 DOI: 10.1038/s41598-023-37652-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/25/2023] [Indexed: 07/12/2023] Open
Abstract
Our study aims to estimate the prevalence of surgical site infections (SSI) following open reduction and internal fixation (ORIF) for mandibular fractures and to determine the effect of potential moderators on it. A systematic literature search (Medline and Scopus databases) was conducted independently by two reviewers. The pooled prevalence with 95% confidence intervals was estimated. Quality assessment as well as outlier and influential analysis were performed. Additionally, subgroup and meta-regression analysis were conducted in order the effect of categorical and continuous variables on the estimated prevalence to be investigated. In total, seventy-five eligible studies (comprising a sum of 5825 participants) were included in this meta-analysis. The overall prevalence of SSI following ORIF for mandibular fractures was estimated as high as 4.2% (95% CI 3.0-5.6%) with significant heterogeneity between studies. One study was identified to be critically influential. In the subgroup analysis, the prevalence was 4.2% (95% CI 2.2-6.6%) among studies conducted in Europe, 4.3% (95% CI 3.1-5.6%) among studies conducted in Asia and higher among those conducted in America (7.3%) (95% CI 4.7-10.3%). It is important for healthcare professionals to be aware of the etiology of these infections, despite the relatively low rate of SSI in these procedures. However, further, well-designed prospective and retrospective studies need to be conducted in order this issue to be fully clarified.
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Affiliation(s)
- Evangelos Kostares
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 115 27, Athens, Greece.
| | - Georgia Kostare
- National and Kapodistrian University of Athens Faculty of Medicine: Ethniko kai Kapodistriako Panepistemio Athenon Iatrike Schole, 115 27, Athens, Greece
| | - Michael Kostares
- National and Kapodistrian University of Athens Faculty of Medicine: Ethniko kai Kapodistriako Panepistemio Athenon Iatrike Schole, 115 27, Athens, Greece
| | - Maria Kantzanou
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 115 27, Athens, Greece
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Thilak G, Hegde P, Mehta D, Pillai S, Shetty V. The Study Intends to Compare the Efficiency of the Modified Tragus Edge Approach and the Retromandibular Transparotid Approach in Patients Who Underwent Open Reduction and Internal Fixation of Low-Level Condylar Fractures. J Maxillofac Oral Surg 2022. [DOI: 10.1007/s12663-022-01723-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Mandal J, Bhutia O, Roychoudhury A, Yadav R, Adhikari M, Chaudhary G. Does the Retromandibular Transparotid Approach Provide Quicker Access to Fracture of Mandibular Subcondyle Compared With the Retromandibular Transmasseteric Anterior Parotid Approach? J Oral Maxillofac Surg 2020; 79:644-651. [PMID: 33160921 DOI: 10.1016/j.joms.2020.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Limited studies are available in the literature comparing various surgical approaches for the management of condylar fractures, and those comparing different types of retromandibular approaches are even fewer in number. This study aimed to compare the efficacy of 2 variants of the retromandibular approach-retromandibular transmasseteric anterior parotid (RMTMAP) and retromandibular transparotid (RMTP) in terms of exposure time, blood loss, facial nerve palsy, sialoceles or parotid fistula formation, infection, and esthetics of scar tissue. PATIENTS AND METHODS A randomized controlled trial was designed in patients with mandibular subcondylar fractures requiring operative intervention. Patients were randomized into 2 groups based on a computer-generated randomization table. Group A included 37 cases, treated with the RMTMAP approach, and group B included 38 cases treated with the RMTP approach. The primary outcome variable was exposure time. Secondary outcome variables were blood loss during exposure, complications like facial nerve palsy, sialocele formation, surgical site infection, and scar esthetics. All patients were followed for 3 months. Collected data were analyzed using the χ2 and analysis of variance tests. RESULTS The mean exposure time for fractures treated with the RMTMAP approach and RMTP approach was 21.08 ± 9.18 and 13.57 ± 6.09, respectively (P < .05). The mean blood loss for RMTMAP and RMTP approach was 11.75 ± 5.11 and 9.9 ± 3.77 mL, respectively (P = .078). No facial nerve injury was seen in patients treated with the RMTMAP approach, whereas 3 (7.8%) patients in the RMTP group had transient facial nerve injury (P = .08). CONCLUSIONS This study concludes that the RMTP approach provides quicker access to the condyle as compared with the RMTMAP approach. However, the incidence of transient facial nerve injury was more in the RMTP approach. Except for reduced blood loss in the RMTP approach, all other parameters were comparable in both the approaches.
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Affiliation(s)
- Jeetendra Mandal
- Junior Resident, Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ongkila Bhutia
- Professor, Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Ajoy Roychoudhury
- Professor and Head, Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Rahul Yadav
- Associate Professor, Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Manoj Adhikari
- Junior Resident, Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ganesh Chaudhary
- Junior Resident, Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
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Algorithm for Management of Mandibular Condylar Base Fractures. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3145. [PMID: 33133982 PMCID: PMC7544252 DOI: 10.1097/gox.0000000000003145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/31/2020] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Increasing evidence suggests that open reduction and internal fixation of condylar base fractures in adults results in improved outcomes in regard to interincisal opening, jaw movement, pain, and malocclusion. However, most of the condylar fractures are managed by maxillomandibular fixation alone due to the need for specialized training and equipment. Our aim was to present an algorithm for condylar base fractures to simplify surgical management. Methods: A retrospective review was performed of patients (n = 22) with condylar base fractures treated from 2016 to 2020. Patients who presented with operative fractures that require open treatment underwent 1 of 2 different techniques depending on the fracture type: a preauricular approach with a transoral approach if the condyle was dislocated (n = 2) or a transoral only approach (n = 20) in nondislocated cases. Operative time, occlusion, range of motion, and postoperative complications were assessed. Results: Condylar base fractures were combined with other mandibular fractures in 16 of 22 patients. Patients with condylar dislocation were managed with a preauricular approach with a secondary transoral incision (n = 2, median 147 minutes). Those without dislocation were treated with a transoral approach (n = 20, median 159 minutes). Most patients were restored to their preoperative occlusion without long-term complications. Conclusions: We present a simplified algorithm for treating condylar base fractures. Our case series suggests that reduction in operative time and clinical success can be achieved with open reduction and internal fixation using a transoral approach alone or in combination with a preauricular approach for dislocated fractures.
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Felix K, Singh M. The Retromandibular Transparotid Approach for Reduction and Internal Fixation of Mandibular Condylar Fractures. Ann Maxillofac Surg 2020; 10:168-177. [PMID: 32855935 PMCID: PMC7433982 DOI: 10.4103/ams.ams_193_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 01/12/2020] [Accepted: 03/30/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction: The retromandibular transparotid approach is most useful for condylar and subcondylar fractures and provides the best access to the joint and ascending ramus. The study aims at evaluating the ease of access and outcomes encountered on using the retromandibular transparotid approach to access the fracture site for the open reduction and internal fixation (ORIF) of condylar and sub-condylar fractures. Materials and Methods: An observational clinical study was carried out among 10 patients with unilateral and bilateral condylar fracture requiring ORIF. Maximal interincisal mouth opening, facial swelling, occlusal discrepancy, facial nerve injury, scar formation, and acceptability and complications including wound dehiscence, infection, and sialocele/salivary fistula were assessed and measured preoperatively and postoperatively. Results: There was a notable improvement in mouth opening and facial nerve weakness. Postoperative intermaxillary fixation was done with selective patients who had a discrepancy in their occlusion. Preoperatively, swelling was present in four patients (40%) out of 10 patients studied. There was no incidence of sialocele/salivary fistula in any of the cases studied. Conclusion: Retromandibular transparotid incision is technique sensitive and thorough knowledge about the retromandibular area is must for good results and minimal morbidity. The cosmetic results are good in this approach, as well as the facial nerve injury were less in this without any permanent damages.
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Affiliation(s)
- Kishore Felix
- Department of Oral and Maxillofacial Surgery, Rajarajeswari Dental College and Hospital, Bengaluru, Karnataka, India
| | - Madhumati Singh
- Department of Oral and Maxillofacial Surgery, Rajarajeswari Dental College and Hospital, Bengaluru, Karnataka, India
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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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Parihar VS, Bandyopadhyay TK, Chattopadhyay PK, Jacob SM. Retromandibular transparotid approach compared with transmasseteric anterior parotid approach for the management of fractures of the mandibular condylar process: a prospective randomised study. Br J Oral Maxillofac Surg 2019; 57:880-885. [PMID: 31402192 DOI: 10.1016/j.bjoms.2019.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 07/09/2019] [Indexed: 12/18/2022]
Abstract
Fractures of the mandibular condyle lead to displacement of the condyle and loss of the height of the ramus. A retromandibular approach is the most commonly used for open reduction and internal fixation (ORIF) of such fractures. We aimed to compare the complications associated with a retromandibular transparotid approach with a retromandibular transmasseteric anterior parotid (TMAP) approach for their management. Thirty patients were randomly selected into two groups (15 in each): Group A comprised the retromandibular transparotid approach and Group B the retromandibular TMAP. The variables evaluated were: operating time, facial nerve injury, occurrence of Frey syndrome, and sialocoele at one week, four weeks, three months, and six months. The mean (SD) age in group A and B was 33.93 (17.97) years and 33.53 (16.15) years, respectively, and there were 28 men and two women. Mean (SD) exposure time in the transparotid approach was 26.93 (5.19) minutes and 25.4 (8.35) minutes in the TMAP approach. The incidence of facial nerve injury was 2/15 patients in the transparotid group and 3/15 in the TMAP group, all of which resolved within six months. The incidence of sialocoele was 2/15 in the transparotid group. The results did not show any significant difference in complications between the two approaches, but the retromandibular transparotid approach provided straight-line access in fractures of the condylar neck, with fewer incidences of nerve injury. The anterior parotid approach, on the other hand, provided easier access for fractures that were medially dislocated or of the condylar base but had an increased incidence of facial nerve injuries.
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Affiliation(s)
- V S Parihar
- Department of Oral and Maxillofacial Surgery, Army Dental Center (Research and Referral), Delhi Cantt, New Delhi, India.
| | - T K Bandyopadhyay
- Department of Oral and Maxillofacial Surgery, Army Dental Center (Research and Referral), Delhi Cantt, New Delhi, India
| | - P K Chattopadhyay
- Department of Oral and Maxillofacial Surgery, Army Dental Center (Research and Referral), Delhi Cantt, New Delhi, India
| | - S M Jacob
- Department of Oral and Maxillofacial Surgery, Army Dental Center (Research and Referral), Delhi Cantt, New Delhi, India
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Lin X, Liu XY, Huang XP. A modified approach from the edge of the tragus in the surgical treatment of mandibular condyle fractures. Ann R Coll Surg Engl 2018; 100:1-6. [PMID: 30112938 PMCID: PMC6204522 DOI: 10.1308/rcsann.2018.0119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2018] [Indexed: 11/22/2022] Open
Abstract
Introduction We present our experiences using a modified surgical approach from the edge of the tragus for mandibular condyle fractures, to reduce the risk of postoperative complications and visible scars. Materials and methods Thirty-two patients presenting with mandibular condyle fractures were treated through a modified approach on the edge of the tragus. The age of the patients ranged from 6 to 62 years. All mandibular condyle fractures were fixed. The patients were asked to start open-mouth training one week postoperatively, undergoing a cone-beam computed tomography examination and clinical follow-up. Postoperative complications were evaluated after surgery. Results Mouth opening was normal (average 39.5 mm) in all the patients during the operation and the occlusion improved significantly compared with preoperatively. No cases of damaged facial nerves were observed during the final follow-up at six months and postoperative scars were less noticeable. Conclusions The modified surgical approach from the edge of the tragus for mandibular condyle fractures provides a good view of the operative field, reduces the risk of facial nerve damage and produces a less noticeable postoperative scar.
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Affiliation(s)
- X Lin
- Department of Oral and Maxillofacial Surgery, Affiliated Hospital of the College of Stomatology, Guangxi Medical University, Nanning Guangxi, China
| | - X-Y Liu
- Department of Oral and Maxillofacial Surgery, Affiliated Hospital of the College of Stomatology, Guangxi Medical University, Nanning Guangxi, China
| | - X-P Huang
- Department of Oral and Maxillofacial Surgery, Affiliated Hospital of the College of Stomatology, Guangxi Medical University, Nanning Guangxi, China
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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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Van Hevele J, Nout E. Complications of the retromandibular transparotid approach for low condylar neck and subcondylar fractures: a retrospective study. J Korean Assoc Oral Maxillofac Surg 2018; 44:73-78. [PMID: 29732312 PMCID: PMC5932275 DOI: 10.5125/jkaoms.2018.44.2.73] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 11/05/2017] [Accepted: 11/20/2017] [Indexed: 11/07/2022] Open
Abstract
Objectives The goal of this study was to evaluate the rates of complications, morbidity, and safety with the transparotid approach. Materials and Methods A retrospective study was conducted and consisted of 53 surgically treated patients in the past five years for low condylar neck and subcondylar fractures. Only patients with malocclusion and who underwent open reduction with internal fixation with the retromandibular transparotid approach were included. The examined parameters were postoperative suboptimal occlusion, deflection, saliva fistula, and facial nerve weakness. Results Fifty-three patients had an open reduction with internal fixation on 55 sides (41 males, 77.4%; mean age, 42 years [range, 18-72 years]). Four patients (7.5%) experienced transient facial nerve weakness of the marginal mandibular branch, but none was permanent. Four patients had a salivary fistula, and 5 patients showed postoperative malocclusion, where one needed repeat surgery after one year. One patient showed long-term deflection. No other complications were observed. Conclusion The retromandibular transparotid approach is a safe procedure for open reduction and internal fixation of low condylar neck and subcondylar fractures, and it has minimal complications.
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Affiliation(s)
- Jeroen Van Hevele
- Department of Oral and Maxillofacial Surgery, ETZ Hospitals, Tilburg, The Netherlands
| | - Erik Nout
- Department of Oral and Maxillofacial Surgery, ETZ Hospitals, Tilburg, The Netherlands
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Al-Moraissi EA, Louvrier A, Colletti G, Wolford LM, Biglioli F, Ragaey M, Meyer C, Ellis E. Does the surgical approach for treating mandibular condylar fractures affect the rate of seventh cranial nerve injuries? A systematic review and meta-analysis based on a new classification for surgical approaches. J Craniomaxillofac Surg 2018; 46:398-412. [DOI: 10.1016/j.jcms.2017.10.024] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 09/20/2017] [Accepted: 10/30/2017] [Indexed: 11/30/2022] Open
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Complications in the treatment of mandibular condylar fractures: Surgical versus conservative treatment. Ann Anat 2018; 216:60-68. [DOI: 10.1016/j.aanat.2017.10.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 10/07/2017] [Accepted: 10/11/2017] [Indexed: 12/15/2022]
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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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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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Transparotid Approach for the Treatment of Condylar Osteochondroma and Ankylosis of the Temporomandibular Joint. J Craniofac Surg 2015; 26:e582-4. [PMID: 26468828 DOI: 10.1097/scs.0000000000002130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Among the methods to treat temporomandibular joint (TMJ), preauricular, submandibular, retromandibular, and intraoral approaches have been described. These approaches, however, occasionally offer inadequate access, owing to the oblique course of the facial nerve, and access can be limited, especially to the medial and anterior part of the infratemporal fossa. The use of the transparotid approach can offer direct visualization of the facial nerves to prevent severe damage, and a wide work field can be achieved from the medial-anterior part of the infratemporal fossa to subcondylar region by retracting the mobilized facial nerves in either the superior or inferior direction. The 2 patients reported herein illustrate the addition of a transparotid approach to the standard procedures for the removal of an osteochondroma and condylectomy with displaced bone fragment for ankyloses of TMJ from the infratemporal fossa.
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Liao HT, Wang PF, Chen CT. Experience with the transparotid approach via a mini-preauricular incision for surgical management of condylar neck fractures. J Craniomaxillofac Surg 2015; 43:1595-601. [DOI: 10.1016/j.jcms.2015.07.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 07/08/2015] [Accepted: 07/23/2015] [Indexed: 10/23/2022] Open
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Surgical treatment of mandibular condyle fractures using the retromandibular anterior transparotid approach and a triangular-positioned double miniplate osteosynthesis technique: A clinical and radiological evaluation of 124 fractures. J Craniomaxillofac Surg 2015; 43:944-9. [PMID: 26027860 DOI: 10.1016/j.jcms.2015.04.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 03/27/2015] [Accepted: 04/22/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Different modalities have been described regarding the treatment of mandibular condyle fractures. The most advantageous and safest one is still a topic of discussion. The present analysis describes the combination of a retromandibular, transparotideal approach combined to a triangular-positioned double-miniplate osteosynthesis, with a special regard for the patients' long term outcomes. MATERIAL AND METHODS Clinical data of 102 patients with 124 condyle fractures treated with the mentioned surgical procedure were evaluated. Functional parameters such as the maximal interincisal distance, deviations/deflections, facial nerve function, occlusion as well as complications regarding the parotid gland, osteosynthesis, and esthetics were evaluated 1 week, 2 weeks, 3 months, and 6 months postoperatively. RESULTS The mean maximal interincisal distance ranged from 38 mm after 1 week to 45 mm after 6 months. Deviations/deflections were seen in 22.5% of the cases 1 week postoperatively and decreased to 2% at 6 months postoperatively. A temporary facial palsy was diagnosed in 3.9% during the first follow-up, whereas no impairment was recorded after 3 or 6 months. At the same time, no patient had occlusional disturbances or complications regarding the parotid gland or the osteosynthesis 6 months postoperatively. CONCLUSIONS Direct fracture visualization and a stable three-dimensional fracture stabilization are the main advantages of the presented combination of a surgical approach and osteosynthesis technique. Additionally, the absence of long-term complications confirms the safety of the procedure. Therefore, it may be considered as a successful treatment option for mandibular condyle fractures.
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Functional outcomes of preauricular underparotid retrograde approach for mandibular condyle fractures. J Craniofac Surg 2014; 25:1078-81. [PMID: 24717314 DOI: 10.1097/scs.0000000000000514] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Management of condyle fractures includes a wide spectrum of alternatives including analgesia alone, physiotherapy, intermaxillary fixation, and open reduction and internal fixation. Various approaches have been previously mentioned for the access to the mandibular condyle. The aim of this retrospective clinical study was to evaluate our clinical results on preauricular underparotid retrograde approach for condylar fractures. This retrospective study included 20 condylar fractures in 16 patients who were treated surgically using a preauricular transparotid retrograde approach between 2010 and 2013. Functional outcomes with this method were addressed in light of the results obtained in this clinical series. We suggest this method in the management of condylar fractures.
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Treatment of mandibular condyle fractures using a modified transparotid approach via the parotid mini-incision: experience with 31 cases. PLoS One 2013; 8:e83525. [PMID: 24386221 PMCID: PMC3873388 DOI: 10.1371/journal.pone.0083525] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 11/05/2013] [Indexed: 11/23/2022] Open
Abstract
Surgery for mandibular condyle fractures must allow direct vision of the fracture, reduce surgical trauma and achieve reduction and fixation while avoiding facial nerve injury. This prospective study was conducted to introduce a new surgical approach for open reduction and internal fixation of mandibular condyle fractures using a modified transparotid approach via the parotid mini-incision, and surgical outcomes were evaluated. The modified transparotid approach via the parotid mini-incision was applied and rigid internal fixation using a small titanium plate was carried out for 36 mandibular condyle fractures in 31 cases. Postoperative follow-up of patients ranged from 3 to 26 months; in the first 3 months after surgery, outcomes for all patients were analyzed by evaluating the degree of mouth opening, occlusal relationship, facial nerve function and results of imaging studies. The occlusal relationships were excellent in all patients and none had symptoms of intraoperative ipsilateral facial nerve injury. The mean degree of mouth opening was 4.0 (maximum 4.8 cm, minimum 3.0 cm). No mandibular deviations were noted in any patient during mouth opening. CT showed complete anatomical reduction of the mandibular condyle fracture in all patients. The modified transparotid approach via the smaller, easily concealed parotid mini-incision is minimally invasive and achieves anatomical reduction and rigid internal fixation with a simplified procedure that directly exposes the fracture site. Study results showed that this procedure is safe and feasible for treating mandibular condyle fracture, and offers a short operative path, protection of the facial nerve and satisfactory aesthetic outcomes.
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Bouchard C, Perreault MH. Postoperative complications associated with the retromandibular approach: a retrospective analysis of 118 subcondylar fractures. J Oral Maxillofac Surg 2013; 72:370-5. [PMID: 24075238 DOI: 10.1016/j.joms.2013.08.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 08/13/2013] [Accepted: 08/13/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the rate of complications associated with the retromandibular approach. MATERIALS AND METHODS The design of this research was a retrospective case-series study. Included were patients who 1) underwent open reduction and internal fixation of the condylar or subcondylar area through a retromandibular approach and 2) had a complete and available medical chart. Excluded were 1) patients treated endoscopically or by other approaches and 2) patients with preoperative facial paralysis. The data collected were age, gender, medical comorbidities, tobacco use, mechanism of injury, anatomic location, concomitant facial fractures, follow-up time, antibiotic protocol, and complications. RESULTS One hundred eight patients (81 male; 118 condyles; age, 13 to 82 yr; mean, 35.6 ± 15.8 yr) met the inclusion criteria. Six patients never returned for postoperative visits and the mean follow-up time for all other patients was 6.5 months (8 days to 5.5 years). Twenty-six cases (22%) of temporary paralysis and 1 case of permanent facial paralysis were noted. Eight patients (6.8%) had persistent partial facial paralysis at their last visit, but all had short postoperative follow-ups. Fourteen cases (11.9%) of infection, 4 salivary fistulas, 2 sialoceles, 1 case of Frey syndrome, and 2 seromas were observed. CONCLUSION The retromandibular approach is a safe method for the treatment of condylar process fractures and major complications are rare.
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Affiliation(s)
- Carl Bouchard
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Centre Hospitalier Universitaire de Québec, Université Laval, Hôpital de l'Enfant-Jésus, Québec, Québec, Canada.
| | - Marie-Hélène Perreault
- Dental Student, Centre Hospitalier Universitaire de Québec, Université Laval, Hôpital de l'Enfant-Jésus, Québec, Québec, Canada
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Kanno T, Sukegawa S, Tatsumi H, Nariai Y, Ishibashi H, Furuki Y, Sekine J. The retromandibular transparotid approach for reduction and rigid internal fixation using two locking miniplates in mandibular condylar neck fractures. Int J Oral Maxillofac Surg 2013; 43:177-84. [PMID: 24070772 DOI: 10.1016/j.ijom.2013.08.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 07/01/2013] [Accepted: 08/19/2013] [Indexed: 11/18/2022]
Abstract
We evaluated the safety, efficacy, and morbidity associated with the treatment of displaced mandibular condylar neck fractures using a retromandibular transparotid approach to reduce and rigidly fix using two 2.0-mm locking miniplates. Our surgical inclusion criteria were: patient selection of open reduction and fixation, displaced unilateral condylar fractures with derangement of occlusion, and bilateral condylar fractures with an anterior open bite. The study group consisted of 19 patients who underwent surgery for 19 mandibular condylar neck fractures; patients were analyzed prospectively, with more than 6 months of follow-up, and were evaluated in terms of functional results, scar formation, postoperative complications, and stability of fixation. The results showed that functional occlusion identical to the preoperative condition and correct anatomical reduction of the condylar segments in centric occlusion, followed by immediate functional recovery, was achieved in all patients. No patient suffered from any major or permanent complication postoperatively, although there were two cases (11%) of temporary facial nerve palsy, which resolved completely within 3 months. Surgical scars were barely visible. The retromandibular transparotid approach with open reduction and rigid internal fixation for displaced condylar neck fractures of the mandible is a feasible and safe, minimally invasive surgical technique that provides reliable clinical results.
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Affiliation(s)
- T Kanno
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan; Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa, Japan.
| | - S Sukegawa
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa, Japan
| | - H Tatsumi
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Y Nariai
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - H Ishibashi
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Y Furuki
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa, Japan
| | - J Sekine
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
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