Experience in the management of subcondylar fractures via a modified extraoral
approach
Awaad Attitallah AL-BISHRI , Sanadi Sajid AHMED , Mian Usman FAROOQ
Department of Maxillofacial Surgery, King Abdullah Medical City, Αl-Noor Specialist Hospital. Makkah, Saudi Arabia
Hellenic Archives of Oral & Maxillofacial Surgery (2012) 2, 83-91
SUMMARY: Α modified surgical approach to the mandi bular condyle without the usual surgical complications is presented. Patients and Methods: This prospective study was conducted from December 2007 to April 2010, in the Department of Maxillofacial Surgery of Al-Noor Specialist Hospital, Makkah, Saudi Arabia. Forty patients with 47 subcondylar fractures were treated. The fractures were surgically treated via a modified extraoral approach with a pre-auricular incision extending to the retromandibular area; access to the condyle was obtained through a cleavage plane between parotid gland and masseter muscle. Patients were carefully followed up and evaluated at first post operative day, one week, one month, three months and six months postoperatively. Results: Our surgical approach provided a safe and fast access to the condylar fracture. Facial nerve examination showed no temporary or permanent injuries. No case of wound infection was found within 6-months follow up. Three (7.5%) patients developed a sialocele and a salivary fistula has been noticed in one case. Satisfactory occlusion was achieved and appropriate mandibular opening was found. Immediate postoperative radiographs revealed anatomic bone reduction. Conclusion: The applied surgical approach had satisfactory results in cases of condylar fractures.
KEY WORDS: mandible, condyle, maxillofacial procedure, complications
REFERENCES
Biglioli F, Colletti G: Mini retromandibular approach to condylar fracture. J Cranio-Maxillofac Surg 36:378-83, 2008
Biglioli F, Colletti G: Transmasseteric approach to condylar fracture by mini-retromandibular access. J Oral Maxillofac Surg 67:2418- 24, 2009
Choi B, Yoo JH: Open reduction of condylar neck fractures with exposure of the facial nerve. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 88:292-296, 1999
Devlin MF, Hislop WS, Carton AT: Open reduction and internal fixation of fractured mandibular condyles by a retromandibular approach: surgical morbidity and informed consent. Br J Oral Maxillofac Surg 40:23-25, 2002
Dunaway DJ, Trott JA: Open reduction and internal fixation of condylar fractures via an extended bicoronal approach with masseteric myotomy. Br J Plastic Surg 49:79, 1996
Ellis E III, McFadden D, Simon P, Throckmorton GS: Surgical complications with open treatment of mandibular condylar process fractures. J Oral Maxillofac Surg 58:950-8, 2000
Hotz RP: Functional jaw orthopedics in the treatment of condylar fractures. Am J of Orthodontics 73:365-378, 1978
Iatrou I, Theologie-Lygidakis N, Tzerbos F: Surgical protocols and outcome for the treatment of maxillofacial fractures in children: 9 years' experience. J Craniomaxillofac Surg 38:511-516, 2010
Iizuka T, Lindqvist C, Hallikainen D, Mikkonen P, Paukku P: Severe bone resorption and osteoarthrosis after mini plate fixation of high condylar fractures; a clinical and radiological study of thirteen patients. Oral Surg Oral Med Oral Pathol 72:400, 1991
Ilkka K, Lisa A, Derholm S, Paukku P, Lindqvist C: Lag-Screw ossiosynthesis of Mandibular Condyle Fractures: A Clinical and Radiological Study. J Oral Maxillofac Surg 53:1397-1404, 1995
Lachner J, Clanton JT, Waite PD: Open reduction and internal rigid fixation of subcondylar fractures via an intraoral approach. Oral Surg 71:257-261, 1991 Lauer G, Haim D, Proff P, Richter G, Pradel W, Fanghanel J, et al: Plate osteosynthesis of the mandibular condyle. Ann Anat 189:412-417, 2007
Manisali M, Amin M, Aghabeigi B, Newman L: Retro-mandibular approach to the mandibular condyle: a clinical and cadaveric study. Int J Oral Maxillofac Surg 32:253-6, 2003
Narayanan V, Kannan R, Sreekumar K: Retromandibular approach for reduction and fixation of mandibular condylar fractures: a clinical experience. Int J Oral Maxillofac Surg 38:835-9, 2009
Schneider M, Lauer G, Eckelt U: Surgical treatment of fractures of the mandibular condyle: A comparison of long-term results following different approaches. Functional, axiographical, and radiological findings. J Craniomaxillofac Surg 35:151-160, 2007
Sesenna E, Raffaini M, Gianni AB, Tullio A, Moscato G: Risultati a distanza nel trattamentofunzionale delle fratture di condilo. Rivista Itaniana di Chirurgia Maxillo-Facciale 2:55-62, 1991
Siegel M, Wetmore R, Postic W, Handler SD, Tom LWC: Mandibular fractures in pediatric patient. Arch Otolaryngol Head Neck Surg 117:533-6, 1991
Tang W, Gao C, Long J, Lin Y, Wang H, Liu L, Tian W: Application of modified retromandibular approach indirectly from the anterior edge of the parotid gland in the surgical treatment of condylar fracture. J Oral Maxillofac Surg 67:552-558, 2009
Trost O, El-Naaj IA, Trouilloud P, Danino A, Malka G: High cervical transmasseteric anteroparotid approach for open reduction and internal fixation of condylar fracture. J Oral Maxillofac Surg 66: 201-204, 2008
Vesnaver A, Gorjanc M, EberlincA, David A, Dovas AK, Kansky AA: The periauricular transparotid approach for open reduction and internal fixation of condylar fractures. J Craniomaxillofac Surg 33:169-179, 2005
Walker RV: Open Reduction of Condylar Fractures of the Mandible in Conjunction with Repair of Discal Injury. A Preliminary Report. J Oral Maxillofac Surg 46:262-3, 1988
Williams JL: Maxillofacial injuries. 2nd edition Vol (I). Churchill Livin - gstone 1995, pp. 405-409.
Wilson AW, Ethunandann M, Brennan PA: Transmasseteric antero - parotid approach for open reduction and internal fixation of condylar fractures. Br J Oral Maxillofac Surg 43:57-60, 2005
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