scholarly journals Minimizing the Submandibular Incision in Endoscopic Subcondylar Fracture Repair

2015 ◽  
Vol 8 (4) ◽  
pp. 315-320 ◽  
Author(s):  
YasserAbdallah Aboelatta ◽  
Amir S. Elbarbary ◽  
Sarah Abdelazeem ◽  
Karim S. Massoud ◽  
Ikram I. Safe
Keyword(s):  
Facial Nerve ◽  
Fracture Repair ◽  
Wound Complications ◽  
Posterior Border ◽  
External Incision ◽  
Subcondylar Fracture ◽  
Facial Nerve Injuries ◽  
Endoscopic Guidance ◽  
Condylar Fractures ◽  
Difficult Cases

Endoscope-assisted treatment of mandibular condylar fractures is an evolving surgical technique of this controversial subject. The approach is performed through an intraoral and additional submandibular incision. This study presents a technique for minimizing the length of the optional submandibular incision. Ten patients with displaced subcondylar fractures and malocclusion underwent endoscope-assisted open reduction and internal fixation (ORIF). A limited (<1 cm) submandibular incision (dissected under endoscopic guidance from within) was needed in eight patients to complement the intraoral incision and facilitate the reduction in the fractures. Satisfactory small scar could be obtained in all patients with neither wound complications nor facial nerve injuries. Our technique depends on dissection first then incision. Performing the external incision after complete intraoral dissection is safe for the facial nerve and minimizes scarring markedly. This very limited submandibular incision facilitates reduction in relatively difficult cases and enables clear visualization of posterior border of the mandible to confirm adequate fracture reduction.

Comparative Evaluation of Clinical and Radiological Outcomes of Retromandibular Transparotid and Transoral Endoscopic-Assisted Approach for Surgical Management of Mandibular Subcondylar Fractures

2020 ◽  
pp. 194338752094909
Author(s):  
Ajit Sinha ◽  
Srivalli Natarajan
Keyword(s):  
Facial Nerve ◽  
Comparative Evaluation ◽  
Statistical Significance ◽  
Functional Results ◽  
Minimally Invasive Approach ◽  
Multiple Fractures ◽  
Invasive Approach ◽  
Subcondylar Fracture ◽  
Facial Nerve Injuries ◽  
Cosmetic Outcomes

Study Design: A prospective randomized comparative study was conducted to evaluate the clinical and radiological outcomes of the retromandibular transparotid (RMT) approach with endoscopic-assisted transoral (ENDO) approach used for open reduction and internal fixation (ORIF) of adult mandibular subcondylar fractures. Objectives: To evaluate and compare the primary functional outcome using the Helkimo’s dysfunction index, the surgical ease, the incidence of facial nerve weakness, the cosmetic outcomes and the number of complications following ORIF of mandibular subcodylar fractures using the RMT and ENDO approaches. Methods: In this prospective study, 20 patients with unilateral/bilateral subcondylay fractures requiring ORIF were recruited between 2017 and 2018. Patients were randomly divided into RMT and ENDO group, 10 patients in each. Clinical and radiological assessment was done preoperatively and in postoperative period it was done at different intervals over the period of 6 months. The intraoperative parameter time taken during surgery was correlated for association with the time elasped since day of trauma and with the fracture severity. Similarly, the presence of multiple fractures of the mandible and postoperative occlusion were evaluated for the association. Results: Comparable functional results were noted in both groups without any statistical significance. ORIF in ENDO group proved to be more time-consuming. For the RMT group, visible scars were rated best or close to best at the end of 6 months but a greater number of facial nerve injuries were reported in the RMT group. Conclusions: Superiority of one approach over others cannot be established since the outcomes were not statistically different. However, the ENDO approach appears to be safer. Therefore, there is a need for the development of innovative armamentarium which would improve the dexterity and ease of the surgeon and hence the total time taken for this minimally invasive approach for the management of subcondylar fracture.

scholarly journals Modified Risdon approach using periangular incision in surgical treatment of subcondylar mandibular fractures

2016 ◽  
Vol 144 (7-8) ◽  
pp. 391-396 ◽  
Author(s):  
Zivorad Nikolic ◽  
Drago Jelovac ◽  
Melvil Sabani ◽  
Jelena Jeremic
Keyword(s):  
Facial Nerve ◽  
Mouth Opening ◽  
Mandibular Fractures ◽  
Safe Procedure ◽  
Aesthetic Result ◽  
Subcondylar Fracture ◽  
Good Cosmetic ◽  
Condylar Fractures ◽  
Subcondylar Region

Introduction. No consensus has been reached yet on the surgical approach for treatment of condylar fractures. Objective. The aim of this study was to present modified Risdon approach (without facial nerve identification) in the treatment of subcondylar mandibular fractures. Method. This is a retrospective study of a period 2005-2012. During this seven-year period, 25 condylar mandibular fractures in 22 men and three women (19-68 years old) were treated by modified Risdon approach without identifying the facial nerve. The main inclusion criterion was subcondylar fracture according to Lindahl classification. Results. No additional morbidity related to postoperative complications, such as infection or salivary fistula, was observed in this series. Only two (8%) patients developed temporary weakness of the marginal branch of the facial nerve, which resolved six weeks postoperatively. Each patient achieved good mouth opening postoperatively. Scar was camouflaged in the first cervical wrinkle. Two patients developed temporomandibular joint dysfunction. No patient had postoperative occlusal disturbance. In all of the patients good aesthetic result was achieved in a two-year follow-up. Conclusion. In comparison with techniques described in the literature, the main advantages of the modified Risdon approach are the following: no need for facial vessels identification; direct, fast, and safe approach to mandibular angle and subcondylar region; relatively simple surgical technique and good cosmetic result - due to aesthetically placed incision. This approach could be recommended for subcondylar fracture as a simplified and safe procedure.

scholarly journals Transmasseteric antero-parotid approach through modified preauricular lazy ‘S’ incision for management of mandible condylar fractures: a prospective study

2018 ◽  
Vol 1 (1) ◽  
pp. 85-89
Author(s):  
Kusuma Duda ◽  
Gaddipati R ◽  
Ramsetti S ◽  
Suvvada B
Keyword(s):  
Facial Nerve ◽  
Prospective Study ◽  
Closed Reduction ◽  
Open Reduction ◽  
Condylar Fracture ◽  
Anatomic Reduction ◽  
Operative Complications ◽  
Preauricular Approach ◽  
A Prospective Study ◽  
Condylar Fractures

To report the surgical details and results of our technique of Transmasseteric antero-parotid approach (TMAP) through modified preauricular lazy ‘S’ incision for management of mandibular condylar fractures. This was an observational analysis of 65 patients where 25 patients were treated with conventional preauricular approach, 25 patients with closed reduction and 15 patients with a mean age of 29.4 years with condylar fractures were treated by TMAP technique between September 2016 to June 2018. Aim of the study was to evaluate the proficiency of TMAP approach for open reduction and internal fixation (ORIF) of condylar fracture. The only complication which was noticed was sialocele formation and managed by drainage. TMAP is versatile since it avoids facial nerve damage as it involves identification and preservation of facial nerve and   has less chances of post-operative complications related to facial nerve injury. The accessibility achieved by this approach is fair enough to facilitate anatomic reduction and fixation of condyle.

Effect of Epineurial Neurorrhaphy on Restoration of Facial Nerve Injuries with Different Levels of Neurotmesis in a Rat Model: A Pilot Study

2018 ◽  
Vol 112 ◽  
pp. e14-e22 ◽  
Author(s):  
Suming Shi ◽  
Yuhang Han ◽  
Lei Xu ◽  
Jianfeng Li ◽  
Yuechen Han ◽  
...  
Keyword(s):  
Pilot Study ◽  
Facial Nerve ◽  
Rat Model ◽  
Nerve Injuries ◽  
Facial Nerve Injuries ◽  
Different Levels

scholarly journals Condylar Neck and Sub-Condylar Fractures: Surgical Consideration and Evolution of the Technique with Short Follow-Up on Five Cases

2020 ◽  
Vol 8 (4) ◽  
pp. 125
Author(s):  
Antonio Cortese ◽  
Antonio Borri ◽  
Marco Bergaminelli ◽  
Fabrizio Bergaminelli ◽  
Pier Paolo Claudio
Keyword(s):  
Facial Nerve ◽  
Nerve Injury ◽  
Maxillofacial Surgery ◽  
Complete Healing ◽  
Oblique View ◽  
Facial Nerve Injury ◽  
Intraoral Approach ◽  
Soft Tissue Dissection ◽  
Condylar Fractures ◽  
Condylar Neck

Condylar neck and sub-condylar fractures of the mandible are a frequent occurrence in maxillofacial surgery. The indication for surgical treatment of these fractures has changed over time, and several techniques have been developed with different results in the attempt to avoid the most worrisome adverse event, i.e., facial nerve injury. In this study, we present a new technique that combines an intraoral and a cutaneous pre-auricular access, which allows for easy and safe access to the surgical site, preventing facial nerve injury and avoiding surgical scars in high-impact aesthetic areas of the neck. Five consecutive patients affected by condylar neck or sub-condylar fractures were treated at a single institution using a combined intraoral and pre-auricular access. Results were evaluated after three months from surgery in terms of mandibular mobility, occurrence of complications, and patient’s satisfaction. All five patients had good outcome, with complete healing of the fracture and no occurrence of complications, including no facial nerve palsy. A key point of the technique is the safe reduction of the two mandibular fragments realized by a combined intraoral and a cutaneous pre-auricular surgical access. The periosteal plan of the ramus can be widely and safely elevated with the intraoral approach and connected to the condylar bone plane by the pre-auricular cutaneous approach without any need for soft tissue dissection at the fracture rim, thereby avoiding facial nerve injuries. Wide ramus periosteum elevation creates an “optical space”, allowing fragment reduction and fixation under direct oblique view without any endoscopic need. Our results strongly suggest that with our technique it is possible to treat sub-condylar and condylar neck fractures safely, avoiding facial nerve injury, which is an unacceptable complication due to its heavy impact on a patient’s life.

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