Fixation Of Subcondylar Fractures Research Articles

A Temporary Intraoperative Fixation Method for the Absorbable Plates Fixation of Condylar Fracture by Retromandibular Transparotid Approach.

The authors describe a temporary intraoperative fixation method for the absorbable plates' fixation of subcondylar fracture by retromandibular transparotid approach. First, the fracture was temporarily fixed with a 4-hole titanium microplate across the fracture line in the center of the lateral surface of the condyle to maintain the reduction of the fracture. Then, two 4-hole absorbable mini-plates were fixed on the posterior and anterior border of the condylar neck. Finally, the 4-hole titanium microplate and screws were removed before the wound closure. In the absorbable plates' fixation of subcondylar fracture by transparotid approach, the method of temporary intraoperative fixation using a 4-hole titanium microplate offsets the limited exposure of the operative field, smooths the operation, and offers the reliability and validity of the absorbable plates' fixation.

Versatility of various 3D non locking miniplates in treatment of mandibular fractures

Context: The optimal management of mandibular fractures continues to evolve. Fractures of mandible predispose the patients to structural, functional and aesthetic compromise if not treated. The current understanding of the biomechanics and fracture healing of the mandible has influenced the modern approach to the open reduction and internal fixation of these fractures. These help us to evaluate shortcomings of compression plates and 2D miniplates leading to development of 3D plates. Aims: To evaluate the versatility and efficacy and complication of 3 different varieties of 3D non locking plates–2x2 and 2x3 and delta plates in the treatment of mandibular fractures at different sites.Materials and Methods: A total of 86 patients of mandibular fractures were managed by open reduction and internal fixation utilizing total 114 three dimensional plates (109 non locking 3D plates (2X2,3X2) and 5 delta plates) were used for fractures of the mandible including symphysis, parasymphysis, body, angle, ramus and condyle over a period of 3 years.Results: The use of 3D plates provided semi-rigid fixation of fractured fragments with no immediate post-operative mobility. Immediate and subsequent postoperative clinical and radiographic evaluation was carried out at 15 days, 1 month, 3 months and 6 months. Post-operative complications observed were post-operative neurosensory deficit in 3 patients, occlusal discrepancy in 3 patients, wound dehiscence in 2 patient, plate exposure in 1 patient and parotid fistula in 1 patient which accounted for 8.6% of total patients. None of the patient suffered from Infection, segmental mobility, paraesthesia. Malunion, non-union. All these were treated successfully with definitive measures.Conclusion: The 3D mini-plate system is a versatile and efficient method for fixation of mandibular fractures. Delta plates are efficient method for reduction and fixation of subcondylar fracture. The only contraindication for 3D plates is their use in mental foramen region (where distance between mental foramen and inferior border is less than 1.5cm).

Antero-parotid Trans-massetric Approach For Reduction Of Mandibular Subcondylar Fractures; Clinical Tricks

Introduction: Mandibular fractures in the subcondylar area are frequent in the trauma of the maxillofacial area. This injury is frequent almost at the same rate in adults and children. These fractures are treated by open reduction along with internal fixation or closed reduction. The patient’s age, general health condition, and healthcare setting must be taken into account when deciding on the surgical option. Most of the approaches for open reduction and internal fixation of subcondylar fractures carry the risks of injury to the facial nerve branches and developing sialocele. Although the antero-parotid trans-masseteric approach which was introduced by Wilson in 2005and has the least post-operative complications among other approaches, it is still not widely used by maxillofacial surgeons. The article will give some clinical tricks after ten years of clinical experience, in using this approach for treating about 245 mandibular condylar fractures, on 205 patients. Methodology: This is a retrospective cohort study to evaluate the results of adult population group comprising 205 patients. There were totally 245 fractures of which 205 patients’ surgery was done. Data were gathered from January 2010 to December 2020. Only minimal complications were observed within the first ten days after surgery, including slight transient weakening of the facial nerve, particularly buccal branches, in 3.4 percent of cases and unusual edema and trismus in 8.7% of cases, both of which recovered within the first ten days. In none of these cases, a parotid leak/sialocele was discovered. Discussion: Although the antero-parotid trans-masseteric approach is not widely used between oral and maxillofacial surgeons worldwide, it has the least post-operative complicationscompared to the other approaches for treating mandibular condylar fractures. Data collected from January 2010 till December 2020 with a total of 245 fractures operated on 205 patients. Only minor complications were noticed during the 10 days post operative period with mild temporary weakness of the buccal branches of facial nerve in 3.4% of cases and post operative unusual edema and trismus in 8.7% which resolved during the first ten days post operatively.No parotid leak/sialocele was found in any of these cases. Our aim is to give some clinical tricks after ten years experience in using this approach to treat condylar fractures, to simplifying the technique and to achieve the best results with the least complications. The tricks include the type of fractures that can be treated with this approach, to identify the surgical site, to retract the parotid gland along with its attached fascia posteriorly to open through the masseter muscle, to identify facial nerve branches in surgical site, the needs for perfect retraction and the use of optimum muscle relaxant to aid during reduction ofdisplaced and dislocated subcondylar fractures of mandible. Results And Conclusion: Only minor complications were noticed during the 10 days post operatively with mild temporary weakness of the buccal branches of facial nerve in 3.4% of cases and unusual moderate to severe post-operative facial edema and trismus in 8.7 % which resolved during the first ten days post operatively. No parotid leak/sialocele was found in any of these cases. We recommend this approach as it is rapid, easy, safe, and effective for treating low subcondylar fractures. We suggest considering perioperatively these clinical tricks can achieve the best outcome with least complications and minimize operating time.

COMPARATIVE STUDY BETWEEN TWO DIFFERENT OSTEOSYNTHESIS DEVICES FOR FIXATION OF SUBCONDYLAR FRACTURE

Statement of problem: Management of subcondylar fracture with proper reduction of temporomandibular joint position and function is a challenge, different osteosynthesis devices are used with great diversity in their types, numbers, positions, and results.Purpose: Comparative study between the efficiency of single miniplate and single minidynamic compression plate in restoration of ramus height, condylar angulation, and tempromandibular joint function in subcondylar fracture cases.Material and Method: 14 patients indicated for open reduction and fixation of subcondylar fractures were divided into two groups each of 7 patients. Group A: subcondylar fractures were fixed using 2.0 single miniplate along posterior border of ramus. Group B: a single 2.0-mm minidynamic compression plates (DCP), were applied along posterior border of ascending ramus for fracture fixation in the other seven patients. Intermaxillary fixation for 10 days was applied for both groups. Clinical and radiograhic follow up were performed at 1, 3, 6 months using panorama and CT. Results: At 6 months postoperatively, there was an improvement of mandibular functions with improvement of inter-incisal opening from 19.1mm and 20.1 mm in group A and B respectively to 35.6mm and 30.8 mm. Which was significantly different (P value =0.04). The shortening in ramus height improved from 3.2mm and 5.2mm in group A and B to 0.8 mm and 0.6 mm, also sagittal angulation of condyle improved from 1.6o and 4.7o in both group respectively to 0.2o and 0.3o with no significant difference between two types of mini-plate. There were no signs of infection, malunion, nonunion or device failure in both groups. except for one case of group A, that suffered from malocclusion with displacements of the fractured segments immediately after the operations, that responded to elastic traction within 15 days.Conclusion: Single 0.2 mm miniplate or mini DCP aided by intermaxillary fixation are successful devices in fixation of subcondylar fracture without complication, with superiority of mini DCP in proper condylar reduction and stable fixation.

Retromandibular transparotid approach for subcondylar mandibular fractures: A retrospective study.

The aim was to evaluate the effectiveness and complications of retromandibular transparotid approach performed for the reduction of dislocated subcondylar fractures. Fourteen patients with subcondylar mandibular fractures were evaluated (8 male, 6 female, age range 19-43 years). The primary predictor variable in the present study was time (preoperative vs postoperative). The primary outcome variables were inflammatory complication, facial nerve deficit (House and Brackmann classification), and presence of parotid fistula. The secondary outcome variables were occlusal disturbances, maximal interincisal opening (MIO), and temporomandibular joint (TMJ) pain (VAS). Excellent occlusion and function was observed postoperatively. One salivary fistula occurred after surgery but was healed after 3 weeks. No inflammatory complication was observed. Three patients had grade III and one patient had grade II facial nerve deficit, all recovered in 6 weeks. All patients were free of pain and no malocclusion was observed. MIO was ranging from 34 to 58 mm (mean 44.4 mm) after 6 months. The retromandibular transparotid approach is feasible and safe. It facilitates reduction and fixation of subcondylar fractures with functional outcomes and rare complications.

Surgical Management of a Mandible Subcondylar Fracture

Open reduction and anatomic reduction can create better function for the temporomandibular joint, compared with closed treatment in mandible fracture surgery. Therefore, the double miniplate fixation technique via mini-retromandibular incision was used in order to make the most stable fixation when performing subcondylar fracture surgery. Those approaches provide good visualization of the subcondyle from the posterior edge of the ramus, allow the surgeon to work perpendicularly to the fracture, and enable direct fracture management. Understanding the biomechanical load in the fixation of subcondylar fractures is also necessary in order to optimize fixation methods. Therefore, we measured the biomechanical loads of four different plate fixation techniques in the experimental model regarding mandibular subcondylar fractures. It was found that the loads measured in the two-plate fixation group with one dynamic compression plate (DCP) and one adaption plate showed the highest deformation and failure loads among the four fixation groups. The loads measured in the one DCP plate fixation group showed higher deformation and failure loads than the loads measured in the two adaption plate fixation group. Therefore, we conclude that the selection of the high profile plate (DCP) is also important in order to create a stable load in the subcondylar fracture.

Transient Total Facial Nerve Paralysis

Endoscopic-assisted repair of subcondylar fractures is an additional tool for management; however, there is a steep learning curve. Generally, this technique allows good visualization of the fracture site for reduction through an incision with an acceptable cosmetic result. Recently, the surgical techniques and technology as well as the indications for endoscopic facial fracture repair are in development; there are few available data in the literature regarding detail complications and recovery processes following endoscopic fracture treatment. The purpose of this article was to reveal unusual complication following endoscopic repair of subcondylar fracture in terms of radiographic, photographic, and recovering orders of the facial nerve and facial reanimations. In our case, no damage to the facial nerve was observed intraoperatively, but the patient had total facial paralysis, immediately postoperatively. At long-term follow-up, the facial nerve function was recovered well within 6 months. The authors consider that transoral endoscopic-assisted open reduction constitutes a valid alternative to a transcutaneous approach for the reduction and fixation of subcondylar fractures. It provides the benefits of open reduction and internal fixation without the permanent complications, such as facial nerve injury.

Endoscopic assisted fixation of subcondylar fractures: application of resorbable plates and screws

Endoscopic assisted fixation of subcondylar fractures: application of resorbable plates and screws