Parotid Fistula Research Articles

Local Flap Reconstructions in Oral Cavity Defects: An Insight from 104 Cases.

Resection of oral cavity carcinoma often leads to complex defects causing functional and aesthetic morbidity. Providing optimum reconstruction with free flaps becomes challenging in a high-volume center setting with constrained resources. Hence, understanding the local flap technique for reconstructing oral cancer defects is prudent. This study is a retrospective analysis of prospectively operated cases of oral cavity resections which were subsequently reconstructed using local flaps from 2019 to 2022. Patients who underwent reconstruction with either melolabial flap, islanded facial artery myomucosal (FAMM) flap, submental flap, supraclavicular artery island flap, infrahyoid flap, or platysma myocutaneous flap (PMF) were included in this analysis. Eligible patients were followed up to evaluate functional outcomes like oral feeding and to analyze the Performance Status Scale for Head and Neck Cancer. The study included 104 patients. The tongue was the most common subsite, resulting in most hemiglossectomy defects, which were reconstructed using the melolabial flap procedure. Buccal mucosa defects in our series were reconstructed using the supraclavicular flap, whereas the submental flap procedure was the choice for lower lip-commissure defects. Complications such as partial and total flap loss, deep neck infection, and donor site complications like infection and gaping, oral cutaneous fistula, parotid fistula, and seroma were analyzed; the supraclavicular flap presented with a majority of complications. Local flaps are an alternative to free flap reconstruction in select cases with optimum functional outcomes and minimal donor site morbidity. This article comprehensively reviews the surgical steps for various local flap procedures in oral cancer defects.

The Successful Management of Non-healing Extraoral Draining Sinus of Odontogenic Origin: A Report of Two Cases

Extraoral draining sinus of odontogenic origin usually lacks intraoral symptoms, thus it may be diagnosed as a cutaneous lesion. It is rare and may be confused with a wide variety of diseases for example furuncle, pericoronitis in relation to the mandibular third molars, parotid fistula, preauricular sinuses, periapical and periodontal pathology, and many more. Patients might seek treatment from their physician as they are not aware of its odontogenic origin and these cases usually are misdiagnosed and leading to inappropriate treatment. Objective: To discuss the detailed management of two cases of extraoral draining sinus that were successfully treated. Case Reports: The first case was referred by the Department of Oral and Maxillofacial Surgery, for management of extraoral draining sinus originating from tooth 36. In the second case, the extraoral draining sinus is caused by pulpal necrosis of several mandibular anterior teeth. Intra-radicular microorganisms in infected root canals primarily obligate anaerobes have been the aetiologic cause of apical periodontitis if left untreated may cause these types of symptoms. Conclusion: As it is uncommon and the absence of any dental symptoms, thus, it’s paramount important to diagnose these types of cases to treat the disease and to avoid unnecessary treatments such as prolonged prescription of antibiotics. Therefore, the dental cause should be ruled out for any cutaneous sinus tract so that a correct diagnosis can be ascertained, and proper management can be delivered to the patient.

Parotid Fistulas after Reconstructive Surgery for the Face and Neck Burn Contracture

Parotid Fistulas after Reconstructive Surgery for the Face and Neck Burn Contracture

Safety and Effectiveness of Limited Incision Facelifts: A Systematic Review and Meta-analysis

Abstract Goals/Purpose Limited incision facelifts offer a less invasive approach compared to a standard facelift and allow for the procedure to be completed under local anesthesia. While there have been various types of limited incision facelifts described, there have been no systematic reviews of their evidence. The purpose of this study is to systematically review the limited incision facelift literature, describe the various surgical approaches and their indications, and summarize their safety and effectiveness. Methods/Technique A systematic review of the literature was performed following the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines and registered with the PROSPERO international prospective register of systematic reviews. The MEDLINE (Pubmed), EMBASE, and Cochrane Central Register of Trials were queried. Screening and full-text review of studies was conducted by two independent evaluators using predetermined inclusion and exclusion criteria. Data obtained from each eligible study included information on author specialty, Oxford Centre for Evidence-Based Medicine level of evidence, and patient demographics. Operative data included anesthetic approach, operative duration, incisional pattern, SMAS technique, concomitant procedures, and drain or tissue sealant use. Complication frequencies were calculated from those studies that specifically described complication data and included the prevalence of hematoma, wounds or skin necrosis, infection, nerve injuries, and revision surgery. Data on patient- and provider-reported outcomes were also collected. Meta-analyses were performed using aggregated data. Proportions are provided with the corresponding 95% confidence interval. A Random-effects model was used to summarize complications data and meta-regressions were conducted to analyze associations with operative variables. Results/Complications A total of 1137 articles were retrieved using the pre-specified search criteria. Following the removal of duplicates, 758 studies were screened using titles and/or abstracts, and 144 articles underwent full-text review. Review yielded twenty articles that met inclusion criteria. Using the Oxford Centre for Evidence-Based Medicine guidelines, 17 (85%) articles provided level IV evidence while three (15%) provided level III evidence. Articles included a total of 4451 patients with an average age of 56 years. Ninety-four percent were women while 6% were men. Forty-two percent of patients underwent surgery awake under local anesthesia, 24% under IV sedation, 18% under intramuscular sedation, and 16% under general anesthesia. Incisional patterns varied but were categorized as limited to pre-auricular (5%), pre-and retro-auricular (10%), pre-auricular with horizontal sideburn extension (30%), pre-auricular with temporal extension (35%), and pre- plus retro-auricular with temporal extension (20%) (Figure). SMAS technique included plication (33%), purse-string suspension (28%), plication plus SMASectomy (11%), plication plus SMASectomy and purse-string suspension (11%), SMASectomy only (6%), or other (18%). Forty-five percent of articles described using drains and 10% described using a tissue sealant. The overall complication frequency was 4.0% (95% CI 2.8-5.2%). The use of a drain or sealant was associated with a decreased complication frequency of 2.6% (95%CI 1.0-4.2%) compared to 5.0% (95% CI 3.4-6.6%) in studies using no drain or sealant (p=0.04). There were no associations found between complications and incision type or anesthetic approach. Eighteen studies described hematoma frequencies. Among these articles, there was a 2.3% hematoma frequency (95% CI 1.5-3.0%). Twenty-seven patients (1.5%) had hematomas that were treated with conservative management like needle aspiration while eight (0.4%) required a return to the operating room. The next most common complication described was temporary nerve injury or neuropraxia with a rate of 0.2% (95% CI 0.1%-0.4%­­­). The frequency of skin necrosis or non-healing wounds was 0.2% (95% CI 0.1%-0.04%). No permanent nerve injuries were described. Other less commonly described complications included widening or hypertrophic scars, dog ear deformities (all within patients undergoing pre-auricular limited incisions), skin dimpling, three cases of parotid fistula, and a DVT in a patient undergoing multiple concomitant body procedures. Seven articles (35%) provided data on patient-reported outcomes while three (15%) provided data on provider-based outcomes, such as ratings of postoperative results. Conclusion To our knowledge, this is the first systematic review and meta-analysis of limited incision facelifts. This surgical approach offers an alternative to traditional rhytidectomy for the properly selected candidate. Meta-analysis demonstrates a low postoperative complication rate which is further reduced in studies using a drain or tissue sealant. This meta-analysis provides plastic surgeons and their patients with an evidence-based reference for complication data and can improve the preoperative counseling process. Future studies should focus on incorporating validated patient-reported outcome measures and comparing surgical approaches.

Transoral Endoscopic-Assisted Reduction and Internal Fixation of Mandibular Condylar Fractures in Children

Extraoral approaches for open reduction and fixation of condylar fractures in children are associated with serious risks of complications, including facial nerve injury, facial scarring, parotid fistula, and auriculotemporal nerve injury. The purpose of this study was to retrospectively evaluate the outcomes of transoral endoscopic-assisted open reduction and internal fixation of condylar fractures and hardware removal in pediatric patients. This study was designed as a retrospective case series. The study included pediatric patients admitted with condylar fractures that were indicated for treatment with open reduction and internal fixation. The patients were clinically and radiographically evaluated with regard to occlusion, mouth opening, lateral and protrusive movement of the mandible, pain, chewing and speech difficulties, and bone healing at the fracture site. CT images were used to assess the reduction of the fractured segment, the stability of fixation and progress of healing of the condylar fracture at follow-up visits. The same surgical treatment approach was applied to all patients. The data from the study were analyzed for a single group without any comparison to other groups. The technique was used for the treatment of 14 subcondylar fractures in 12 patients between the ages of 3 to 11years. A total of 28 transoral endoscopic-assisted approach to the condylar region either for reduction and internal fixation or hardware removal were applied. The mean operating time was 53.1 (±11.3) minutes for the fracture repair and 20 (±2.6) minutes for hardware removal, respectively. The mean follow-up time of the patients was 17.8 (±2.7) months (median: 18) months. All patients regained stable occlusion, satisfactory mandibular motion, stable fixation, and complete bone healing at the fracture site at the end of their follow-up period. There was no transient of permanent facial nerve or trigeminal nerve injury in any of the patients. Endoscopically assisted transoral approach is a reliable technique for reduction and internal fixation of condylar fracture and hardware removal in pediatric patients. The serious risks of extraoral approaches including facial nerve injury, facial scar, and parotid fistula can be eliminated by using this technique.

Comparison of three different approaches in treatment of mandibular condylar fractures - Our experience.

The principal transfacial routes described to approach condylar process fractures are preauricular, retromandibular, high submandibular, and their various modifications. The selection of a specific surgical approach mainly depends on the level of condylar fracture, displacement/dislocation of the proximal segment and time elapsed from the date of trauma. Not too many studies proclaim a unanimous consensus on "gold standard" approaches for particular levels of fracture. This study was conducted with the aim to lay down guidelines for determining the ideal surgical approach for treating different condylar fractures based on different clinical situations. This prospective study was conducted on 60 patients that underwent open reduction internal fixation of condylar fractures according to preset study design. Inclusion criteria were fracture displacement more than 10 degrees, dislocation, shortening of ramal height more than 2 mm. Patients having maxillofacial fractures other than mandible and condylar fractures in edentulous patients were excluded from this study. The risk of facial nerve injury was more in endaural group and parotid fistula was more evident in retromandibular subparotid group but there was no statistical difference between the groups. The surgical scar was inconspicuous in all three groups. Excellent results were achieved in the other parameters such as mouth opening, range of motion, bite force, and occlusion with all the three approaches. Postoperative CT scan showed satisfactory anatomical reduction. This study concludes that the decision-making on the approach to be selected for any particular condylar fracture depends on the level of fracture, presence of fracture dislocation, and time elapsed from the date of trauma.

Comparative study between preauricular retromandibular anteroparotid approach and retromandibular transparotid approach in open reduction and internal fixation of subcondylar fracture on facial nerve injury and parotid fistula

Background: Condyle fractures account for 17.5 percent to 50 percent of all mandibular fractures, although there are still many debates on whether to treat them close or open. There are several techniques of managing the mandibular condyle, each with its own set of benefits and drawbacks. Aim: compare the innovative preauricular transmasseteric anteroparotid approach (P-TMAP) to the usual retromandibular transparotid technique. Patients and methods: 20 cases, patients with an odd number (1,3,5,7,9,11,13,15,17,19) received a preauricular transmasseteric anteroparotid approach (study group), while patients with a double number (2,4,6,8,10,12,14,16,18,20) had a retromandibular transparotid approach (control group) (control group). Patients were closely monitored for six months. Results: Fractures were caused by a road traffic accident (RTA) in 6(60%) of the cases, interpersonal violence in 3(30%) of the cases and falling in 1(10%) of the cases in both groups. Immediate postoperative facial nerve affection was higher in the transparotid approach group (30%) than in the anteroparotid approach group (10%), but both groups exhibited no statistically significant difference three months after surgery. There were no parotid injuries in any of the cases in either group.

Iodoform Gauze Packing is an Alternative Therapy for Postoperative Parotid Fistula.

Surgery-related salivary fistula is the result of intraoperative or postoperative parotid gland damage and extravasation of fluid secreted by acinar into the interstitial space. Most are treated conservatively. Local injection of botulinum toxin is an effective method, but it is relatively expensive and not available in some hospitals. In clinical practice, the authors observed that packing iodoform gauze from the fistula toward the parotid gland can quickly stoppostoperative salivary fistulain several patients. This method is simple and easy to implement, and the effect is quick. The disappearance of the salivary fistula was observed on the next day after packing the iodoform gauze. Iodoform gauze packing is an alternative therapy for postoperative parotid fistula. It can be used in areas where botulinum toxin is not available.

A Retrospective Analysis on the Effects and Complications of Endoscope-Assisted Transoral Approach and Lateral Cervical Approach in the Resection of Parapharyngeal Space Tumors.

Objective To observe and compare the effects and complications of endoscope-assisted transoral approach and lateral cervical approach in the resection of parapharyngeal space (PSS) tumors. Methods From January 2013 to September 2021, 69 patients with parapharyngeal space tumors in the Affiliated Hospital of Jiangnan University were divided into the control group (n = 37) and the observation group (n = 32) according to the mode of operation. The tumors in the parapharyngeal space were resected by the lateral cervical approach in the control group, and the tumors in the parapharyngeal space were removed by endoscopy-assisted transoral approach in the observation group. The general clinical data and operation conditions of the two groups, including operative blood loss, operation time, drainage volume and drainage time, hospital stay, perioperative pain degree, and tumor resection rate were collected and analyzed statistically. The patients were followed up for 6 months, and the complications of the two groups were recorded. Results Compared with the control group, the operation time in the observation group was significantly shorter, and the amount of intraoperative bleeding in the observation group was significantly less than that in the control group, and the difference was statistically significant (P < 0.05). The postoperative drainage was less and the hospital stay in the observation group was shorter than that in the control group, and the difference was statistically significant (P < 0.05). There was no significant difference in tumor resection rate between the two groups. The visual analog scale (VAS) score on the 1st and 3rd day after operation in the observation group was lower than that in the control group. After treatment, some patients in the two groups had complications such as nerve injury, dysphagia, difficulty in mouth opening, massive hemorrhage, and parotid fistula. The total incidence of complications in the observation group was lower than that in the control group, and the difference was statistically significant (P < 0.05). Conclusions The effect of the endoscope-assisted transoral approach is similar to that of the lateral cervical approach in the resection of tumors in parapharyngeal space, but the endoscope-assisted transoral approach has shorter operation time, less intraoperative bleeding, and less postoperative drainage. The indwelling time and hospital stay of the drainage device were shorter than those of the patients with transcervical approach, and the perioperative stress response of patients with endoscope-assisted transoral approach is mild, which is beneficial to the physical and mental recovery of the patients.

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).

Endoscope-Assisted Resection of Benign Parotid Tumors via Concealed Post-Auricular Sulcus Incision.

To investigate the feasibility, safety, and effectiveness of endoscopic-assisted resection of benign parotid tumors via concealed post-auricular sulcus incision. Between October 2019 and March 2021, eligible patients with diagnosed benign parotid tumors were prospectively included and randomly assigned to two groups: the endoscope-assisted post-auricular sulcus incision group (endoscope group) and the conventional Blair "S" incision group (conventional group). A total of 45 patients were finally included, including 24 subjects in the endoscope group and 21 subjects in the conventional group. No obvious differences were observed in basic information between these two groups of patients. The surgical incision length in endoscope group patients was 4.0 ± 0.4 cm, which was significantly shorter than that in conventional group patients, 10.3 ± 1.6 cm (p< 0.001). The total intraoperative blood loss, the first post-operative day drainage volume, the total post-operative drainage volume, and the total drainage days were all significantly lower in endoscope group patients than in conventional group patients (all p< 0.05). Among 3 months follow-ups, no local recurrence or residual tumor were found in both groups of patients, and there were none of them had permanent facial paralysis or parotid fistula. The self-evaluated appearance satisfaction VAS scores of endoscope group patients were all 0, which was significantly lower than that of conventional group patients, 4.7 ± 1.6 (p< 0.001). Compared with the conventional Blair "S" incision surgery, the endoscope-assisted resection of the benign parotid tumors via concealed post-auricular sulcus incision was safe and effective and showed advantages of faster recovery and better self-assessments of appearance satisfaction. 2 Laryngoscope, 133:133-138, 2023.

Parotid fistula and/or salivary collection: an underrecognized and underreported preventable complication following surgery for oral cancer

Parotid fistula after surgery for oral cancer is a less commonly recognized and less reported complication. In this study, we aimed to report its incidence and identify factors predisposing patients to it and the management of the patients in our cohort. This was a retrospective study of treatment-naive patients with oral cancer who underwent surgery from January 2019 to December 2020 in a single unit of our institute. Patients who were operated for recurrence and second primary were excluded. A total of 434 patients were included in the study. Most were men (n=352; 81.1%) and presented with an advanced clinical stage (n=318; 73.2%). The incidence of parotid fistula in our study was 6.9% (n=30 of 434). Buccal mucosa/gingival buccal sulcus subsite (P=.05; odds ratio [OR]=3.423; 95% CI, 0.969-12.087) and advanced clinical T stage (P=.003; OR=6.15; 95% CI, 1.835-20.608) were the 2 most important factors predisposing patients to the development of parotid fistula after surgery for oral cancer. Parotid fistula is a less common complication after surgery for oral cancer. A conservative treatment approach is usually successful in treating this complication.

Treatment Outcome Comparison Between two 3-Dimensional Plates (Y-Shaped Plate Versus Trapezoidal Condylar Plate) in Management of Mandible Condylar Fracture: A Randomized Control Trial.

To compare the treatment outcomes (clinical, functional and radiographical) using the two different 3-Dimensional plates in open reduction internal fixation of mandibular condylar fracture (MCF). Assessment of ease of fixation and fixation time were also performed. 20 MCF patients were divided equally into two groups (Group A: Trapezoidal Condylar Plate and Group B: Y-shaped plate) and the treatment outcomes were compared. Intraoperatively time required for fixation was also compared. The patients were followed up at different timelines till 3months. Baseline parameters had statistically insignificant distribution in both groups implying effective randomization and balanced confounding factors. Intraoperatively, adequate anatomical reduction was achieved in both groups with statistically insignificant difference in time required for fixation. Postoperatively, no statistically significant difference was found in radiographic and functional parameters. None of the patients in either group reported with facial nerve injury, condylar resorption, Temporomandibular Disorders. However, 02 patients in Group A and 01 patient in Group B presented with infection, parotid fistula, and hardware failure respectively with statistically insignificant difference. This study concluded that the treatment outcomes were satisfactory with the use of both 3-D plate, but further studies with larger sample size and longer follow up are required.

A Case of Parotid Gland Fistula After Microtia Reconstruction Successfully Treated With Botulinum Toxin Type A.

Parotid gland fistula after microtia reconstruction is relatively rare, with only 3 cases having been reported in the literature. It may be caused by the presence of an accessory parotid gland or surgical damage to parotid gland tissues. The principal treatment is dressing the wound. Here, we report the first case of parotid fistula after microtia reconstruction using a delayed retroauricular flap, which healed following wound dressing and an injection of botulinum toxin type A (CBTXA) into the parotid gland.

CONSERVATIVE MANAGEMENT OF PAROTID SIALOCELE :- A CASE REPORT

The collection of the saliva in the soft tissue plane is termed as sialocele. When this communicates with the skin and drains it is known as parotid fistula. Sialocele occurs due to injury to the parotid gland parenchyma or duct, this result in accumulation of saliva in periglandular and glandular tissues or in subcutaneous cavity. In this article we report a case of Parotid sialocele formation following inadvertant incison given for space infection in parotid region. We followed conservative treatment and got excellent result.

Bilateral Biplanar Distraction Osteogenesis in Facial Deformity Secondary to Temporomandibular Ankylosis.

The purpose of this single-centre prospective clinical study was to evaluate the correction of severe facial deformity and Obstructive sleep apnoea hypopnoea syndrome (OSAHS) in 22 patients aged from 9 to 42years (mean 20.09) of bilateralTemporomandibular joint ankylosis. Patients underwent multisegment distraction using external bilateral bidirectional distractors. Facial deformity was evaluated clinically in terms of mouth opening and neck chin angle and cephalometrically in terms of corpus length (gonion-pogonion), ramal height (articulare-gonion), chin deficiency (N perpendicular to Pog and SNB). OSAHS was evaluated through Epworth sleepiness scale, Berlin's questionnaire, pharyngeal airway space, apnoeic hypoapnoeic index, oxygen desaturation index, average arterial oxygen saturation and minimal fall in O2 saturation. Patients were followed up for a period of 13-74months (mean 28.68). Statistically highly significant results were obtained in all parameters. Complications encountered were pin infection (13.63%), loosening of pins (4.5%), wound dehiscence (9.09%), tooth fracture (4.5%) and parotid fistula (9.09%). Intermediate segment necrosis and vector loss were not observed. This study is a large case series using two corticotomy cuts for external bilateral bidirectional distracters with concomitant neo callous moulding in patients both pre- and post-ankylosis release. It is extremely efficient in correcting mandibular corpal and ramal deficiency as well as improving OSAHS.

Initial Outcome of Surgical Management of Parotid Gland Neoplasm

Introduction: Surgical excision is the gold standard for treatment of parotid gland neoplasm. But the complex relationship of the tumour to the facial nerve in the parotid gland makes the surgery very challenging.&#x0D; Objective: To evaluate the initial outcome of parotid gland neoplasm surgery.&#x0D; Materials and Methods: This cross-sectional observational study was conducted from January to December 2012 where 20 surgically treated patients with parotid gland neoplasm were selected by random sampling technique. They were followed up from 03 to 06 months to assess the minor post-operative complications.&#x0D; Results: The study revealed that 35% of patients belonged to the 4th decade of life. Pleomorphic adenoma constituted 85% of the tumours. Superficial parotidectomy was performed in 95% of cases. 40% of patients developed neuropraxia of the marginal mandibular branch of the facial nerve but all improved over a period of 3-6 months. 5% had permanent facial nerve weakness. Frey’s syndrome was observed in 20% of cases clinically but improved gradually. The rate of wound infection, parotid fistula and hypoesthesia of the skin over the ear lobule occurred in 10%, 5% and 20% cases respectively.&#x0D; Conclusion: Safe and effective parotid gland surgery requires a clear understanding of the regional anatomy, the experience of the surgeon, meticulous surgical technique along with detailed preoperative informed consent for surgery to reduce post-operative complications and morbidity of the patient.&#x0D; JAFMC Bangladesh. Vol 15, No 2 (December) 2019: 193-195

Does the Retromandibular Transparotid Approach Provide Quicker Access to Fracture of Mandibular Subcondyle Compared With the Retromandibular Transmasseteric Anterior Parotid Approach?

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. 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 3months. Collected data were analyzed using the χ2 and analysis of variance tests. 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±3.77mL, 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). 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.

Application of multi-slice spiral CT in the diagnosis of children's parotid cleft deformity

Objective:The aim of this study is to evaluate the value of multi-slice spiral CT （CT） and multi-planar reconstruction （MPR） in the diagnosis of children with parotid cleft deformity. Method:The CT images of 55 cases of branchial cleft deformity confirmed by surgery and pathology were retrospectively analyzed. Result:CT examination showed that 37 cases had strip-like, tubular fistula or cystic mass located in the anterior cervical triangle, anterior margin of sternocleidomastoid muscle, and 2 of them had bilateral fistula structure. In 16 casescystic mass and tubular fistula were found in the parotid gland or at the edge of the parotid gland. One case was accompanied by atresia of the lateral auditory meatus. After contrast enhancement, the cystic wall（tube wall） of 55 patients were enhanced. In 9 patients with infection, the boundary of the lesion was blurred, and the density of the cyst or lumen increased after contrast enhancement. MSCT diagnosed 6 cases of parotid cleft cyst with fistula, 35 cases of branchial cleft cyst, 13 cases of parotid fistula, and 1 case misdiagnosed as lymphadenitis. Among all the cases, 15 were type Ⅰ, 36 were type Ⅱand 4 were type Ⅲ. Compared with the results of pathological diagnosis and clinical operation, the accuracy of qualitative diagnosis and localization was 99.9% and 100.0%. Conclusion:Multi-slice spiral CT thin-slice images combined with MPR image post-processing technology can better display the location of branchial cyst and the course of branchial fistula.

Variations in the retromandibular approach to the condyle-transparotid versus anteroparotid transmasseteric – a prospective clinical comparative study

BackgroundThe management of mandibular condylar fracture remains controversial many surgeons still favour the open reduction and internal fixation (ORIF) which provides good result and immediate functioning as compared to closed reduction. With proven consensus for ORIF, dilemma remains in choosing the surgical approach to condyle due to proximity of complex and important anatomic structure. Various extra-oral surgical approaches are available for ORIF including preauricular, submandibular, retromandibular, transmasseteric anteroparotid etc. Variations in retromandibular approach such as transparotid, retro-parotid and anteroparotid are reported in literature. In our study we compared the retromandibular transparotid and retromandibular anteroparotid transmasseteric variations. MethodologyThirty condylar fracture in 26 patients, 15 in each group (group A – Retromandibular transparotid approach & group B – Retromandibular anteroparotid approach) were treated under general anaesthesia with naos-tracheal intubation and by the same surgeon having 20 years of experience in maxillofacial surgeries. We evaluated time taken for the procedure, amount of bone exposure, intra-operative haemorrhage. Postoperative presence of infection, sinus and fistula formation at the incision site, parotid fistula formation, facial nerve functioning using House-Brackman scale in immediate postoperative period, 3rd month postoperatively and 6 month postoperatively. ResultThe mean average time taken for group A was 78.2minutes and mean average time taken for group B was 64.8minutes. None of the patient had haemorrhage intra-operatively in both the groups. Exposure was sufficient in both the groups with same length of the incision. None of the patient suffered from postoperative infection in both the groups. Parotid fistula formation was present in 2 patients in group A while none of the patient had parotid fistula in group B. Three patients out of 15 had the transient facial nerve weakness in group A which got resolved in 6 month while none of the patient had facial nerve weakness in group B. All patients had adequate mouth opening with no occlusal discrepancies. ConclusionRetromandibular anteroparotid approach as described in this study has proven to be an extremely useful approach provides good access, and associated with minimal complications and morbidity compare to retromandibular transparotid approach. It is hence safe to say that this approach is relatively useful for an inexperienced and novice surgeon as well.