Retromandibular Approach Research Articles

Minimal Access Retromandibular Approach to Fractures of Vertical Segment of the Mandible: A Versatile Technique

Abstract Introduction Fractures of the condylar region of the mandible, although fairly common, also generate the most debate regarding management—both closed and open treatment options have been recommended and shown to yield good results. We present our experience with a minimal access retromandibular approach to fractures of the vertical mandible. Materials and Methods This is a retrospective study of all patients who underwent open reduction and internal fixation for fractures of the vertical mandible (condyle, subcondylar region, ramus) using a retromandibular approach at a tertiary care hospital in a metropolitan city in India between January 2022 and July 2023. All fractures were approached using a standard technique through a retromandibular incision and a transparotid route. The proximal segment was mobilized, reduced, and fixed to the ramus with two 2-mm miniplates—one along the posterior border and the other along the sigmoid notch border. Postoperative guiding elastics were placed for 2 weeks without any rigid maxillomandibular fixation. Patients were followed at weekly intervals for 1 month followed by monthly visits for 6 months. At each visit, mouth opening, occlusion, and facial nerve function were assessed. Scar quality was assessed by both examiner and patient using the Patient and Observer Scar Assessment Scale (POSAS) scoring system. Results A total of 25 subcondylar fractures in 20 patients were fixed using the retromandibular approach. Nineteen were male and 1 was female. The etiology of trauma was road accident (8), fall from train (2), fall from height (5) and assault (5). Fifteen patients had unilateral fractures while 5 had bilateral fractures. All patients had concomitant fractures of the mandibular arch which were also fixed. The interval between trauma and surgery ranged from 5 to 28 days. All patients had premature molar contact on the side of fracture with anterior open bite. Mouth opening ranged from 1.5 to 2.5 cm. All the fractures could be fixed using the retromandibular approach. None of the patients developed any facial nerve dysfunction or salivary leak. The occlusion was restored to pretrauma status in all patients and was stable at 6 months' follow-up. Mouth opening ranged from 3.5 to 4 cm. The POSAS observer score ranged from 09 to 19 with a mean score of 12.7. The POSAS patient score ranged from 17 to 28 with a mean score of 20.3 revealing that all patients were extremely happy with the scar. Conclusion The minimal access retromandibular approach to the vertical mandible is a versatile technique enabling accurate reduction and fixation of fractures of the vertical segment of the mandible with good long-term functional and cosmetic results.

Clinical Outcome of Open Reduction and Internal Fixation of Mandibular Condyle Fracture: A Prospective Observational Study

Introduction: Condyle of mandible plays crucial role in functioning of jaw. Untimely and inadequate treatment leads to deformity of face along with range of complications. The purpose of this study was to assess outcomes of open reduction and internal fixation of mandibular condyle fractures in terms of mouth opening, facial nerve function and occlusion.Methods: This was a prospective observational study conducted at Chitwan Medical College. Thirty-two patients of mandibular condyle fracture were treated by open reduction and internal fixation via retromandibular approach and evaluated for mouth opening, facial nerve function, and occlusion on 2nd day, 10th day and 25th day postoperatively. All collected data were entered on SPSS version 21 and analyzed using descriptive statistical methods. The results were presented as graphs and tables.Results: Of 32 patients, 7 patients show abnormal occlusion while 25 patients show normal occlusion. A gradual improvement in mouth opening and facial nerve function was also seen on 25th day.Conclusion: Open reduction and internal fixation gives superior clinical outcomes in terms of mouth opening, facial nerve function and occlusion. It also allows good anatomical repositioning and early function.Keywords: Facial nerve function, Mouth opening, Occlusion, Open reduction internal fixation Layman summary: The mandible is largest and strongest bone of face. However, it is also most common facial bone that is fractured. Condyle of the mandible is highly prevalent site of mandibular fracture. The fracture of mandible is managed by open or closed reduction. Both of the methods have their own merits and demerits. In this study, we planned to assess the outcomes of open reduction and internal fixation of mandibular condyle fractures at a tertiary care center of Nepal. We found that ORIF has a good clinical outcome in mandibular fracture in terms of mouth opening, facial nerve function and occlusion.

A "Window" to Protect the Facial Nerve: A Descriptive Cadaveric Study.

Success in skeletal surgery depends on adequate access and exposure of the underlying skeletal structures. The retromandibular approach exposes the ramus condyle region through the posterior border of the mandible by utilizing the space between marginal mandibular and buccal branches of the facial nerve. Length of this safety window and accessibility varies in each individual owing to the differing ramifications of peripheral branches of facial nerve. These variations cannot be adequately assessed through clinical studies. Cadaveric studies permit us to extensively explore the surgical area to demystify the branching pattern and its relationship to the adjacent structures. Thirty well-preserved cadaveric facial halves were dissected using a retromandibular incision. Visibility and accessibility were objectively graded through a scale. The safety window and furcation distance were measured using caliper and scale. The appearance of the retromandibular vein was also noted. Eighteen facial halves showed maximum accessibility wherein the surgeon is expected to visualize the condylar neck, subcondylar region and posterior half of ramus. In 8 facial halves, accessibility was limited to subcondylar and midportion of posterior ramus, and in 8 facial halves, accessibility was limited to the midportion of ramus of the mandible. Safety window ranged from 1.9 to 3.5 cms. Distance between the posterior border of mandible and bifurcation of the facial nerve ranged from 0.5 to 1.5 cms. Facial nerve was encountered in 24 facial halves during the retromandibular approach. Retromandibular vein was encountered in 23 facial halves during the retromandibular approach. The retromandibular approach is a versatile approach to the condyle subcondylar area as it provides much-required visibility and accessibility. The facial nerve branching pattern and intercommunicating branches determine the safety window which is adequate in most cases. The retromandibular vein is a reliable landmark predicting the vicinity of the facial nerve.

Retromandibular Approach and its Different Variations in the Management of Fracture Condyle: Surgical Experience.

The management of condylar fractures is a controversial topic in maxillofacial surgery. Surgical treatment is the preferred treatment choice nowadays and the article aims to describe different variations of the retromandibular approach with their surgical outcome based on experience. A total of 15 cases were managed with the retromandibular approach and its different variations. We advocate retromandibular approach for the management of condyle fractures, and among which retromandibular retroparotid and retromandibular anteroparotid provide best accessiblity with less bleeding and minimal risk of injury to the facial nerve.

Study of Facial Nerve Function Following Retromandibular Open Reduction of Mandibular Condylar Fracture

At least 1/3rd (26–40%) of all mandibular fractures occur in the condylar region, making it one of the most common fracture sites. They can further lead to morphological & functional damage when undetected or poorly managed. Condylar fractures that are misdiagnosed or improperly treated can cause substantial functional impairment, such as malocclusion, decreased mouth opening due to jaw deviation, and restricted lateral mandibular motions. Objectives: The aim of the study was to examine facial nerve function following retromandibular trans parotid ORIF for mandibular sub-condylar fractures. Methodology: After receiving the necessary ethical approval, 50 patients who presented with unilateral condylar fractures, sub condylar fractures (36), & neck fractures (14) (Ellis classification)5 were chosen. All of the research participants, who underwent open reduction using a retromandibular technique, provided informed consent. Results: All 50 patients were assessed and no patients were excluded. The healing went well, and no one experienced significant scarring or hardware infection. 7 (14%) individuals experienced transient buccal branch weakness, while 2 (4%) experienced transient zygomatic branch dimness Keywords: Condylar fracture, Open reduction, Retromandibular approach, Anatomical reduction

Comparative evaluation of open reduction and internal fixation using delta plate versus conservative treatment in management of mandibular subcondylar fractures in adults

The aim of the evaluative study was to compare the efficacy of standard conservative treatment and the open reduction internal fixation (ORIF) using the delta titanium plates in the mandibular subcondylar fractures in adults. Patients who diagnosed with mandibular subcondylar fracture in the department from January 2018 up to September 2019 were recruited into the study. The patients satisfying the inclusion criteria were randomly assigned to two groups in a 1:1 ratio (10 in each group). Group A comprised patients treated using delta titanium plates through open reduction and internal fixation and Group B comprised patients treated with closed reduction. Informed consent was taken for all the patients. All the patients of Group A underwent ORIF under GA via retromandibular approach. Pain was significantly higher in 1 and 3 month follow up in group B compared to group A. Comparison of mouth opening in both the groups show statistically significant difference at 3 and 6 month compared to baseline mouth opening. Deviation was more prevalent at 1 and 3 month follow up in group B compared to group A. Presence of mandibular deviation at 1, 3 and 6 month was statistically insignificant for both the groups.Our experience with 3D stable delta plate provides better treatment outcomes in terms of easy adaptation to the anatomy of the fracture site, better 3D stability and functional osteosynthesis.

Efficacy of Retromandibular Approach in The Management of Mandibular Subcondyle Fractures

Mandibular condylar fracturing are a common outcome of mandibular trauma. Condylar and subcondylar injuries benefit best from the retromandibular technique, which also offers the greatest exposure to the joint and ascending ramus. Objective: To determine the efficacy of the retromandibular approach in treating condylar fractures with open reduction and internal fixation (ORIF). Methods: A total of 25 subjects with age range 14 to 55 years having unilateral mandibular condylar fractures with disturbed occlusion utilizingretromandibular approach were included in the study. Relevant information was gathered and evaluated. Results: The average age of the sufferer was 31.18 ± 8.17 years and mean duration of fracture was 5.32 ± 0.73 days. There were 21(84%) male patients and 04 (16%) female sufferers. RTA was the most common mode of injury seen among patients (60%). The shattered segments' anatomic reduction and fixation were successful. The efficacy was 72% on basis of ease of operation and 96% on fracture stability. Conclusion: This technique is effective in term of ease of operation and fracture stability. Scar acceptability can be considered drawback of this procedure

Is the retromandibular approach a suitable approach to anatomical reduction of unilateral subcondylar fracture? A non-randomized clinical trial

The aim of this study was to evaluate the efficacy of the retromandibular approach (RMA) to produce three-dimensional (3-D) reduction of the unilateral subcondylar fracture and Temporomandibular Joint (TMJ) functional implication.Methods: A prospective cohort study was designed. Twenty-nine patients with unilateral subcondylar fracture underwent consecutively Open Reduction, and Internal Fixation. The cohorts were divided into two groups; RMA group (n = 16, 55.17%) and submandibular approach SMA group (n = 13, 44.82%). The primary outcome was the anatomical 3-D reduction of the condyle. The secondary outcome was to compare the condyle position and inclination finding with TMJ outcomes. Helkimo Index score was used to evaluate the TMJ outcome at six months postoperatively.Result: There was a significant difference between the mediolateral condylar inclination, condylar medial and vertical positions when RMA compared with SMA groups (P < 0.05). The medial joint space was correlated with the medial condylar position in both groups (P < 0.05). The Helkimo Ai and Di was associated with mediolateral condylar inclination in SMG; however, Helkimo Ai was found to be correlated with the RMA group.Conclusion: The current study demonstrates that the RMA could re-establish the anatomical position of the unilateral subcondylar fracture in patients undergoing ORIF. The clinical outcome of the TMJ with RMA was better than SMA.

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

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

Comparison of Preauricular Versus Retromandibular Approach in the Management of Mandibular Condyle Fractures

Objective: To compare the rate of complications encountered on using different incision to access the fracture site for the open reduction and internal fixation of condylar fractures.&#x0D; Setting: Department of Oral &amp; Maxillofacial Surgery, Institute of Dentistry, LUMHS&#x0D; Subject and Methods: A total 64 patients with unilateral condyle fractures were randomly treated into two groups. Thirty two patients in group A were treated with preauricular incision and 32 were treated with Retro mandibular incision. Patients were followed for period of upto six months for assessment of complications of facial nerve injury such as: salivary fistula and hypertrophic scar formation.&#x0D; Results: The average age of the patients was 31.66±9.40 years. Rate of facial nerve palsy was significantly high in group A than group B (18.75% vs. 6.25%; p=0.021) similarly, the rate of salivary fistula and scar formation were also significantly high in group A as compare to groups B (12.5% vs. 1.56% p=0.026) and (14.06% vs. 1.56%;p=0.013) respectively. &#x0D; Conclusion: The retromandibular approach is more suitable for the lower level condylar neck fractures, providing a direct visual field and wide, straight-line access for implant fixation at this region.

Evaluation of efficacy 3Dimensional 4-hole trapezoid condyle plate for treatment of base of condyle fracture.

The aim of our study was to evaluate the effectiveness of open reduction and internal fixation of the base of condyle using a 3D 4-hole trapezoid condyle plate (4-HTCP). A group of 25 subjects of an age range of 21-52 years (mean 32.7 ± 8.7 years) were treated of which, 7(28%) were female and 18 (72%), were male. All the patients were examined according to standard protocol. A retromandibular approach was used in all the patients. The time taken for operating on the condyle alone was recorded it was between 30 minutes to one hour in 5 (20%) patients, between one-two hours in 19 (76%) patients and greater than two hours in 1 (4%) patient. Time taken from reduction of fracture to placement of the last screw was recorded. In 15 (60%) patients the time taken was less than ten minutes, in 10 (40%) patients the time taken ranged from 10-15 minutes. 6 (24%) patients needed additional exposure to facilitate the procedure. Postoperatively all the patients were followed up for a minimum of 9 months and a maximum of 30 months (mean 19.5 ± 5.87 months). The range of mandibular movements was satisfactory. The maximum incisal opening was in the range of 25-37 mm (mean- 31.4 ± 3.38 mm)on the first post-operative day. 31.4 ± 3.4 mm 6 weeks postoperatively, 43.8 ± 4.3 mm 3 months postoperatively, 46.7 ± 2.9 mm 6 months postoperatively and 49.7 ± 4.5 mm 9 months postoperatively. Taking into consideration the transient hypofunction of the facial nerve (8%) and TMJ disorder (8%) the aggregate complication rate in our study was 16%. Our study concludes that 4HTCP is a reliable and rigid choice of osteosynthesis for the base of condyle fractures.

A comparative evaluation of retromandibular versus Modified Risdon approach in surgical treatment of condylar fracture

The purpose of this study was aimed to compare the efficiency and safety of retromandibular versus modified Risdon approach using periangular incision for open reduction and internal fixation of low subcondylar mandibular fracture. Open reduction and internal fixation with different plating systems were utilized via retromandibular approach (group I) and via modified Risdon approach with periangular incision (group II).Twenty four (n= 24) condylar fractures in 21 adult patients were divided randomly into two equal groups (12 each) according to the cutaneous incision (approach) utilized. The evaluation score for scarring in group I it was excellent in 9 patients, good in 2 patients and acceptable in only one patient (Mean 2.4 ± SD 3.38). While in group II was excellent in 10 patients and good in 2 patients (Mean 2.4 ± SD 3.87) and the p value was 0.591. Symptoms of transient facial nerve weakness were noted in only 3 patients in group I with slight to moderate dysfunction (Mean 2 ± SD 3.21), while only one patient had facial nerve weakness in group II with House - Brackman score of 2 immediate postoperatively and this got resolved in 6 weeks (Mean 2 ± SD 4.04) and the p value was 0.00022.Within the limitations of the study it seems that a modified Risdon approach using periangular incision for reduction and fixation of low subcondylar fracture should be preferred whenever possible because it yields better outcomes.

Comparison of Preauricular Approach Versus Retromandibular Approach in Management of Condylar Fractures

Objectives: Surgical treatment of patients with multiple mandibular fractures involving condylar segments may be a difficult proposition for a maxillofacial surgeon. These fractures can be double or triple fractures of the lower mandible and can also be associated with other fractures of the face. While many authors have suggested that the conventional approach to reducing and stabilizing a mandibular symphysis / para-symphysis fracture is appropriate before addressing a fractured condyle, there is another school of thought that suggests that the condylar segment should be reduced and repaired first. This article aims to review the results of operations where the reduction and fixation of a fractured condyle is performed prior to other associated mandible fractures, and to explore the effectiveness of various surgical methods including preauricular and retromandibular proposed in this case. Place and Duration: In the Oral and Maxillofacial surgery department of Faryal Dental College, Lahore for two-years duration from Jan 2018 to Jan 2020. Material and methods: The study included 60 surgically treated patients with multiple mandible fractures (double / triple), including the condyle component. For treatment of the fractured condylar segments, the preauricular and retromandibular (anterior parotid-transmasseteric) approach was used. Results: Condyle fracture was the first segment to be managed during sequencing of surgical treatment, regardless of the method used. First, good reduction and stabilization have been achieved with limited complications in treating a condyle fracture. Conclusion: While it is the surgeon's prerogative to sort multiple mandible fractures, addressing the condylar segment first provides the operator with a viable alternative to the conventional technique. Key words: condylar fractures, multiple mandibular fractures, preauricular approach, retromandibular approach

Outcomes of the Nonendoscopic Transoral Approach to Subcondylar Mandible Fractures

The transoral approach (TRA) to subcondylar fractures without any endoscopic or transbuccal assistance is not a common technique. The purpose of this study was to measure and compare the quality of open reduction and internal fixation (ORIF) between the TRA and the retromandibular approach (RMB), including types and frequencies of postoperative complications. In our retrospective cohort study, we enrolled a sample of patients with displaced subcondylar mandible fractures treated by ORIF. The predictor was the approach mode: TRA or RMB. In postoperative computed tomography (CT) data sets, we measured the angles of the condylar process in relation to references: 1) midline, 2) lateral ramus border, and 3) posterior ramus border. The primary outcome variable was the reduction outcome, which was calculated as the difference between the total of all angles of the operated side and the non-affected side. Secondary outcomes were postoperative complications extracted from patients' files. Other variables were age, gender, number of plates, operation time and a modified AO trauma score. In bivariate analysis, we compared the outcome between both groups. Sixty-four patients were included in total, with TRA performed in 50%. Patients with TRA were younger (31 vs 41, P=.003), and the trauma score was lower (1.9 vs 3.3, P < .001). Reduction outcome remained comparable between both techniques (mean 3.7° for both, P=.92). Complication rates were similar, although facial nerve palsy was absent for TRA (0 vs 4, P=.039). We suggest TRA for selected patients with displaced, single fragmented subcondylar fractures. Reduction outcome shows a comparable exactness to RMB, while TRA is safer for the facial nerve.

The retromandibular transparotid approach vs. retromandibular retroparotid approach for the mandibular condyle

Aim: The mandible is regarded as a frequently fractured bone in patients who present with maxillofacial trauma accounting for almost 15.5% to 59% of all facial fractures. Managing condylar trauma has remained to be a point of contention amongst experts, regardless of the advances in surgical modalities and methodologies, and the treatment plan is often determined by the preference and the experience of the surgeon. There exist various approaches in the literature, each with its own specific benefits and drawbacks. With this study, we aimed to evaluate the prevalence of post-operative complications in patients who experienced ORIF by means of the retromandibular approach, by comparing the outcomes of one group having undergone transparotid surgery, with another that underwent retroparotid surgery. Methods: An experimental trial was undertaken. Convenience sampling was done from among the cases of condylar neck and base fracture visiting the department of OMFS, Dow University of Health Sciences from January 2017 to December 2019. An overall 26 patients were divided into 2 groups of 13 members each; one was managed using Open Reduction Internal Fixation (ORIF) by means of a retromandibular transparotid approach while the other group was treated with ORIF by means of a retromandibular retroparotid approach. A 6 month follow-up was done to assess range of active motion, occlusion, and complications such as deviation/deflection, neural injury, infections, sialocele, salivary fistulae and Frey’s syndrome in both groups. Results: There was no statistically significant difference between the two groups in terms of inter-incisal opening, right and left lateral movements, or protrusion. One patient in the retroparotid group had deviation on mouth opening (7.69%), while one in the transparotid group reported with infection (7.69%), and 2 developed post operative seromas (15.38%). None had persisting facial nerve palsy at 6 months. Conclusion: We find no significant disparity between the 2 approaches at a follow-up of 6 months; therefore, the primary determining factor for selection of either technique is surgeon preference and appropriate case selection.

Management of mandibular condylar fractures by the retromandibular approach – An evaluation of its complications

Background: Mandibular condyle fractures are commonly encountered in the practice of maxillofacial surgeon. Even though being a commonly seen fracture, the fracture condyle of the mandible demands meticulous diagnosis and a tailor made treatment plan for each and every patient. The treatment plan largely depends on the age of the patient and the displacement of the fractured fragment. This retrospective study provides an insight in to the management of fracture mandibular condyle by retromandibular approach.&#x0D; Aims and Objectives: The aim of this study was to evaluate the complications of the retromandibular transparotid approach in surgically operated patients with mandibular condylar fractures.&#x0D; Materials and Methods: A retrospective study was performed by analyzing the treatment records of patients who underwent open reduction and internal fixation (ORIF) by the retromandibular transparotid approach for seven years. Thirty-five patients who fulfilled the criteria were included in the study. Clinical parameters such as marginal mandibular nerve weakness, sialocele, occlusal derangement and decreased mouth opening were recorded during the first, fourth and twelfth weeks postoperatively. The retrieved data were analyzed for complications of the retromandibular approach in the management of mandibular condylar fractures.&#x0D; Results: In patients (N= 35) who underwent ORIF by the retromandibular transparotid approach, findings recorded at the end of the first week included 5 patients with sialocele, 2 patients with derangement of occlusion, 6 patients with restricted mouth opening and 1 patient with marginal mandibular nerve weakness. However, postoperatively, at the end of 4 weeks, the only complication observed was sialocele in 3 patients. Furthermore, at the end of 12 weeks, sialocele had completely resolved in all 3 patients, and they were free of complications.&#x0D; Conclusion: The retromandibular transparotid approach is a reliable and straightforward technique with manageable complications.

Analysis of facial nerve function after open reduction of mandibular condylar fracture via a retromandibular approach

Mandibular condylar fractures account for a sizeable segment amongst facial fractures. Previously most of these fractures were managed conservatively with periods of Intermaxillary fixation(IMF). Shortcomings of such an approach such as prolonged pain, Tmj dysfunction and delayed return to function has shifted the discourse to open reduction and internal fixation of the fractured mandibular condyle.ORIF is the universally accepted and mainstay of intervention. Numerous extra oral approaches have been employed with various modifications. The retromandibular transparotid approach is a relatively simple and direct approach to the posterior mandible, enabling the surgeon to deal with sub condylar and condylar neck fractures with relative ease. This approach is a safe approach and does not result in permanent palsy of any of the branches of the facial nerve. To analyse facial nerve function after ORIF of mandibular sub condylar fractures through the retromandibular transparotid approach. 25 patients reporting with unilateral condylar fractures, sub condylar (16) and neck fracture (9) (Ellis classification)consenting for the study were taken up. All patients were followed up for 8 months. Post-operative nerve function was evaluated at 24 hours after surgery, 1,4,12 weeks and at the end of 8 months. 4(16%) patients presented with weakness of the facial nerve. Buccal branch (3) and zygomatic branch (1). In all cases the weakness was temporary and no permanent deficit was noted.

The Preauricular Transmasseteric Approach: A Novel Option for the Exposure of Mandibular Condyle Fracture

Background: Mandibular Condyle fractures are common and the traditional method for the exposure is the retromandibular approach, however it presents some limitations and considerations among facial nerve palsy and parotid gland fistulae. This technical note present a novel approach to the subcondylar fractures, using preauricular incision with an innovative transmasseteric dissection. Study Design: Technical note. Objective: Present a novel approach to the subcondylar fractures, using preauricular incision with an innovative transmasseteric dissection. Methods: Patients diagnosed for mandibular condyle fractures in a Level 1 Trauma Center in Brazil. All the procedures were performed in the shortest possible time since the trauma. Traditional preauricular incision with gentle lower dissection through the superficial musculoaponeurotic system, the facial nerve branches are exposed and retracted. The parotid gland capsule plane is outlined and the parotid gland is retracted posteriorly. The masseteric fascia is exposed and the masseteric muscle is incised and the blunt dissection continues toward the periosteum and the mandibular condyle. Results: Eight patients were surgically managed in the acute trauma with a mean of 2.57 days to the operation. Transient parotid gland fistulae was observed in only 12.5% of the patients. Facial nerve palsy was observed in 37.5% of the patients in the first 7 days of postoperative time, with no records of persistent facial nerve paralysis. Conclusions: The preauricular transmasseteric approach is a reliable and versatile option for the exposure of the mandibular condyle, being a safe and aesthetic incision on the management of the subcondylar area. The surgical team use it as a novel tool in the approach for condyle fractures.

Fixation of subcondylar fractures of the mandible: a randomized clinical trial comparing one trapezoidal plate with two miniplates

Subcondylar fracture of the mandible accounts for 25–35% of all mandibular fractures. In the past, most subcondylar fractures were managed non-surgically. The traditional method of fixation for subcondylar fractures uses two miniplates; however some bench studies have reported that trapezoidal plates are superior. The aim of this study was to compare the outcomes of subcondylar fractures fixed either with two non-parallel straight miniplates or with one trapezoidal plate. A randomized clinical trial was designed and implemented. Fifty-two consecutive patients with subcondylar fractures were recruited. All patients underwent surgery via a retromandibular approach. The time taken for fixation of the plate after fracture reduction and postoperative outcomes and complications were compared between the groups. The trapezoidal plates were superior in terms of ease of adaptation and time taken for fixation (P= 0.0001). Plate fracture was observed only in the two miniplates group, in four (16%) patients. Outcomes were similar in the two groups in terms of occlusion, mouth opening, protrusion, and lateral excursion. In conclusion, both systems – two miniplates and the trapezoidal plate – provide functionally stable fixation. The outcome was significantly better for the trapezoidal plate than for two miniplates regarding the time taken for insertion and ease of adaptation, but not for other parameters.

Retrospective analysis on the outcome of open and closed reduction of mandibular condylar fractures at tertiary centre of Gujarat

AimAim of this study is to analyse the epidemiology, treatment modalities and complications faced in management of mandibular condylar fractures by surgical and conservative treatment, over period of five years at our centre. Material and methodData of patients who were diagnosed with condylar fractures of mandible from 2013 to 2018 was collected, and were evaluated on the basis of Etiology, fracture pattern, age, sex, associated injuries, treatment modalities and complications. ResultsThe sample size of 82 patients (total 204), 67 male (81.71%) and 15 female (18.29%) (Male: female = 4.5:1), commonly affected 21–40 years age group. RTA is the most common cause (67.07). Subcondylar fractures were significantly related to RTA under influence of alcohol (48.5%). Total 55 (67%) were treated conservatively and (30.59%) of this belonged to MacLennan I. MacLennan II and III were mostly treated surgically with retromandibular approach being the most common. ConclusionThe principal factors which determine the treatment plan are the level of the fracture and the degree of displacement. Most of undisplaced fractures can be managed by closed non surgical treatment. Open reduction is justified mostly in adults with undisplaced or displaced fractures associated with Malocclusion and patients requiring immediate function. Even after these guidelines many other factors like Medical condition, Patient acceptance & Cost can be a deciding factor.