Transmasseteric Anteroparotid Approach Research Articles

Modified tragus edge incision and transmasseteric anteroparotid approach to condyle reconstruction.

This study aimed to analyze the application value of a modified tragus edge incision and transmasseteric anteroparotid approach to condyle reconstruction. Condyle reconstruction was performed in 16 patients (9 females and 7 males) with modified tragus edge incision and transmasseteric anteroparotid approach. After regular follow-up, the function of condyle reconstruction was evaluated by clinical indicators, such as parotid salivary fistula, facial nerve function, mouth opening, occlusal relationship, and facial scar. The morphology of rib graft rib cartilage was evaluated by imaging indicators, such as panoramic radiography, CT, and three-dimensional CT image reconstruction. At 6-36 months postoperative follow-up, all patients had good recovery of facial appearance, concealed incisional scar, no parotid salivary fistula, good mouth opening, and occlusion. One case had temporary facial paralysis and recovered after treatment. Radiographic evaluation further showed that costochondral graft survived in normal anatomic locations. The modified tragus edge incision and transmasseteric anteroparotid approach can effectively reduce parotid salivary fistula and facial nerve injury in condylar reconstruction. The surgical field was clearly exposed, and the incision scar was concealed without increasing the incidence of other complications. Thus, this approach is worthy of clinical promotion.

"Cervicomastoid Versus Retromandibular Extension of Pre-Auricular Incision in Transmasseteric Anteroparotid Approach for Condylar Fracture Management-a Prospective Study".

Treating mandibular condylar fractures has always been a matter of debate and controversy. However, there are various approaches, but it is of utmost importance that the surgical procedure must guarantee maximum safety for the facial nerve with best cosmetic outcome and minimizing complications. This prospective study was designed to compare cervicomastoid and retromandibular extension of pre-auricular incision in transmasseteric anteroparotid approach for condylar fractures management. The study was conducted in the Department of Oral and Maxillofacial Surgery, Bapuji Dental College and Hospital, Davangere from November 2015 to May 2017, and a total of 16 condylar fractures were surgically accessed for the management and were divided into two groups, cervicomastoid (Group A) and retromandibular extension (Group B) for evaluating parameters such as to assess the access to condylar region, post-operative edema, cosmetic outcome, time taken to access and facial nerve injury. Clinically the time taken was significantly less in the cervicomastoid group even though, there was no statistically significant difference regarding access to the fracture site, post-operative edema, facial nerve injury and cosmetic outcome between two groups. In our opinion the anteroparotid transmasseteric approach is appropriate for surgical management of mandibular condylar fractures as it provides adequate access, ensures safety of the facial nerve and is relatively easy to master. We realize that rather both incisions are good, but cervicomastoid variant is better choice in many aspects one being time taken for the surgery because of better tissue laxity of neck skin when seen in comparison.

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.

Complications of the Transmasseteric Anteroparotid Approach for Subcondylar Fractures: A Retrospective Study.

A retrospective analysis of patients with subcondylar fractures treated via a transmasseteric anteroparotid approach by the Oral and Maxillofacial Department at the University of Oklahoma. The goal of this study was to evaluate complications, morbidity, and safety with the transmasseteric anteroparotid approach for treatment of subcondylar fractures, and compare it to other findings previously reported in the literature. A retrospective study was conducted that consisted of 23 surgically treated patients in the past 2 years for subcondylar fractures. Only patients with pre-operative malocclusion and who underwent open reduction with internal fixation with the transmasseteric anteroparotid (TMAP) approach were included. Exclusion criteria included 1) patients treated with closed reduction 2) patients who failed the minimum of 1, 3, and 6-week post-operative visits. The examined parameters were the degree of mouth opening, occlusal relationship, facial nerve function, incidence of salivary fistula and results of imaging studies. 20 of the surgically treated patients met the inclusion criteria. Two patients were excluded due to poor post-operative follow up and 1 was a revision of an attempted closed reduction by an outside surgeon that presented with pre-existing complications. There were no cases of temporary or permanent facial nerve paralysis reported. There were 3 salivary fistulas and 2 sialoceles, which were managed conservatively and resolved within 2 weeks, and 2 cases of inadequate post-surgical maximal incisal opening (<40 mm) were observed. The transmasseteric anteroparotid approach is a safe approach for open reduction and internal fixation of low condylar neck and subcondylar fractures, and it has minimal complications.

Clinical Assessment of Retromandibular Antero-Parotid Approach for Reduction of Mandibular Subcondylar Fractures: Report of 60 Cases and Review of the Literature.

This study assessed the efficacy of the retromandibular antero-parotid approach for open reduction and internal fixation (ORIF) of subcondylar fractures. Sixty patients with the mean age of 31.03 years underwent surgical reduction with a 20–25mm incision in the retromandibular area with an antero-parotid transmasseteric approach. All patients were followed between 6 to 12 months. At the end of the first week, six patients exhibited postoperative malocclusion. At the next visits, all patients had optimal occlusion. Maximal interincisal opening (MIO) of 56 patients (93.3%) was >37mm, and only four patients (6.7%) had MIO<37mm. In three patients (5%), weakness of the buccal branch of the facial nerve was noticed postoperatively. No salivary gland complications were seen. The surgical scar was hardly noticeable. Retromandibular access with transmasseteric antero-parotid approach is the technique of choice for treatment of high- and low-level subcondylar fractures with adequate visibility and direct access to the condylar area.

Modified Tragus Edge and Transmasseteric Anteroparotid Approach for Intracapsular and Condylar Neck Fractures.

The aim of this study was to evaluate the effects of protecting the facial nerve and reducing the scar visibility using a modified tragus edge and transmasseteric anteroparotid approach compared to classic preauricular approach for intracapsular and condylar neck fractures. This retrospective study included 64 patients (78 sides) who underwent surgical treatment for intracapsular or condylar neck fractures from January 2014 to June 2018. Patients were divided into the experimental group (treated via a modified tragus edge and transmasseteric anteroparotid approach), and the control group (treated via the classical preauricular approach). Therapeutic outcome assessment parameters included facial nerve injury, salivary fistulae, wound infection, restricted mouth opening, postoperative occlusion disorders, and scar visibility. In the control group, there were 3 cases of facial nerve injuries and 2 cases of salivary fistulae. One case of temporary facial nerve injury occurred in the experimental group, with complete recovery within 1 month. The scars were less visible in the experimental group than in the control group. These results suggest that a modified tragus edge and transmasseteric anteroparotid approach reduced the incidences of facial nerve injuries, minimized the scar visibility, improved exposure of the operative site and fixation of titanium screws or plates, and did not increase the frequency of other complications.

Evaluation of Complications Following a Trans-masseteric Antero-parotid Approach for Patients with Sub-condylar Fractures of Their Temporomandibular Joint. A Retrospective Study.

Sub-condylar fractures of the temporomandibular joint can be treated by an extraoral or intraoral approach. Trans-masseteric antero-parotid approach (TMAP) is an extraoral approach utilising a retromandibular incision. The authors evaluated patients' status and any complications of using TMAP from the years 2013-2017. There were 39 patients (44 fractures). When using TMAP, in 43 fractures the fragments were favourably positioned, in one case the position was compromised. Of the complications, postoperative palsy of the facial nerve was reported 6.8% - in all cases this was only temporary. Late occlusion had an equal number of complications (in 2 cases this was as a result of an infectious complication of the wound, and in 2 cases due to resorption of the proximal fragment). Muscular pain and dysfunction of the temporomandibular joint following trauma were observed consistently in 6.8% of patients. Sialocoele, a non-conforming scar, and infectious complications were observed in 4.5% of patients. TMAP allows rapid surgical performance, with a good view for perfect repositioning and fixation of fragments of sub-condylar fractures of the temporomandibular joint. The complications associated with this approach are, for the most part, temporary, the aesthetic handicap of a scar is considered by patients to be acceptable. Overall, it is possible to evaluate retromandibular TMAP as safe, and the authors recommended it for treatment of sub-condylar fractures of the mandible.

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

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.

Transmasseteric antero-parotid (TMAP) approach: a surgical technique adaptation for ectopic subcondylar third molar removal and literature review (1980-2014)

Introduction: Subcondylar ectopic third molars are rare and their surgical management can be difficult. Our literature review identified eight patients (1980-2014) who had ectopic subcondylar third molars surgically removed; seven by an extraoral approach and one intraorally. Conventional extraoral approaches to the subcondylar region include preauricular, retromandibular, or submandibular. We adapted the TMAP approach to remove a subcondylar ectopic third molar and associated odontogenic cyst. This was the first description of this technique for this clinical problem.

Transmasseteric antero-parotid approach: a technique adaptation for ectopic subcondylar third molar removal and associated dentigerous cyst enucleation

by Wilson et al. in 2005 to manage condylarfractures. We adapted this approach to remove a subcondy-lar ectopic third molar and associated odontogenic cyst, andto the best of our knowledge this is the first report of thistechnique being used for this clinical problem. We chosethe TMAP approach to reduce the surgical morbidity antic-ipated with alternative approaches as it has a low risk ofiatrogenic injury to the facial nerve and reduces the riskof injury to the lingual nerve. An intraoral approach wouldrequire coronoidectomy and further lateral and medial ramuscortical bone removal, increasing the risk of condylar frac-ture. In contrast to an intraoral approach the TMAP approach

Results of Transmasseteric Anteroparotid Approach for Mandibular Condylar Fractures

Management of condylar fractures has been the subject of much disagreement and debate. There is no general consensus for definitive treatment. Although there is a growing tendency for open reduction and internal fixation technique, risks and morbidity of the surgical procedure are still a point of concern for maxillofacial surgeons. To reduce potential complications and improve surgical exposure, the transmasseteric anteroparotid approach was introduced. Since 2008, we have operated on 6 patients (7 fractures) using this approach. The technique is easy to learn, provides adequate surgical exposure for open reduction internal fixation, and has few complication rates.

Open Reduction and Internal Fixation of Low Subcondylar Fractures of Mandible Through High Cervical Transmasseteric Anteroparotid Approach

The aim of the present study was to evaluate the functional and radiologic results of low subcondylar fracture fixation with modus TCP plates (Medartis, Basel, Switzerland) using a high cervical transmasseteric anteroparotid approach. A prospective study was designed, enrolling all minimum-aged 15-year-old echomorphology patients presenting with displaced low subcondylar fracture with occlusion disturbances during a 41-month period. All fractures were fixed with modus TCP plates using high cervical transmasseteric anteroparotid approach. All patients underwent immediate physiotherapy and a 6-week liquid and semiliquid feeding period. Clinical and radiologic examinations were performed at 1 week and 1, 3, and 6 months. A total of 35 patients presenting with 38 fractures were enrolled with a mean follow-up of 17 months. All fractures had healed at 6 months in the correct anatomic position in 73.7%. Occlusion was deemed normal in 80% of the patients. The mandibular movement was normal in 97.1%, with the mouth opening up to 40 mm, mean lateral movement of 11 mm without a difference between the 2 sides, and a mean protrusion of 12 mm. Minimal asymmetry remained in 15.6%. No facial palsy occurred, including no transient facial palsy. Complications consisted of 1 infection and 1 plate fracture requiring surgical revision. Low subcondylar fracture fixation with modus TCP plates using a high cervical transmasseteric anteroparotid approach is a safe and reproducible procedure providing excellent functional results. This procedure has been routinely performed in our department.