The purpose of this study is to evaluate patient's outcomes after condylar fractures treated with the modified external fixation system from 2008 to 2012.A group of 58 patients with unilateral and bilateral fractures of mandibular condyle was admitted in the authors' study.The final sample included a total of 44 patients, 24 males (54.6%) and 20 females (45.4%).The remaining 14 (24%) patients were excluded because they did not fulfill all the criteria requested.After 12 months from surgery, the functional-clinical evaluation of mouth's maximum opening and mostly extent of lateral excursion and of protrusion showed the following results: 8% of the sample showed a maximum mouth opening <30 mm, 72% of the sample showed a maximum mouth opening between 30 and 40 mm, 20% of the sample showed a maximum mouth opening >40 mm lateral excursion (contralateral to fracture) and protrusion was respectively of 9.5 and 3.9 mm.Only 2 (4.5%) of the 44 evaluated patients reported headaches. 86.5% of the patients showed no postoperative temporomandibular joint dysfunction; 9% of them reported occasional clicking, while 4.5% reported recurrent disorders. The average satisfaction score of surgery outcome reported by patients was 94.5/100, and it ranged between 50/100 and 100/100.
However, its use in an environment without aquatic resistance can cause severe damage. 3 Because of the unusual and unpredictable mechanism of injury, the surgical procedure and specialist teams required to remove a harpoon will depend on the affected structures. 1,2 Harpoon removal from craniofacial structures requires a meticulous approach to avoid damage to noble structures, since it has barb on the spear, with the potential to generate resistance to surgical removal. [1][2][3] If the barb is immobile, it is extremely difficult to remove it without surgical approach. 3 Closed mobile barbs into the tissue may be opened during vigorous attempts to remove them. 3,4 In the present case, the harpoon was very close to the left internal carotid, thus the approach to the brain, as well as the careful manipulation of the artefact was critical to avoid further injury. The knowledge of the shaft type and anatomy is essential. 4 Furthermore, the trajectory is different between accident and suicide attempt. 4,5 Owing to the seriousness of the case, a multispecialty approach was vital, including postsurgical support from the neurosurgery, maxillofacial, ophthalmology, and psychology teams which the patient's physical and mental health.
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