Introduction
The retromandibular transparotid approach provides the shortest and the most direct access to mandibular sub‐condylar fractures. However, this approach is less preferred due to the fear of facial nerve injury. The aim of this study was to evaluate the safety and morbidity of the retromandibular transparotid approach for open reduction and internal fixation of sub‐condylar mandibular fractures.
Methods
A retrospective cohort study of 29 patients with 35 sub‐condylar mandibular fractures who underwent open reduction and internal fixation through the retromandibular transparotid approach was conducted. The primary study variable was facial nerve palsy, whereas the secondary variables were infection, sialocele, salivary fistula, stability of the fractured segments, post‐operative malocclusion, Frey's syndrome, and unesthetic scar. All patients were followed up for 6 months. Predictor variables included age, gender, side, location, displacement, etiology, concomitant maxillofacial fractures, and healing status. Fisher's exact test was calculated to find the association between primary variables and predictor variables.
Result
Out of 35 sub‐condylar fractures (29 patients; 23 male, 6 female), four (11.42%) developed transient facial nerve palsy. Fractures at the condylar neck level (P = .045) and with displacement (P = .026) were significantly associated with the development of facial nerve palsy. Four patients (13.8%) developed slight malocclusion, two had surgical site infections, two developed sialoceles, and one had a salivary fistula.
Conclusion
The retromandibular transparotid approach is safe and effective with rare major complications in the management of sub‐condylar fractures of the mandible. Condylar neck fractures and displaced fractured segments are associated with an increased risk of development of facial nerve palsy.
Introduction: The purpose of this study was to assess the various indications of impacted mandibular third molar removal and pathologies associated with it.
Methods: A retrospective cross-sectional study was conducted in the Department of Oral Surgery, Gandaki Medical College. The clinical case records from September 2016 to August 2019 were retrieved, reviewed, and analyzed. Surgically removed impacted mandibular third molars for which orthopantomogram were available and the lesions verified histologically were included in the study. Orthopantomograms were studied to determine the angular position of the impacted mandibular third molars and associated pathology. The data was entered in SPSS 20 and descriptive statistics was applied.
Results: A total of 1344 impacted mandibular third molars (Male-709, 52.8%; Female - 635, 47.2%) were surgically extracted during the three-year period. The majority of patients (36.5%) were in the age groups of 25 - 34 years with a higher incidence of mesioangular impaction (33%). Recurrent pericoronitis (62.9%) was the most common indication followed by caries (11.7%). The radiographically detectable lesion was seen in 471 (35%) cases out of which 304 (64.5%) were symptomatic at the time of extraction. Among137 histopathologically diagnosed cases, chronic inflammatory lesion (76, 55.9%) was the most common finding.
Conclusion: Awareness of the indications for removal of impacted mandibular third molars helps in proper management and prevention of future complications associated with retention and delayed extraction of such teeth. So, regular and periodic clinical and radiographic examination is required for patients with impacted mandibular third molars.
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