Facial nerve injuries associated with the retromandibular transparotid approach for reduction and fixation of mandibular condyle fractures

Shi, Dan; Patil, Pavan Manohar; Gupta, Ritika

doi:10.1016/j.jcms.2014.12.009

Cited by 42 publications

(27 citation statements)

References 26 publications

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“…A possible solution for the reduction of facial nerve damage is the intraoral endoscopic approach, which uses an angled screwdriver or the buccal punch method for plate fixation, especially in cases with lateral displaced fragmentation. In absorbable plate fixation, the intraoral approach with endoscopic view is often used with almost no facial nerve damage and less scarring 22 23 .…”

Section: Discussionmentioning

confidence: 99%

Complications of the retromandibular transparotid approach for low condylar neck and subcondylar fractures: a retrospective study

Hevele

Nout

2018

J Korean Assoc Oral Maxillofac Surg

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ObjectivesThe goal of this study was to evaluate the rates of complications, morbidity, and safety with the transparotid approach.Materials and MethodsA retrospective study was conducted and consisted of 53 surgically treated patients in the past five years for low condylar neck and subcondylar fractures. Only patients with malocclusion and who underwent open reduction with internal fixation with the retromandibular transparotid approach were included. The examined parameters were postoperative suboptimal occlusion, deflection, saliva fistula, and facial nerve weakness.ResultsFifty-three patients had an open reduction with internal fixation on 55 sides (41 males, 77.4%; mean age, 42 years [range, 18–72 years]). Four patients (7.5%) experienced transient facial nerve weakness of the marginal mandibular branch, but none was permanent. Four patients had a salivary fistula, and 5 patients showed postoperative malocclusion, where one needed repeat surgery after one year. One patient showed long-term deflection. No other complications were observed.ConclusionThe retromandibular transparotid approach is a safe procedure for open reduction and internal fixation of low condylar neck and subcondylar fractures, and it has minimal complications.

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Section: Discussionmentioning

confidence: 99%

Complications of the retromandibular transparotid approach for low condylar neck and subcondylar fractures: a retrospective study

Hevele

Nout

2018

J Korean Assoc Oral Maxillofac Surg

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“…The included patients experienced only postoperative swelling and pain which resolved in the first week. Consistent with other studies, this was considered a normal reaction to the surgical interference after the open reduction at the fracture site (14)(15)(16) .…”

Section: Discussionmentioning

confidence: 57%

Computer manufactured Patient-specific Auto-reducible plate versus standard Trapezoid plate in Unilateral Subcondylar fractures

Amr¹,

Kamel²,

Hatem

2018

Egyptian Dental Journal

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Purpose: Subcondylar fractures account for a high incidence of mandibular fractures representing a frustrating clinical dysfunction and serious complications when maltreated. This study aimed to compare the computer designed and manufactured patient-specific auto-reducible plate to the standard trapezoid plate in attempt to reach the optimal geometrical design for subcondylar fracture plate fixation. Patients and methods:A total of sixteen patients suffering from unilateral subcondylar fracture were included in this study from the outpatient clinic of the department of oral and maxillofacial surgery, faculty of Dentistry, Cairo University. All patients were subjected to preoperative clinical evaluation and 3-D CT examination to assess the degree of fracture displacement and condylar location. The selected patients were divided into two groups, eight patients each. In group A patients, virtual fracture reduction through mirroring of the unaffected intact side was performed, which was then used as a template for designing and processing of the titanium patient-specific condylar plate via direct metal laser sintering. While in group B patients, the unilateral sub-condylar fractures were manually reduced into position and fixed in place by the standard trapezoidal mini-plate. Fixation of the plates in both groups was then performed using 2.0 mini-screws. Postoperative clinical assessment of the occlusion, Maximum inter-incisal opening (MIO) and mandibular deviation was done at one week, 1 month & 3 months. Immediate postoperative radiographic assessment was performed through the superimposition of the postoperative CT data of the fixed fracture on the preoperative virtually reduced mandibular model as a reference CT data to validate and compare the accuracy of the achieved postoperative fixation in both groups. Results:The surgeries in all cases proceeded without any complications. Surgical site examination was normal with no signs of infection. The occlusion was satisfactory at the end of the study interval despite the initial slight immediate postoperative occlusal discrepancy found in both groups. Deviation was not completely absent in both groups at the end of the follow-up period. The MIO ranged from 39-47 mm at the end of the study with no significant difference between both groups. The CT scan revealed the almost precise adaptation of both plates in place with no significant difference, however, with the advantageous fracture auto-reduction, intra-operative time saving and ease of application recorded with the use of the PS-condylar plate in group A patients. The mean operating time for reduction and fixation using the PS-condylar plate was 90 minutes compared to a mean of 88 minutes using the standard reduction and trapezoid plate fixation technique. (3268)Khaled Amr, et al.

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“…They also observed four salivary fistulae, two sialoceles, one case of Frey's syndrome, and two seromas. Shi et al 28 retrospectively analyzed 102 neck and sub‐condylar fractures and found various degrees of facial nerve injury in 18% of patients. They reported that condylar neck fracture, fracture‐dislocation, and operator inexperience were the three factors associated with facial nerve injury.…”

Section: Discussionmentioning

confidence: 99%

Retromandibular transparotid approach for subcondylar mandibular fracture: A retrospective study

Koirala

Subedi

2020

Dental Traumatology

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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.

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Facial nerve injuries associated with the retromandibular transparotid approach for reduction and fixation of mandibular condyle fractures

Cited by 42 publications

References 26 publications

Complications of the retromandibular transparotid approach for low condylar neck and subcondylar fractures: a retrospective study

Complications of the retromandibular transparotid approach for low condylar neck and subcondylar fractures: a retrospective study

Computer manufactured Patient-specific Auto-reducible plate versus standard Trapezoid plate in Unilateral Subcondylar fractures

Retromandibular transparotid approach for subcondylar mandibular fracture: A retrospective study

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