Transoral vs. extraoral approach in the treatment of condylar neck fractures

Boehle, Andreas Paul; Herrmann, Eva; Ghanaati, Sharam; Ballon, Alexander; Landes, Constantin A.

doi:10.1016/j.jcms.2014.11.010

Cited by 16 publications

(4 citation statements)

References 46 publications

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“…Another investigation by Colletti et al came to the conclusion that an intraoral method was a viable substitute for transcutaneous submandibular access in the therapy of subcondylar fractures [ 15 ]. There is no risk to the marginal mandibular nerve, despite Boehle et al's evaluation of endoscopic open reduction and internal rigid fixation of subcondylar fractures, reporting an incidence of 4.5% [ 16 ]. In addition, the transoral method requires less intrusive surgery than the extraoral method.…”

Section: Discussionmentioning

confidence: 99%

A Comparative Assessment of Right-Angle Screwdriver Versus Conventional Screwdriver for Orthognathic Surgeries

Ravindran,

Somasundaram,

Raja

et al. 2024

Cureus

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Background Bilateral orthognathic surgery is one of the unique and challenging orthognathic surgeries that gained popularity after numerous modifications to the techniques. Using linear equipment inside the oral cavity might lead to malalignment or structural weakness due to incorrect placement, making the ramus osteotomy more difficult. By directly positioning the instrument perpendicularly over the mandibular ramus region, a right-angle drill can help promote a more ergonomic approach. Objectives The primary objective was to compare the efficacy of a right-angle screwdriver over a conventional screwdriver for orthognathic surgery using clinical parameters. The second objective was to assess the ease of fixation, the ease of osteotomy, and the time taken for the surgery in both groups. Methods This prospective observational study, comparing the effectiveness of conventional and right-angle screwdrivers for orthognathic surgery, was carried out on 12 patients. A split-mouth design was chosen. For the 12 patients, a right-angle screwdriver was used to secure the right mandibular plate and screw, while a traditional straight handpiece was used to fix the left plate and screw. Clinical parameters such as the ease of osteotomy, the ease of fixation, the time taken for fixation, and the postoperative angulation of the screw in relation to the bone with cone beam computed tomography were evaluated. The procedure was communicated to the patients, followed by obtaining written informed consent. Result Statistical analysis was done using descriptive and inferential statistics using an independent sample t-test and an unpaired t-test. IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, NY, USA), was used. The level of significance was set at a p-value of <0.05. Compared to a conventional screwdriver, the right-angle screwdriver made osteotomies and fixations easier for 12 patients and also required less surgical time. Statistically, it was shown that ease of fixation had a statistically significant difference among right-angled and conventional screwdrivers (p-value < 0.001), whereas time taken had an insignificant difference (p-value 0.13). The angulation of screw fixation with the right angle showed a consistent result of fixation perpendicular to the bone when compared with conventional screwdrivers providing stable fixation, which was statistically significant (p-value < 0.001). Conclusion Compared to the conventional screwdriver used in orthognathic procedures, the right-angle screwdriver ensures solid fixation and eliminates the challenges encountered while drilling and screwing posteriorly positioned screws.

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Section: Discussionmentioning

confidence: 99%

A Comparative Assessment of Right-Angle Screwdriver Versus Conventional Screwdriver for Orthognathic Surgeries

Ravindran,

Somasundaram,

Raja

et al. 2024

Cureus

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“…The extraoral, transcutaneous peri-angular approach has gained some popularity during the last decade (1,2,6,7,13,15,19,20,21). Despite the excellent results reported with regard to low incidences of FNI and injury of the parotid gland, the periangular approach is not well represented in the literature.…”

Section: Discussionmentioning

confidence: 99%

Periangular transmasseteric infraparotid approach in the treatment of condylar-base and low condylar‑neck fractures

Hirjak¹,

Vavro²,

Dvoranová³

et al. 2021

BLL

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AIM: Mandibular condylar fractures account for 25 to 52 % of all mandibular fractures. Though current literature favors open reduction and internal fi xation (ORIF) of condylar-base and low condylar-neck fractures, extraoral approaches are usually considered to be complicated by the risk of facial nerve injury and other possible complications. This study was undertaken to demonstrate that the periangular transmasseteric infraparotid surgical approach (TMIP) to condylar-base and low condylar-neck fractures provides excellent access to the bony fragments with minimal risk of complications such as facial nerve and parotid gland injury. PATIENTS: In the period from January 2010 to December 2018, 81patients (96 fractures) with condylar-base and low condylar-neck fractures underwent ORIF via periangular transmasseteric infraparotid surgical approach. RESULTS: The results of this retrospective study showed minimal postoperative complications. The periangular transmasseteric infraparotid surgical approach allowed precise anatomic repositioning and fi xation of the bony fragments in almost all cases except for two juvenile cases with noticeable scars and one case with plate fracture. There were no transient or permanent facial nerve palsies, parotid gland or salivary fi stulae complications during a 12-month follow-up period. CONCLUSION: The periangular infraparotid transmasseteric approach to ORIF of condylar-base and low condylar-neck fractures is an effective and safe approach allowing accurate anatomic reposition and fi xation of the fragments with minimum surgical complications (Tab. 1, Fig. 12, Ref. 21). Text in PDF www.elis.sk KEYWORDS: condylar base, condylar neck, open reduction and internal fi xation (ORIF), facial nerve injury (FNI), transient/permanent facial nerve palsy, parotid gland injury.

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“…The reported incidence of facial nerve damage with different extraoral approaches ranges from 0 to 24%, while long-term injuries range from 0% to just 4%. 12,13 Between temporary and permanent facial nerve pareses, temporary pareses is more. 2,13 Choice of extraoral approach also affects the incidence of facial nerve paresis.…”

Section: Discussionmentioning

confidence: 99%

“…12,13 Between temporary and permanent facial nerve pareses, temporary pareses is more. 2,13 Choice of extraoral approach also affects the incidence of facial nerve paresis. Among the approaches, the mini-retromandibular approach and retromandibular approaches have been described as easy and quick with least risk of transient or permanent facial nerve damage.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic-Assisted Intraoral Open Reduction Internal Fixation of Mandibular Subcondylar Fractures: Initial Experiences from a Tertiary-Care Maxillofacial Center in India

Anehosur

Joshi

Rajendiran

2018

Craniomaxillofacial Trauma & Reconstruction

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Management of condylar fractures is a highly controversial and debatable area. Open reduction and internal fixation (ORIF) using an extraoral approach has certain benefits over the nonsurgical treatment. Risk of damage to the facial nerve and an extraoral scar remains constant deterrents. An endoscopic-assisted ORIF offers an intraoral approach, thus eliminating consequences such as scarring. Though this technique offers unparalleled advantages, it is associated with a steep learning curve. Surgical results improve only with patience and experience. Patients with condylar fractures reported to SDM Craniofacial Unit, Dharwad, India, from 2013 to 2015 are included. Patients were treated with endoscopic-assisted ORIF and were evaluated for functional outcomes that included occlusion, maximal interincisal opening, and deviation of mouth and complications such as facial nerve pareses, postsurgical infection, and morbidity. Fifteen patients included in the study: 4 left sided and 11 right sided fractures. Nine patients had associated other mandibular fracture. Mean age of the patients was 28.2 years. Mean mouth opening at the end of 1 week, 6 weeks, and 6 months was 32.6, 37.8, and 40.5 mm, respectively. Transient facial nerve pareses were noted in one patient, and an extraoral draining sinus was noted in another. Endoscopic-assisted ORIF has a definite scope in management of condylar fractures. Results are more predictable with appropriate case selection due to a steep learning curve and intraoperative technical challenges. An initial experience in ORIF using extraoral approaches would greatly benefit a surgeon in utilizing this novel and alternate tool.

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Transoral vs. extraoral approach in the treatment of condylar neck fractures

Cited by 16 publications

References 46 publications

A Comparative Assessment of Right-Angle Screwdriver Versus Conventional Screwdriver for Orthognathic Surgeries

A Comparative Assessment of Right-Angle Screwdriver Versus Conventional Screwdriver for Orthognathic Surgeries

Periangular transmasseteric infraparotid approach in the treatment of condylar-base and low condylar‑neck fractures

Endoscopic-Assisted Intraoral Open Reduction Internal Fixation of Mandibular Subcondylar Fractures: Initial Experiences from a Tertiary-Care Maxillofacial Center in India

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