Surgical approaches of condylar fracture management - A Mini Review

Thippusultan F; Achuthan N A

doi:10.56501/intjclinicopatholcorrel.v7i1.553

Authors

Thippusultan F Undergraduate, Department of Oral and Maxillofacial Surgery, Vinayaka Missions Sankarachariyar Dental College, Vinayaka Missions Research Foundation, Salem District, Tamil Nadu, India - 636308.
Achuthan N A Associate Professor, Department of Oral and Maxillofacial Surgery, Vinayaka Missions Sankarachariyar Dental College, Vinayaka Missions Research Foundation, Salem District, Tamil Nadu, India-636308.

DOI:

https://doi.org/10.56501/intjclinicopatholcorrel.v7i1.553

Keywords:

Condylar Fracture, Facial Nerve, Neck Fractures

Abstract

Mandibular condylar neck and subcondylar fractures are common in maxillofacial surgery. The justification for surgical treatment of these fractures has varied over time, to avoid the most concerning side event, namely facial nerve injury. We offer a new approach that combines intraoral and cutaneous pre-auricular access, allowing for quick and safe access to the surgical site while avoiding facial nerve injury and surgical scars in high-impact aesthetic areas of the neck. Five patients with condylar neck or subcondylar fractures were treated at the same hospital using a combined intraoral and pre-auricular approach. Three months following surgery, the results were assessed in terms of mandibular mobility, complications, and patient satisfaction All five patients had a positive outcome, with complete fracture healing and no sequelae, including no facial nerve palsy. The safe reduction of the two mandibular pieces achieved by a combined intraoral and cutaneous pre-auricular surgical access is a major element of the approach. The periosteal plan of the ramus can be broadly and safely elevated using the intraoral approach and connected to the condylar bone plane with the pre-auricular cutaneous approach, avoiding facial nerve damage. The wide ramus periosteum elevation generates an "optical space" that allows fragment reduction and fixation in direct oblique view without the requirement for endoscopic intervention. Our findings strongly imply that with our technique, it is possible to treat sub-condyle and condylar neck fractures safely while avoiding facial nerve injury, which is an undesirable consequence due to its severe impact on quality of life.

Publication Facts

This article

Author statements

Data availability

N/A

16%

External funding

No

32%

Competing interests

N/A

11%

This journal

Other journals

Articles accepted

19%

33%

Days to publication

166

145

Indexed in

—

Editor & editorial board: profiles
Academic society: N/A
Publisher: MM Publications

References

Al-Moraissi EA, Ellis E 3rd. Surgical treatment of adult mandibular condylar fractures provides better outcomes than closed treatment: a systematic review and meta-analysis. J Oral Maxillofac Surg. 2015 Mar;73(3):482–93.

Al-Moraissi EA, Ellis E 3rd. Surgical treatment of adult mandibular condylar fractures provides better outcomes than

closed treatment: a systematic review and meta-analysis. J Oral Maxillofac Surg. 2015 Mar;73(3):482–93.

Shackelford TK, Larsen RJ. Facial asymmetry as an indicator of psychological, emotional, and physiological distress. J Pers Soc Psychol. 1997 Feb;72(2):456–66.

Verhoeven JW, Ruijter JM, Cune MS, de Putter C. Densitometric measurements of the mandible: accuracy and validity of intraoral versus extraoral radiographical techniques in an in vitro study. Clin Oral Implants Res. 1998 Oct;9(5):333–42.

Chang CY, Cass SP. Management of facial nerve injury due to temporal bone trauma. Am J Otol. 1999 Jan;20(1):96–114.

Dulguerov P, Quinodoz D, Cosendai G, Piletta P, Marchal F, Lehmann W. Prevention of Frey syndrome during parotidectomy. Arch Otolaryngol Head Neck Surg. 1999 Aug;125(8):833–9.

Madsen MJ, McDaniel CA, Haug RH. A biomechanical evaluation of plating techniques used for reconstructing mandibular symphysis/parasymphysis fractures. J Oral Maxillofac Surg. 2008 Oct;66(10):2012–9.

Boucher L, Jacoby J. Posterior border movements of the human mandible. J Prosthet Dent. 1961 Sep 1;11(5):836–41.

Tümer C, Eset AE, Atabek A. Ectopic impacted mandibular third molar in the subcondylar region associated with a dentigerous cyst: a case report. Quintessence Int. 2002 Mar;33(3):231–3.

Michaels R. A Symmetry of Asymmetries: A Private-International-Law Reconstruction of Lindahl's Work on Boundaries. Duke J. Comp. & Int'l L.. 2018;29:405.

Kubota M, Nakano H, Sanjo I, Satoh K, Sanjo T, Kamegai T, et al. Maxillofacial morphology and masseter muscle

thickness in adults. Eur J Orthod. 1998 Oct;20(5):535–42.

Ketelaar M, Vermeer A, Hart H, van Petegem-van Beek E, Helders PJ. Effects of a functional therapy program on motor abilities of children with cerebral palsy. Phys Ther. 2001 Sep;81(9):1534–45.

Bhutia O, Kumar L, Jose A, Roychoudhury A, Trikha A. Evaluation of facial nerve following open reduction and internal fixation of subcondylar fracture through retromandibular transparotid approach. Br J Oral Maxillofac Surg. 2014 Mar;52(3):236–40.

Avery BS. A sialocoele and unusual parotid fistula-a case report. Br J Oral Surg. 1980 Jun;18(1):40–4.

Liao HT, Wang PF, Chen CT. Experience with the transparotid approach via a mini-preauricular incision for surgical management of condylar neck fractures. J Craniomaxillofac Surg. 2015 Oct;43(8):1595–601.

Olesen UK, Nygaard T, Prince DE, Gardner MP, Singh UM, McNally MA, et al. Plate-assisted Bone Segment Transport With Motorized Lengthening Nails and Locking Plates: A Technique to Treat Femoral and Tibial Bone Defects. J Am Acad Orthop Surg Glob Res Rev. 2019 Aug;3(8):e064.

Shibuya N, Humphers JM, Fluhman BL, Jupiter DC. Factors associated with nonunion, delayed union, and malunion in foot and ankle surgery in diabetic patients. J Foot Ankle Surg. 2013 Mar;52(2):207–11.

Nogami S, Kataoka Y, Yamauchi K, Yanagisawa Y, Imoto K, Kumasaka A, et al. Condylar Resorption Following Compressive Mechanical Stress in Rabbit Model - Association of Matrix Metalloproteinases. In Vivo. 2022 Sep;36(5):2126–33.

19. Ishimaru M, Matsui H, Ono S, HagiwaraY, Morita K, Yasunaga H. Preoperative Oral care and effect on postoperative complications after major cancer surgery. Br J Surg. 2018 Nov;105(12):1688–96.