Keywords
Mandibular condyle
Oral surgical procedures
How to Cite
Abstract
Aim: The mandible is regarded as a frequently fractured bone in patients who present with maxillofacial trauma accounting for almost 15.5% to 59% of all facial fractures. Managing condylar trauma has remained to be a point of contention amongst experts, regardless of the advances in surgical modalities and methodologies, and the treatment plan is often determined by the preference and the experience of the surgeon. There exist various approaches in the literature, each with its own specific benefits and drawbacks. With this study, we aimed to evaluate the prevalence of post-operative complications in patients who experienced ORIF by means of the retromandibular approach, by comparing the outcomes of one group having undergone transparotid surgery, with another that underwent retroparotid surgery. Methods: An experimental trial was undertaken. Convenience sampling was done from among the cases of condylar neck and base fracture visiting the department of OMFS, Dow University of Health Sciences from January 2017 to December 2019. An overall 26 patients were divided into 2 groups of 13 members each; one was managed using Open Reduction Internal Fixation (ORIF) by means of a retromandibular transparotid approach while the other group was treated with ORIF by means of a retromandibular retroparotid approach. A 6 month follow-up was done to assess range of active motion, occlusion, and complications such as deviation/deflection, neural injury, infections, sialocele, salivary fistulae and Frey’s syndrome in both groups. Results: There was no statistically significant difference between the two groups in terms of inter-incisal opening, right and left lateral movements, or protrusion. One patient in the retroparotid group had deviation on mouth opening (7.69%), while one in the transparotid group reported with infection (7.69%), and 2 developed post operative seromas (15.38%). None had persisting facial nerve palsy at 6 months. Conclusion: We find no significant disparity between the 2 approaches at a follow-up of 6 months; therefore, the primary determining factor for selection of either technique is surgeon preference and appropriate case selection.
References
Long X. The relationship between temporomandibular joint ankylosis and condylar fractures. Chin J Dent Res. 2012;15(1):17-20.
Ferretti C, Bryant R, Becker P, Lawrence C. Temporomandibular joint morphology following post-traumatic ankylosis in 26 patients. nt J Oral Maxillofac Surg. 2005 Jun;34(4):376-81. doi: 10.1016/j.ijom.2004.09.003.
Parihar V, Bandyopadhyay T, Chattopadhyay P, Jacob S. Retromandibular transparotid approach compared with transmasseteric anterior parotid approach for the management of fractures of the mandibular condylar process: a prospective randomised study. Br J Oral Maxillofac Surg. 2019 Nov;57(9):880-5. doi: 10.1016/j.bjoms.2019.07.010.
Tang W, Gao C, Long J, Lin Y, Wang H, Liu L, et al. Application of modified retromandibular approach indirectly from the anterior edge of the parotid gland in the surgical treatment of condylar fracture. J Oral Maxillofac Surg. 2009 Mar;67(3):552-8. doi: 10.1016/j.joms.2008.06.066.
Tomar K. Efficacy of the retroparotid trans-masseteric approach via retromandibular incision in orif of subcondylar fractures: our institution experience. J Maxillofac Oral Surg. 2018 Sep;17(3):332-8. doi: 10.1007/s12663-017-1022-y.
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. doi: 10.1016/j.bjoms.2013.12.002.
Trost O, Trouilloud P, Malka G. Open reduction and internal fixation of low subcondylar fractures of mandible through high cervical transmasseteric anteroparotid approach. J Oral Maxillofac Surg. 2009 Nov;67(11):2446-51. doi: 10.1016/j.joms.2009.04.109.
Ebenezer V, Ramalingam B, Sivakumar M. Trans Parotid and retroparotid approach for the management of condylar fracture (case study). World J Med Sci. 2014;10(2):229-32. doi: 10.5829/idosi.wjms.2014.10.2.82244.
Neff A, Cornelius CP, Rasse M, Torre DD, Audigé L. The Comprehensive AOCMF Classification System: condylar process fractures - level 3 tutorial. Craniomaxillofac Trauma Reconstr. 2014 Dec;7(Suppl 1):S044-58. doi: 10.1055/s-0034-1389559.
Meyer C, Kahn J-L, Boutemi P, Wilk A. Photoelastic analysis of bone deformation in the region of the mandibular condyle during mastication. J Craniomaxillofac Surg. 2002 Jun;30(3):160-9. doi: 10.1054/jcms.2002.0297.
Ahmed S, Usmani RV, Shaikh AH, Iqbal N, Hassan SMU, Ali A. Mandibular fractures; pattern and presentation of mandibular fractures in dow international dental college: five year review. Professional Med J. 2018;25(10):1596-9. doi 10.29309/TPMJ/18.4574.
Al-Moraissi EA, Louvrier A, Colletti G, Wolford LM, Biglioli F, Ragaey M, et al. Does the surgical approach for treating mandibular condylar fractures affect the rate of seventh cranial nerve injuries? A systematic review and meta-analysis based on a new classification for surgical approaches. J Craniomaxillofac Surg. 2018 Mar;46(3):398-412. doi: 10.1016/j.jcms.2017.10.024.
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. doi: 10.1016/j.joms.2014.09.027.
Vincent AG, Ducic Y, Kellman R. Fractures of the mandibular condyle. Facial Plast Surg. 2019 Dec;35(6):623-6. doi: 10.1055/s-0039-1700888.
Ajmal S, Khan MA, Jadoon H, Malik SA. Management protocol of mandibular fractures at Pakistan Institute of Medical Sciences, Islamabad, Pakistan. J Ayub Med Coll Abbottabad. 2007;19(3):51-5.
Cheema SA, Amin F. Incidence and causes of maxillofacial skeletal injuries at the Mayo Hospital in Lahore, Pakistan. Br J Oral Maxillofac Surg. 2006 Jun;44(3):232-4. doi: 10.1016/j.bjoms.2005.05.017.
Lindahl L. Condylar fractures of the mandible: I. Classification and relation to age, occlusion, and concomitant injuries of teeth and teeth-supporting structures, and fractures of the mandibular body. Int J Oral Surg. 1977 Feb;6(1):12-21. doi: 10.1016/s0300-9785(77)80067-7.
Bouchard C, Perreault M-H. Postoperative complications associated with the retromandibular approach: a retrospective analysis of 118 subcondylar fractures. J Oral Maxillofac Surg. 2014 Feb;72(2):370-5. doi: 10.1016/j.joms.2013.08.014.
Rozeboom AVJ, Dubois L, Bos RRM, Spijker R, de Lange J. Open treatment of condylar fractures via extraoral approaches: A review of complications. J Craniomaxillofac Surg. 2018 Aug;46(8):1232-40. doi: 10.1016/j.jcms.2018.04.020.
Rozeboom A, Dubois L, Bos R, Spijker R, De Lange J. Open treatment of unilateral mandibular condyle fractures in adults: a systematic review. Int J Oral Maxillofac Surg. 2017 Oct;46(10):1257-66. doi: 10.1016/j.ijom.2017.06.018.
Mellor T, Shaw R. Frey's syndrome following fracture of the mandibular condyle: case report and literature review. Injury. 1996 Jun;27(5):359-60. doi: 10.1016/0020-1383(96)00010-1.
Sverzut CE, Trivellato AE, Serra ECS, Ferraz EP, Sverzut AT. Frey's syndrome after condylar fracture: case report. Braz Dent J. 2004;15(2):159-62. doi: 10.1590/s0103-64402004000200014.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2021 Brazilian Journal of Oral Sciences
Downloads
