Efficacy of Retromandibular Transparotid Approach for the Management of Extracapsular Subcondylar Mandibular Fractures Using 2-mm Titanium Miniplates: A Prospective Clinical Study

Ghezta, Narotam Kumar; Bhardwaj, Yogesh; Rani, Pooja; Ram, Rangila

doi:10.1016/j.joms.2016.03.045

Cited by 15 publications

(12 citation statements)

References 19 publications

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“…They also reported a salivary fistula in 2.3% of patients. Ghezta et al 25 In the current study, 11.4% of the patients had FNP, and the buccal branch was involved in all cases. Among them, 8.7% had a slight weakness (Grade II) and 2.9% had a moderate weakness (Grade III)…”

Section: Discussionsupporting

confidence: 56%

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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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Section: Discussionsupporting

confidence: 56%

“…They also reported a salivary fistula in 2.3% of patients. Ghezta et al 25 reported 8% incidence of transient FNP involving the buccal and marginal mandibular branches using the retromandibular approach in 47 sub‐condylar fractures. All FNP recovered completely within 6 months.…”

Section: Discussionmentioning

confidence: 99%

Retromandibular transparotid approach for subcondylar mandibular fracture: A retrospective study

Koirala

Subedi

2020

Dental Traumatology

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“…Only the intraoral approach (Silverman, 1925; Jacobovicz et al ., 1998), which does not necessitate transcutaneous incisions, is really free from these potential pitfalls. [ 25 ] The intraoral approach requires special instruments and training to utilize the endoscope (Loukota 2006), which is often difficult, relatively uncommon, and time-consuming while training. [ 26 ]…”

Section: Discussionmentioning

confidence: 99%

The retromandibular transparotid approach for reduction and internal fixation of mandibular condylar fractures

Felix

Singh

2020

Ann Maxillofac Surg

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Introduction: The retromandibular transparotid approach is most useful for condylar and subcondylar fractures and provides the best access to the joint and ascending ramus. The study aims at evaluating the ease of access and outcomes encountered on using the retromandibular transparotid approach to access the fracture site for the open reduction and internal fixation (ORIF) of condylar and sub-condylar fractures. Materials and Methods: An observational clinical study was carried out among 10 patients with unilateral and bilateral condylar fracture requiring ORIF. Maximal interincisal mouth opening, facial swelling, occlusal discrepancy, facial nerve injury, scar formation, and acceptability and complications including wound dehiscence, infection, and sialocele/salivary fistula were assessed and measured preoperatively and postoperatively. Results: There was a notable improvement in mouth opening and facial nerve weakness. Postoperative intermaxillary fixation was done with selective patients who had a discrepancy in their occlusion. Preoperatively, swelling was present in four patients (40%) out of 10 patients studied. There was no incidence of sialocele/salivary fistula in any of the cases studied. Conclusion: Retromandibular transparotid incision is technique sensitive and thorough knowledge about the retromandibular area is must for good results and minimal morbidity. The cosmetic results are good in this approach, as well as the facial nerve injury were less in this without any permanent damages.

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“…For the subcondylar fractures, preauricular approach is too high to access below the sigmoid notch regions [ 6 ] and submandibular approach is too low to access the subcondylar regions [ 6 , 7 ] and requires extensive stretching the facial nerve branches and may cause transient facial nerve weakness [ 8 ] when exposing the lesions. The retromandibular incision is closer to the subcondylar fracture sites [ 7 , 9 ]; however, the retromandibular incision only may achieve a limited exposure [ 10 ]. Therefore, this case patient who had subcondylar fracture extending to the condylar neck region was treated with transparotid retromandibular incision extending to the preauricular earlobe lesion.…”

Section: Discussionmentioning

confidence: 99%

Treatment of intractable parotid sialocele occurred after open reduction-fixation of mandibular subcondylar fracture

Hwang¹,

You²,

Burm³

2018

Arch Craniofac Surg

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A sialocele is a subcutaneous cavity containing saliva, most often caused by facial trauma or iatrogenic complications. In subcondylar fractures, most surgeons are conscious of facial nerve injury; however, they usually pay little attention to the parotid duct injury. We report the case of a 41-year-old man with a sialocele, approximately 5×3 cm in size, which developed 1 week after subcondylar fracture reduction. The sialocele became progressively enlarged despite conservative management. Computed tomography showed a thin-walled cyst between the body and tail of the parotid gland. Fluid leakage outside the cyst was noted where the skin was thin. Sialography showed a cutting edge of the inferior interlobular major duct before forming the common major duct that seemed to be injured during the subcondylar fracture reduction process. We decided on prompt surgical treatment, and the sialocele was completely excised. A duct from the parotid tail, secreting salivary secretion into the cyst, was ligated. Botulinum toxin was administrated to block the salivary secretion and preventing recurrence. Treatment was successful. In addition, we found that parotid major ducts are enveloped by the deep lobe and extensive dissection during the subcondylar fracture reduction may cause parotid major duct injury.

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Efficacy of Retromandibular Transparotid Approach for the Management of Extracapsular Subcondylar Mandibular Fractures Using 2-mm Titanium Miniplates: A Prospective Clinical Study

Cited by 15 publications

References 19 publications

Retromandibular transparotid approach for subcondylar mandibular fracture: A retrospective study

Retromandibular transparotid approach for subcondylar mandibular fracture: A retrospective study

The retromandibular transparotid approach for reduction and internal fixation of mandibular condylar fractures

Treatment of intractable parotid sialocele occurred after open reduction-fixation of mandibular subcondylar fracture

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