Endoscopic-Assisted Treatment Combined With Transoral and Transbuccal Approach to Mandibular Subcondylar Fractures

The aim of this study was to evaluate the rhombic three-dimensional plate in fixation of displaced low subcondylar mandibular fractures clinically and radiographically. MATERIALS AND METHODS: This is a prospective, interventional, single armed case series study that was carried out on twelve patients with displaced low subcondylar mandibular fracture. Open reduction and internal fixation was utilized to treat those fractures using rhombic 3D plate, patients were collected from the department of Oral and Maxillofacial surgery, Faculty of Dentistry, Tanta University. All cases were treated with retromandibular approach. Post-operative evaluation: all patients underwent regular follow up for six months. The following parameters were evaluated: a. Maximal mouth opening, b. Lateral and protrusive mandibular movements, c. Chewing and occlusion, d. Clicking and tenderness of TMJ, e. Vertical height of the ramus, f. Anteroposterior angulation of the condyle. RESULTS: 6 months after the operation, the functional parameters returned to normal, with an average mouth opening of 43.6 mm, protrusion of 9.6 mm, and laterotrusion of 10.5 mm. No clicks or tender TMJ, normal function of facial nerve. Radiographic controls showed good fracture alignment, no plate fracture, bending or loose screws were observed. CONCLUSIONS: The clinical and radiographical data suggested that the rhombic three-dimensional plate is suitable for treatment of condylar fractures and provided stable fixation.

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“…Biomechanical and clinical studies have confirmed that these plates allow for sufficient neutralization of strains. 15…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Rhombic Three Dimensional Plate in Fixation of Displaced Low Subcondylar Mandibular Fractures

Eldahab

Shoushan

Elshall

et al. 2019

OMX

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“…The treatment of condylar fractures has been an arduous topic of debate and has significantly changed in the last century. They can be managed both via conservative treatment or by open reduction and internal fixation (ORIF) 10,11 . Traditionally, the majority of condylar process fractures have been managed with closed techniques, typically with maxillomandibular fixation and elastics 12 .…”

Section: Discussionmentioning

confidence: 99%

Endoscopic-assisted approach in the treatment of subcondylar fractures: our experience.

Martínez¹,

Vera²,

Niño³

et al. 2022

j.maxilo

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The management of subcondylar fractures has been very controversial in the maxillofacial literature. The open reduction and internal fixation (ORIF) technique has been considered by many authors the gold standard in selected cases. However, with the rise in endoscopic techniques in the craniomaxillofacial area, new boundaries and less invasive techniques are being explored. The endoscopic approach of subcondylar fractures has proved overall good and similar results to open approaches whilst reducing complications such as facial nerve injury. In this article we purpose to describe our experience with the endoscopic approach to subcondylar fractures. Patients and methods:We retrospectively analyzed 11 patients with subcondylar fractures treated at our department via an endoscopic approach. The number and type of plates used in each patient is recorded. Results and complications observed for all patients are described as well as functional outcomes in terms of mouth opening at 1 week, 3 months and 6 months postoperatively.Results: One patient presented with transient damage to the marginal and frontal branches of the facial nerve. 18.2 % of patients had their hardware removed due to pain or infection at the fracture site. No cases of salivary fistula or sialocele were found in this study. Mean mouth opening at one week postoperatively was 31.8 mm which increased to 37.8 mm at 6 months after surgery, meaning an increase of 18.86 % through the follow-up. Also, 18.2 % of patients presented with persistent deviation with mouth opening and one patient presented with postoperative persistent malocclusion that was treated with intermaxillary fixation and elastics. Conclusion:The endoscopic management of subcondylar fractures is a safe alternative to the open approach, specially in favorable cases, which reduces the risk of complications associa ted to open approaches, such as unfavorable scarring, salivary gland complications and facial nerve damage. In our series only one patient presented with transient damage to the facial nerve. 18.2 % of the plates were removed, which is a high percentage and should be evaluated, although the small size of the series should be taken into account. Maxillofacial surgeons should be encouraged to learn and trained in endoscopic techniques and include the endoscopic assisted approach in their surgical armamentarium.

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“…En un estudio de Kang et al 4 , la duración media de la operación fue de 200 min, González-García et al 22 , informaron que la duración media de la operación fue de 81 min. Akdag et al 23 , tuvieron una duración promedio de 106 min. Nuestro estudio desarrolló sus tratamientos quirúrgicos en un tiempo promedio de 120 min, considerando un abordaje retromandibular extraoral adicional.…”

Section: Discussionunclassified

Tratamiento Quirúrgico de Fracturas de Cóndilo Mandibular: Reducción asistida por endoscopio como complemento al tratamiento convencional

Muñoz¹,

Manríquez²,

Muñoz³

et al. 2021

Rev. Cirugia

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Introducción: Las fracturas de cóndilo presentan una alta incidencia dentro las fracturas de mandíbula. Son principalmente tratadas por reducción abierta y fijación interna mediante elementos de osteosíntesis (ORIF), o por reducción cerrada (CR) con fijación máxilo-mandibular (MMF). El tratamiento asistido por endoscopio de estas fracturas, ofrece una alternativa y complemento quirúrgico a las limitaciones que se pueden presentar en la ORIF clásica.Objetivo: Describir la técnica de reducción quirúrgica asistida por endoscopio mediante acceso transoral y acceso retromandibular, como complemento a la técnica quirúrgica convencional para el tratamiento de fracturas de cóndilo mandibular, evaluando criterios clínicos en una serie de casos operados por esta técnica.Materiales y método: Estudio descriptivo de presentación de serie de casos de pacientes con fractura de cóndilo, tratados con reducción quirúrgica asistida por endoscopio mediante accesos transoral y retromandibular, entre los años 2017 y 2018. Resultados De los siete pacientes operados, un 85,7% presentó una función mandibular normal, un 100% presentó una función motora neurológica facial normal, y un 71,4% no presentó dolor postoperatorio en el control de los 6 meses. Todos los pacientes recuperaron la oclusión que tenían de forma previa a la fractura mandibular. No se reportaron casos que tuvieran la necesidad de reintervención quirúrgica.ConclusionesLa reducción quirúrgica asistida por endoscopio para las fracturas de cóndilo mandibular es una técnica que ofrece un complemento a la técnica quirúrgica convencional, permitiendo mayor visibilidad de las estructuras, menor morbilidad quirúrgica y complicaciones mínimas en relación a las técnicas convencionales descritas

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Endoscopic-Assisted Treatment Combined With Transoral and Transbuccal Approach to Mandibular Subcondylar Fractures

Cited by 9 publications

References 28 publications

Evaluation of Rhombic Three Dimensional Plate in Fixation of Displaced Low Subcondylar Mandibular Fractures

Evaluation of Rhombic Three Dimensional Plate in Fixation of Displaced Low Subcondylar Mandibular Fractures

Endoscopic-assisted approach in the treatment of subcondylar fractures: our experience.

Tratamiento Quirúrgico de Fracturas de Cóndilo Mandibular: Reducción asistida por endoscopio como complemento al tratamiento convencional

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