The Role of a Deep Neuromuscular Block in the Treatment of Mandibular Subcondylar Fractures

Abstract

Mandibular fractures are the third most frequents maxillo-facial fractures. Most frequent site is the subcondylar region. Different approaches to reach subcondylar region, have been described. In the study was evaluated the advantages of neuromuscular block during endoscopic surgery for subcondylar fractures. Twenty-five patients affected by subcondylar fractures were enrolled in this study and divided in 2 groups; group A: patients who received an intraoperative booster of curare during surgical procedure and group B patients who underwent surgery treated without the intraoperative booster of curare. All patients were treated successfully by endoscope-assisted transoral approach. The analysis of time required for surgery showed a reduction in group A comparing to group B. The mean time for surgery for the patients in group B with displacement between 08 and 458 was 170 minutes, and for 458 to 908 was 230 minutes. In group A, the mean time was 117.5 minutes for patients with condylar displacement between 08 and 458, and 147.5 minutes for the other group. In conclusion, deep neuromuscular block seems to improve the surgical conditions in patients undergoing subcondylar endoscopic assisted surgery, further study needs to assess this surgical technique in order to better define this surgical protocol.

Condylar Fractures: Multistep Surgical Planning by Mini-Invasive Approach, Patient Series

“…With the transoral approach, the risk of facial damage is minimal and visible scars are avoided. 12 Drawbacks for this technique are related to the technical difficulties for surgical reduction and fixation, particularly in widely dislocated fractures.…”

New Minimally Invasive Intraoral Procedure for Condylar Fractures: Clinical Presentation and Considerations on Current Techniques

“…5 An endoscopic reduction via intraoral approach has also been recently described. 6 Open reduction and internal fixation is considered the treatment of choice in displaced fractures providing good alignment, also restoring facial symmetry, function, and anatomical alignment. 6 The main drawbacks include cutaneous scar formation due to skin incisions, possible facial nerve injury (FNI) during soft tissue dissection or traction near the posterior and lateral sides of the mandible, and a limited surgical field of view elevating FNI risk.…”

“…Open reduction and internal fixation is considered the treatment of choice in displaced fractures providing good alignment, also restoring facial symmetry, function, and anatomical alignment 6 …”