Trans-tragal incision for improved exposure of diacapitular and condylar neck fractures

Pau, Mauro; Feichtinger, Matthias; Reinbacher, Knut; Ivancic, Paul C.; Kärcher, Hans

doi:10.1016/j.ijom.2011.10.006

Cited by 15 publications

(4 citation statements)

References 11 publications

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“…In addition to the unsightly incision location, the continued tension from retraction can traumatize the skin edges, perhaps increasing scarring. Recently, Pau et al described a modified preauricular approach to include a trans-tragal extension 11. This modification provided greater access to the condyle but may not reduce the need for retraction (1/16 patients developed temporary impairment of a branch of the facial nerve) and access to the coronoid is insufficient.…”

Section: Discussionmentioning

confidence: 99%

Component Approach to the Temporomandibular Joint and Coronoid Process

Pfaff

Clune

Steinbacher

2014

Craniomaxillofacial Trauma & Reconstruction

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Reconstruction of the temporomandibular joint (TMJ) region is challenging. The conventional direct preauricular incision permits only limited access to the TMJ and surrounding structures, therefore risking injury to the facial nerve during retraction. The ideal approach allows sufficient exposure, preservation of underlying neurovascular structures, and achieves an optimal aesthetic outcome. We describe a preauricular posttragal incision with a superficial musculoaponeurotic system flap to allow wide exposure of the zygomatic arch, TMJ, condyle, and coronoid process. We postulate that this approach improves access, lessens the amount of retraction required, and creates a more inconspicuous scar.

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Section: Discussionmentioning

confidence: 99%

Component Approach to the Temporomandibular Joint and Coronoid Process

Pfaff

Clune

Steinbacher

2014

Craniomaxillofacial Trauma & Reconstruction

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“…Surgical approaches that minimise operative complications and reduce complications such as injuries to the facial nerve have also changed the indications for open treatment. For instance, Pau et al . describe a trans‐tragal approach to the condylar head that combines the endaural approach with hockey stick incision and offers wide exposure of the TMJ as well as good aesthetics and reduced post‐operative morbidity.…”

Section: Treatment Of Intracapsular Condylar Fracturementioning

confidence: 99%

Diacapitular fracture of the mandibular condyle: the current thinking

Udeabor

Braimoh

2013

Oral Surgery

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Diacapitular fracture of the mandibular condyle occurs quite commonly following trauma to the jaws. However, many surgeons shy away from its surgical treatment because of the technical difficulties involved and would rather manage it conservatively. The difficulties range from surgical access and proper repositioning of the fractured segments to the application of mini‐ or micro‐plates. Inadequate treatment can result in limitations in mouth opening, among other complications. Over the years, no clear‐cut guidelines and common ground have been agreed upon across the surgical world with regard to the treatment of this very challenging fracture. Different surgeons at different times have put forward their experiences in the management of diacapitular fractures, and the controversy seems to linger despite advances in surgical techniques and armamentarium. This review article, therefore, is an overview of current thought on the management of diacapitular fractures of the mandibular condyle that is intended to harmonise some of the views in the literature.

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“…Not too many studies proclaim a unanimous consensus on “gold standard” approaches for particular levels of fracture. Of these, the preauricular incision is suitable for the treatment of diacapitular and condylar neck fractures[ 4 , 5 ] but is rather unsuitable for of subcondylar fractures, wherein fixation becomes cumbersome, as screws cannot be oriented perpendicular to the plate. [ 6 ] The retromandibular approach is most commonly used for condylar neck and base fractures whereas high submandibular is a relatively newer approach for the same.…”

Section: Introductionmentioning

confidence: 99%

Comparison of three different approaches in treatment of mandibular condylar fractures – Our experience

Dhuvad

Mansuri

Anchlia

et al. 2023

National Journal of Maxillofacial Surgery

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Background: The principal transfacial routes described to approach condylar process fractures are preauricular, retromandibular, high submandibular, and their various modifications. The selection of a specific surgical approach mainly depends on the level of condylar fracture, displacement/dislocation of the proximal segment and time elapsed from the date of trauma. Not too many studies proclaim a unanimous consensus on “gold standard” approaches for particular levels of fracture. Aim: This study was conducted with the aim to lay down guidelines for determining the ideal surgical approach for treating different condylar fractures based on different clinical situations. Methodology: This prospective study was conducted on 60 patients that underwent open reduction internal fixation of condylar fractures according to preset study design. Inclusion criteria were fracture displacement more than 10 degrees, dislocation, shortening of ramal height more than 2 mm. Patients having maxillofacial fractures other than mandible and condylar fractures in edentulous patients were excluded from this study. Results: The risk of facial nerve injury was more in endaural group and parotid fistula was more evident in retromandibular subparotid group but there was no statistical difference between the groups. The surgical scar was inconspicuous in all three groups. Excellent results were achieved in the other parameters such as mouth opening, range of motion, bite force, and occlusion with all the three approaches. Postoperative CT scan showed satisfactory anatomical reduction. Conclusion: This study concludes that the decision-making on the approach to be selected for any particular condylar fracture depends on the level of fracture, presence of fracture dislocation, and time elapsed from the date of trauma.

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Trans-tragal incision for improved exposure of diacapitular and condylar neck fractures

Cited by 15 publications

References 11 publications

Component Approach to the Temporomandibular Joint and Coronoid Process

Component Approach to the Temporomandibular Joint and Coronoid Process

Diacapitular fracture of the mandibular condyle: the current thinking

Comparison of three different approaches in treatment of mandibular condylar fractures – Our experience

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