Skip to main content

Advertisement

Log in

Evaluation of Retro Mandibular Approach to Open Reduction and Internal Fixation of Condylar Fractures: A Cross-sectional Study

  • Research Paper
  • Published:
Journal of Maxillofacial and Oral Surgery Aims and scope Submit manuscript

Abstract

Purpose

The present study was carried out to evaluate the usefulness of mini retromandibular approach on accessibility, scarring and stability in open reduction and internal fixation of sub condylar fractures.

Materials and Methods

Fifteen patients underwent open reduction and rigid fixation of middle and low subcondylar fractures, with mini-retro mandibular approach.

Results

No signs of infection were observed in any patient postoperatively. Surgical scar was imperceptible and esthetically acceptable in all the cases. Out of 15 patients, only one patient had discrepancy in occlusion and after 2 months satisfactory centric occlusion was achieved. Salivary fistula (parotid fistula) was observed in 3 cases within 1 week postoperatively, which was treated spontaneously with the use of hypertonic saline. Transient facial nerve weakness was observed in 2 patients, in one patient it resolved in 4 weeks postoperatively and in second patient 3 months postoperatively. Mouth opening increased in all the patients with time. Average mouth opening at 1 week interval was 19.6 mm, at 2 months interval 28.2 mm, and after 6 months 38.33 mm suggesting that mouth opening gradually increased with time. At the end of 2 months postoperatively none of the patients had any restriction in lateral movements. At 2 months postoperatively 4 patients had deviation but none of the patients had any deviation 6 months postoperatively.

Conclusion

It is evident from the results of our study that open reduction and internal fixation using mini-retromandibular approach is good treatment option in management of mandibular condylar fractures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9

Similar content being viewed by others

References

  1. Ellis E III, Dean J (1993) Rigid fixation of mandibular condyle fractures. Oral Surg Oral Med Oral Pathol 76:6–15

    Article  PubMed  Google Scholar 

  2. Silvennoinen U, Iizuka T, Lindqvist C, Oikarinen K (1992) Different patterns of condylar fractures: an analysis of 382 patients in a 3-year period. J Oral Maxillofac Surg 50:1032–1037

    Article  CAS  PubMed  Google Scholar 

  3. Zachariades N, Mezitis M, Mourouzis C, Papadakis D, Spanou A (2006) Fractures of the mandibular condyle: a review of 466 cases. Literature review, reflections and proposals. J Cranio Maxillofac Surg 34:421–432

    Article  Google Scholar 

  4. Wassmund M (1934) Uber luxationsfrakturen des kiefergelenkes. Dtsch Kieferchir 1:27

    Google Scholar 

  5. Kohler A (1956) Die Behandlung der luxationsfrakturen in wachsendenund ausgewachsenen Kiefer—Sowie ihre Ergebnisse. Dtsch Stomatol 6:561

    Google Scholar 

  6. Haug RH, Brandt MT (2007) Closed reduction, open reduction, and endoscopic assistance: current thoughts on the management of mandibular condyle fractures. Plast Reconstr Surg 120(Suppl. 2):90S

    Article  CAS  PubMed  Google Scholar 

  7. Palmieri C, Ellis E III, Throckmorton GS (1999) Mandibular motion after closed and open treatment of unilateral mandibular condylar process fractures. J Oral Maxillofac Surg 57:764

    Article  CAS  PubMed  Google Scholar 

  8. Ellis E III, Simon P, Throckmorton GS (2000) Occlusal results after open or closed treatment of fractures of the mandibular condylar process. J Oral Maxillofac Surg 58:260

    Article  PubMed  Google Scholar 

  9. Ellis E III, Throckmorton GS (2001) Bite forces after open or closed treatment of mandibular condylar process fractures. J Oral Maxillofac Surg 59:389

    Article  PubMed  Google Scholar 

  10. Throckmorton GS, Ellis E III (2000) Recovery of mandibular motion after closed and open treatment of unilateral mandibular condylar process fractures. Int J Oral Maxillofac Surg 29:421

    Article  CAS  PubMed  Google Scholar 

  11. Throckmorton GS, Ellis E III, Hayasaki H (2004) Masticatory motion after surgical or nonsurgical treatment for unilateral fractures of the mandibular condylar process. J Oral Maxillofac Surg 62:127

    Article  PubMed  Google Scholar 

  12. Eckelt U, Schneider M, Erasmus F et al (2006) Open versus closed treatment of fractures of the mandibular condylar process—A prospective randomized multi-centre study. J Cranio Maxillofacial Surg 34:306

    Article  Google Scholar 

  13. Schneider M, Lauer G, Eckelt U (2007) Surgical treatment of fractures of the mandibular condyle: a comparison of long term results following different approaches—functional, axiographical, and radiological findings. J Cranio Maxillofacial Surg 35:151

    Article  Google Scholar 

  14. Myall R (1994) Condylar injuries in children: what is different about them? In: Whortington P (ed) Controversies in oral and maxillofacial surgery. WB Saunders, Philadelphia, pp 191–200

    Google Scholar 

  15. Hovinga J, Boering G, Stegenga B (1999) Long term results of nonsurgical management of condylar fractures in children. Int J Oral Maxillofac Surg 28:429

    Article  CAS  PubMed  Google Scholar 

  16. Undt G, Kermer C, Rasse M, Sinko K, Ewers R (1999) Transoral miniplate osteosynthesis of condylar neck fractures. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 88:534–543

    Article  CAS  PubMed  Google Scholar 

  17. Loukota RA (2006) Endoscopically assisted reduction and fixation of condylar neck/base fractures–the learning curve. Br J Oral Maxillofac Surg 44:480

    Article  CAS  PubMed  Google Scholar 

  18. Jensen T, Jensen J, Norholt SE et al (2006) Open reduction and rigid internal fixation of mandibular condylar fractures by an intraoral approach: a long term follow-up study of 15 patients. J Oral Maxillofac Surg 64:1771

    Google Scholar 

  19. Tasanen A, Lamberg MA (1976) Transosseous wiring in the treatment of condylar fractures of the mandible. J Maxillofac Surg 4:200

    Article  CAS  PubMed  Google Scholar 

  20. Kallela I, Soderholm AL, Paukku P et al (1995) Lag screw osteosynthesis of mandibular condyle fractures: a clinical and radiological study. J Oral Maxillofac Surg 53:1397

    Article  CAS  PubMed  Google Scholar 

  21. Ellis E III, McFadden D, Simon P et al (2000) Surgical complications with open treatment of mandibular condylar process fractures. J Oral Maxillofac Surg 58:950

    Article  PubMed  Google Scholar 

  22. Manisali M, Amin M, Aghabeigi B et al (2003) Retromandibular approach to the mandibular condyle: a clinical and cadaveric study. Int J Oral Maxillofac Surg 32:253

    Article  CAS  PubMed  Google Scholar 

  23. Vesnaver A, Gorjanc M, Eberlinc A et al (2005) The periauricular transparotid approach for open reduction and internal fixation of condylar fractures. J Cranio Maxillofacial Surg 33:169

    Google Scholar 

  24. Zide MF, Kent JN (1983) Indications for open reduction of mandibular condyle fractures. J Oral Maxillofac Surg 41:89–98

    Article  CAS  PubMed  Google Scholar 

  25. Fernandez JA, Mathog RH (1987) Open treatment of condylar fractures with biphase technique. Arch Otolaryngol Head Neck Surg 113:262–266

    Article  CAS  PubMed  Google Scholar 

  26. Stiesch-Scholz M, Schmidt S, Eckardt A (2005) Condylar motion after open and closed treatment of mandibular condylar fractures. J Oral Maxillofac Surg 63:1304–1309

    Article  PubMed  Google Scholar 

  27. Chossegros C, Cheynet F, Blanc JL, Bourezak Z (1996) Short retromandibular approach of subcondylar fractures: clinical and radiologic long-term evaluation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 82:248–252

    Article  CAS  PubMed  Google Scholar 

  28. Biglioli F, Colletti G (2009) Transmasseter approach to condylar fractures by mini- retromandibular access. J Oral Maxillofac Surg 67:2418–2424

    Article  PubMed  Google Scholar 

  29. Parsons ME (2004) Sclerotherapy basics. Dermatol Clin 22:501–508

    Article  PubMed  Google Scholar 

  30. Rao JKD, Gehlot N, Laxmy V, Siwach V (2011) Management of parotid fistula using hypertonic saline. Natl J Maxillofac Surg 2:177–180

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  31. Devlin MF, Hislop WS, Carton AT (2002) Open reduction and internal fixation of fractured mandibular condyles by a retromandibular approach: surgical morbidity and informed consent. Br J Oral Maxillofac Surg 40:23–25

    Article  CAS  PubMed  Google Scholar 

  32. Hyde N, Manisali M, Aghabeigi B, Sneddon K, Newman L (2002) The role of open reduction and internal fixation in unilateral fractures of the mandibular condyle: a prospective study. Br J Oral Maxillofac Surg 40:19–22

    Article  CAS  PubMed  Google Scholar 

  33. Iannetti G, Cascone P (1995) Use of rigid external fixation in fractures of the mandibular condyle. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 80:394–397

    Article  CAS  PubMed  Google Scholar 

  34. Widmark G, Bågenholm T, Kahnberg KE, Lindahl L (1996) Open reduction of subcondylar fractures. A study of functional rehabilitation. Int J Oral Maxillofac Surg 25:107–111

    Article  CAS  PubMed  Google Scholar 

  35. Sugiura T, Yamamoto K, Murakami K, Sugimura M (2001) A comparative evaluation of osteosynthesis with lag screws, miniplates, or Kirschner wires for mandibular condylar process fractures. J Oral Maxillofac Surg 59:1161–1168

    Article  CAS  PubMed  Google Scholar 

  36. Villarreal PM, Monje F, Junquera LM, Mateo J, Morillo AJ, González C (2004) Mandibular condyle fractures: determinants of treatment and outcome. J Oral Maxillofac Surg 62:155–163

    Article  PubMed  Google Scholar 

  37. Choi BH, Yi CK, Yoo JH (2001) Clinical evaluation of 3 types of plate osteosynthesis for fixation of condylar neck fractures. J Oral Maxillofac Surg 59:734–737

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to J. K. Dayashankara Rao.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rao, J.K.D., Gehlot, N. & Siwach, V. Evaluation of Retro Mandibular Approach to Open Reduction and Internal Fixation of Condylar Fractures: A Cross-sectional Study. J. Maxillofac. Oral Surg. 13, 488–494 (2014). https://doi.org/10.1007/s12663-013-0559-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12663-013-0559-7

Keywords

Navigation