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A simple technique to aid open reduction and internal fixation of condylar fractures approached via retromandibular incision
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British Journal of Oral and Maxillofacial Surgery 51 (2013) 457–458
Technical note
A simple technique to aid open reduction and internal fixation of condylar fractures approached via retromandibular incision D. Gahir, S. Khandavilli ∗ , R. Burnham Department of Oral and Maxillofacial Surgery, University Hospital of North Staffordshire, Stoke-on-Trent ST4 6QG, United Kingdom Accepted 24 October 2012 Available online 20 November 2012 Keywords: Condyle; Fracture; Open reduction and internal fixation; Retromandibular; Approach
The treatment of condylar fractures have increasingly involved the use of surgical intervention,1 and several approaches2 have been described to gain access to the fracture site, each with their own advantages and disadvantages. Subcondylar fractures commonly result in medial displacement of the condylar head, which causes loss of ramal height.3 Therefore, to restore normal ramal height, and to maintain the anatomy of the joint and masticatory function precise anatomical reduction is vital.4 Several methods have been reported to distract the condylar fracture to aid its reduction. They include application of digital pressure over the molar teeth,3 placement of a bite block on the affected side, and use of modified angulated elevators.5 We describe a simple technique that aids the reduction of overriding fracture fragments mainly during a transparotid approach through a retromandibular incision.
Technique The fracture is exposed through a standard retromandibular incision with a transparotid approach that is augmented by submasseteric dissection to the angle of the mandible without detaching the pterygomasseteric sling. An osteosynthesis screw from the mandibular fixation kit 2.0 mm in diameter and roughly 12 mm long is placed at the angle and left to protrude slightly. ∗
Fig. 1. A 14-gauge cannula inserted from the angle of the mandible showing the traction wire being passed down the needle.
A 14-gauge intravenous cannula is inserted into the surgical site from the lower border of the mandible. While protecting the edges of the skin, the free ends of a 0.5 mm looped wire are passed down the needle of the cannula (Fig. 1) so that they protrude at the luer connector end of the cannula when the needle is removed (Fig. 2). The loop is then hooked over the protruding screw at the angle (Fig. 3) and traction is applied along the wire in a number of vectors to distract the fragments and help reduce the fracture. Once adequate reduction and fixation have been done the screw is removed and the wire pulled further into the plastic catheter and removed safely inside the cannula. The benefits of this technique are first, the ease with which the traction wire can be passed without the need for an incision and dissection at the angle of the mandible, and secondly,
Corresponding author. Tel.: +441782715444. E-mail address: [email protected] (S. Khandavilli).
0266-4356/$ – see front matter © 2012 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.bjoms.2012.10.015
458
D. Gahir et al. / British Journal of Oral and Maxillofacial Surgery 51 (2013) 457–458
the plastic catheter of the intravenous cannula acts as a protective cover to prevent accidental damage to the tissue. Also, it uses materials that are readily available in the operating theatre, requires no extra preparation, and is simple and safe.
Conflict of interest None.
References Fig. 2. The free ends of the traction wire are exposed when the needle is withdrawn.
Fig. 3. A loop in the traction wire engages the screw at the angle of the mandible.
1. Abdel-Galil K, Loukota R. Fractures of the mandibular condyle: evidence base and current concepts of management. Br J Oral Maxillofac Surg 2010;48:520–6. 2. Knepil GJ, Kanatas AN, Loukota RJ. Classification of surgical approaches to the mandibular condyle. Br J Oral Maxillofac Surg 2011;49:664–5. 3. Ebenezer V, Ramalingam B. Comparison of approaches for rigid fixation of sub-condylar fractures. J Oral Maxillofac Surg 2011;10:38–44. 4. Narayanan V, Ramadorai A, Ravi P, Nirvikalpa N. Transmasseteric anterior parotid approach for condylar fractures: experience of 129 cases. Br J Oral Maxillofac Surg 2012;50:420–4. 5. Schön R, Schramm A, Gellrich NC, Schmelzeisen R. Follow-up of condylar fractures of the mandible in 8 patients at 18 months after transoral endoscopic-assisted open treatment. J Oral Maxillofac Surg 2003;61:49–54.
British Journal of Oral and Maxillofacial Surgery 51 (2013) 457–458
Technical note
A simple technique to aid open reduction and internal fixation of condylar fractures approached via retromandibular incision D. Gahir, S. Khandavilli ∗ , R. Burnham Department of Oral and Maxillofacial Surgery, University Hospital of North Staffordshire, Stoke-on-Trent ST4 6QG, United Kingdom Accepted 24 October 2012 Available online 20 November 2012 Keywords: Condyle; Fracture; Open reduction and internal fixation; Retromandibular; Approach
The treatment of condylar fractures have increasingly involved the use of surgical intervention,1 and several approaches2 have been described to gain access to the fracture site, each with their own advantages and disadvantages. Subcondylar fractures commonly result in medial displacement of the condylar head, which causes loss of ramal height.3 Therefore, to restore normal ramal height, and to maintain the anatomy of the joint and masticatory function precise anatomical reduction is vital.4 Several methods have been reported to distract the condylar fracture to aid its reduction. They include application of digital pressure over the molar teeth,3 placement of a bite block on the affected side, and use of modified angulated elevators.5 We describe a simple technique that aids the reduction of overriding fracture fragments mainly during a transparotid approach through a retromandibular incision.
Technique The fracture is exposed through a standard retromandibular incision with a transparotid approach that is augmented by submasseteric dissection to the angle of the mandible without detaching the pterygomasseteric sling. An osteosynthesis screw from the mandibular fixation kit 2.0 mm in diameter and roughly 12 mm long is placed at the angle and left to protrude slightly. ∗
Fig. 1. A 14-gauge cannula inserted from the angle of the mandible showing the traction wire being passed down the needle.
A 14-gauge intravenous cannula is inserted into the surgical site from the lower border of the mandible. While protecting the edges of the skin, the free ends of a 0.5 mm looped wire are passed down the needle of the cannula (Fig. 1) so that they protrude at the luer connector end of the cannula when the needle is removed (Fig. 2). The loop is then hooked over the protruding screw at the angle (Fig. 3) and traction is applied along the wire in a number of vectors to distract the fragments and help reduce the fracture. Once adequate reduction and fixation have been done the screw is removed and the wire pulled further into the plastic catheter and removed safely inside the cannula. The benefits of this technique are first, the ease with which the traction wire can be passed without the need for an incision and dissection at the angle of the mandible, and secondly,
Corresponding author. Tel.: +441782715444. E-mail address: [email protected] (S. Khandavilli).
0266-4356/$ – see front matter © 2012 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.bjoms.2012.10.015
458
D. Gahir et al. / British Journal of Oral and Maxillofacial Surgery 51 (2013) 457–458
the plastic catheter of the intravenous cannula acts as a protective cover to prevent accidental damage to the tissue. Also, it uses materials that are readily available in the operating theatre, requires no extra preparation, and is simple and safe.
Conflict of interest None.
References Fig. 2. The free ends of the traction wire are exposed when the needle is withdrawn.
Fig. 3. A loop in the traction wire engages the screw at the angle of the mandible.
1. Abdel-Galil K, Loukota R. Fractures of the mandibular condyle: evidence base and current concepts of management. Br J Oral Maxillofac Surg 2010;48:520–6. 2. Knepil GJ, Kanatas AN, Loukota RJ. Classification of surgical approaches to the mandibular condyle. Br J Oral Maxillofac Surg 2011;49:664–5. 3. Ebenezer V, Ramalingam B. Comparison of approaches for rigid fixation of sub-condylar fractures. J Oral Maxillofac Surg 2011;10:38–44. 4. Narayanan V, Ramadorai A, Ravi P, Nirvikalpa N. Transmasseteric anterior parotid approach for condylar fractures: experience of 129 cases. Br J Oral Maxillofac Surg 2012;50:420–4. 5. Schön R, Schramm A, Gellrich NC, Schmelzeisen R. Follow-up of condylar fractures of the mandible in 8 patients at 18 months after transoral endoscopic-assisted open treatment. J Oral Maxillofac Surg 2003;61:49–54.