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Open reduction of condylar fractures—A right treatment perspective?
1072
Trauma
Kamoricho, Kishiwada City, Osaka 5968522, Japan Fractures of the mandibular condyle constitute about 30% of mandibular fractures. Many cases treated nonsurgically with intermaxillary fixation, but in some cases due to multiple trauma left untreated. Such nonsurgical treatment with severe dislocations leads to complications like deformity, malunion, malocclusion, deviation, etc. We have applied distraction osteogenesis for condylar fractures to avoid the complications, particularly deviation and deformity. In this study, we evaluated this new technique. The subjects were 15 patients, ranged in age from 23 to 56 years with the condylar fractures. The L-shape osteotomy of the posterior mandibular ramus designed for this procedure. Active distraction was started after a latency period of 3–5 days with a rate of 0.5 mm twice daily. The mean extent of lengthening was 12.6 mm (range 8–16.5 mm). All patients ended with a symmetrical chin position and X-rays. In all cases, we achieved improved occlusion, face symmetry and pain reduction. But in one case, the slight deviation of mandible has left when opening mouth. The new surgical treatment distraction osteogenesis—for the patients with condylar fractures is useful. doi:10.1016/j.ijom.2007.08.411
O17.5 Open reduction of condylar fractures—a right treatment perspective? V. Deshmukh*, A. Gaikwad Deshmukh Institute of Maxillofacial Surgery & Research Centre, Bassiye Nagar, New Baijipura, Jalna Road, Aurangabad, MS, India The aim of this study was to evaluate the outcome of open reduction of condylar fractures. Seventy-three patients having 84 condylar fractures of various types operated by a single surgeon between 1991 and 2007 were analysed retrospectively. Rigid fixation was done in 70 cases by using plates and screws whilst condylectomy was done in 14 cases. Explorations were done either by an extended Risdons or by preauricular approach. No immobilisation was done. Results were analysed immediately, after 3 months and over long-term with respect to occlusal status, mouth opening and deviation, TMJ pain, Facial nerve func-
tion and chewing efficiency. Suitability of approach with respect to access, ease, safety, duration and aesthetics was also analysed. In no case, malocclusion was noted. Facial paralysis occurred in one case (1.2%). Temporary Temporal branch weakness associated with preauricular approach was seen in 20 cases (34.4%), while Mandibular branch weakness associated with the extended Risdons approach was seen in eight cases (30%). Two wounds (2.4%) got infected requiring plate removal. Mouth opening and chewing efficiency could be restored to normal within 3 months. No TMJ pain noted after 3 months. No case showed healing problem. Preauricular approach was superior to extended Risdons approach. Considering the outcome, extra oral open reduction should be the treatment of choice in the management of condylar fractures. doi:10.1016/j.ijom.2007.08.412
O17.6 A comparative evaluation of stability between resorbable and nonresorbable plates in condylar fracture K. Lahoti*, K. K. Rai, B. Jayade, K. V. D. Kumar, M. C. Dayanand Department of Oral, Maxillofacial and Reconstructive Surgery, Bapuji Dental College and Hospital, Davangere, Karnataka 577004, India Treatment methods for condylar process fractures remain controversial. In the preantibiotic era, most fractures of condylar process have been treated nonsurgically because of risk of wound infection, the proximity of nerves and vessels and the absence of osteosynthesis material. The late complications after closed reduction of condylar fractures were deviation of jaw, limited lateral and protrusive movements, reduced mouth opening, asymmetrical laughing and lip pursing, delayed healing, subjective discomfort due to longer MMF and TMJ derangement. Therefore, a surgical open reduction and internal fixation aims to achieve (1) early mobilisation of the jaw and functional rehabilitation and shortened MMF, (2) anatomical reduction, (3) symmetrical jaw movements, (4) restoration of vertical dimension and (5) adequate dental occlusion. A resorbable miniplate system for promoting osteosynthesis is developed and applied to oral and maxillofacial surgery which has great advantages. In this presentation, the advantages and disadvantages of resorbable
miniplate system is evaluated clinically, technically and radiographically against the conventional nonresorbable miniplate system in the treatment of fractures of mandibular condylar process. doi:10.1016/j.ijom.2007.08.413
O17.7 THE ROAD NOT TAKEN Retromandibular with modified transparotid access for subcondylar fractures S.S. Sundaram*, K. Kanadasan, K. Raja, A. Gnanam Department of Oral and Maxillofacial Surgery, S.R.M. Dental College, Bharathi salai, Ramapuram, Chennai, India Treatment of fractures of the mandibular condylar fractures varies among centres as there is still no general consensus. The aim of this study was to determine the safety of the approach using two different surgical methods for the sub-condylar region. A study was conducted on nine patients with displaced sub-condylar fractures. Patients were followed-up and postoperatively the various parameters like mouth opening, deviation while opening, occlusion, sialocele, facial nerve weakness and facial symmetry were analysed. In two cases, sialocele occurred which healed spontaneously. The occlusion was normal postoperatively in all cases. There was no facial nerve weakness encountered in any of the cases. Intraoperatively, the retromandibular vein was observed in three cases in the retromandibular approach and it was not encountered in any of the retromandibular approach with modified transparotid approach. In conclusion, the retromandibular with modified transparotid approach is safe and effective for mandibular subcondylar fractures. doi:10.1016/j.ijom.2007.08.414
O17.8 Anterior parotid—transmassetric approach for fixation and reduction of condylar fractures V. Narayanan Saveetha University, Chennai Apollo Hospitals, Chennai Sundaram Medical Foundation, Chennai, India Aim: The aim of this paper was to determine the safety and efficiency of surgical treatment of condylar fractures in 31
Trauma
Kamoricho, Kishiwada City, Osaka 5968522, Japan Fractures of the mandibular condyle constitute about 30% of mandibular fractures. Many cases treated nonsurgically with intermaxillary fixation, but in some cases due to multiple trauma left untreated. Such nonsurgical treatment with severe dislocations leads to complications like deformity, malunion, malocclusion, deviation, etc. We have applied distraction osteogenesis for condylar fractures to avoid the complications, particularly deviation and deformity. In this study, we evaluated this new technique. The subjects were 15 patients, ranged in age from 23 to 56 years with the condylar fractures. The L-shape osteotomy of the posterior mandibular ramus designed for this procedure. Active distraction was started after a latency period of 3–5 days with a rate of 0.5 mm twice daily. The mean extent of lengthening was 12.6 mm (range 8–16.5 mm). All patients ended with a symmetrical chin position and X-rays. In all cases, we achieved improved occlusion, face symmetry and pain reduction. But in one case, the slight deviation of mandible has left when opening mouth. The new surgical treatment distraction osteogenesis—for the patients with condylar fractures is useful. doi:10.1016/j.ijom.2007.08.411
O17.5 Open reduction of condylar fractures—a right treatment perspective? V. Deshmukh*, A. Gaikwad Deshmukh Institute of Maxillofacial Surgery & Research Centre, Bassiye Nagar, New Baijipura, Jalna Road, Aurangabad, MS, India The aim of this study was to evaluate the outcome of open reduction of condylar fractures. Seventy-three patients having 84 condylar fractures of various types operated by a single surgeon between 1991 and 2007 were analysed retrospectively. Rigid fixation was done in 70 cases by using plates and screws whilst condylectomy was done in 14 cases. Explorations were done either by an extended Risdons or by preauricular approach. No immobilisation was done. Results were analysed immediately, after 3 months and over long-term with respect to occlusal status, mouth opening and deviation, TMJ pain, Facial nerve func-
tion and chewing efficiency. Suitability of approach with respect to access, ease, safety, duration and aesthetics was also analysed. In no case, malocclusion was noted. Facial paralysis occurred in one case (1.2%). Temporary Temporal branch weakness associated with preauricular approach was seen in 20 cases (34.4%), while Mandibular branch weakness associated with the extended Risdons approach was seen in eight cases (30%). Two wounds (2.4%) got infected requiring plate removal. Mouth opening and chewing efficiency could be restored to normal within 3 months. No TMJ pain noted after 3 months. No case showed healing problem. Preauricular approach was superior to extended Risdons approach. Considering the outcome, extra oral open reduction should be the treatment of choice in the management of condylar fractures. doi:10.1016/j.ijom.2007.08.412
O17.6 A comparative evaluation of stability between resorbable and nonresorbable plates in condylar fracture K. Lahoti*, K. K. Rai, B. Jayade, K. V. D. Kumar, M. C. Dayanand Department of Oral, Maxillofacial and Reconstructive Surgery, Bapuji Dental College and Hospital, Davangere, Karnataka 577004, India Treatment methods for condylar process fractures remain controversial. In the preantibiotic era, most fractures of condylar process have been treated nonsurgically because of risk of wound infection, the proximity of nerves and vessels and the absence of osteosynthesis material. The late complications after closed reduction of condylar fractures were deviation of jaw, limited lateral and protrusive movements, reduced mouth opening, asymmetrical laughing and lip pursing, delayed healing, subjective discomfort due to longer MMF and TMJ derangement. Therefore, a surgical open reduction and internal fixation aims to achieve (1) early mobilisation of the jaw and functional rehabilitation and shortened MMF, (2) anatomical reduction, (3) symmetrical jaw movements, (4) restoration of vertical dimension and (5) adequate dental occlusion. A resorbable miniplate system for promoting osteosynthesis is developed and applied to oral and maxillofacial surgery which has great advantages. In this presentation, the advantages and disadvantages of resorbable
miniplate system is evaluated clinically, technically and radiographically against the conventional nonresorbable miniplate system in the treatment of fractures of mandibular condylar process. doi:10.1016/j.ijom.2007.08.413
O17.7 THE ROAD NOT TAKEN Retromandibular with modified transparotid access for subcondylar fractures S.S. Sundaram*, K. Kanadasan, K. Raja, A. Gnanam Department of Oral and Maxillofacial Surgery, S.R.M. Dental College, Bharathi salai, Ramapuram, Chennai, India Treatment of fractures of the mandibular condylar fractures varies among centres as there is still no general consensus. The aim of this study was to determine the safety of the approach using two different surgical methods for the sub-condylar region. A study was conducted on nine patients with displaced sub-condylar fractures. Patients were followed-up and postoperatively the various parameters like mouth opening, deviation while opening, occlusion, sialocele, facial nerve weakness and facial symmetry were analysed. In two cases, sialocele occurred which healed spontaneously. The occlusion was normal postoperatively in all cases. There was no facial nerve weakness encountered in any of the cases. Intraoperatively, the retromandibular vein was observed in three cases in the retromandibular approach and it was not encountered in any of the retromandibular approach with modified transparotid approach. In conclusion, the retromandibular with modified transparotid approach is safe and effective for mandibular subcondylar fractures. doi:10.1016/j.ijom.2007.08.414
O17.8 Anterior parotid—transmassetric approach for fixation and reduction of condylar fractures V. Narayanan Saveetha University, Chennai Apollo Hospitals, Chennai Sundaram Medical Foundation, Chennai, India Aim: The aim of this paper was to determine the safety and efficiency of surgical treatment of condylar fractures in 31