CRB modification to retromandibular approach for management of subcondylar fractures

The aim of this study was to evaluate the efficacy of CRB modification of retromandibular approach to gain surgical access for open reduction and internal fixation of mandibular sub-condylar fractures. A total number of 264 sustained extra-capsular subcondylar fractures from 230 patients were selected for the study over the period of 5 years. Evaluation of intraoperative accessibility, postoperative facial nerve function, postoperative complications and scar was ca-rried out. All the patients were treated using CRB Curvilinear approach. Patient follow up was re-corded for 1 year on a regular interval basis. Symptoms of postoperative facial nerve injury were seen in 2 patients which recovered with time, postoperative complications were not encountered in any case and minimum scar mark hidden in the cervical skin crease. Hence open reduction and internal fixation for Subcondylar fracture of mandible by using the CRB modification of re-tromandibular approach is a good alternative for other conventional approaches in having ease of access, ease of fixation, reduced incidences of injury to facial nerve and its branches with good aesthetic outcome

Sialocele como Complicação de Acesso Retromandibular: Relato de Caso / Sialocele as a complication of the retromandibular approach: a case report

A sialocele é o acúmulo de extravasamento salivar numa cavidade subcutânea, ocorrendo, principalmente, após, um episódio traumático ou infeccioso no parênquima da glândula parótida, lesão do ducto parotídeo ou estenose ductal com subsequente dilatação. A realização do correto diagnóstico e o tratamento imediato das lesões traumáticas da glândula parótida tornam-se importantes para evitar complicações. Várias modalidades de tratamento são mencionadas na literatura, e a escolha dependerá do tempo de evolução desde a lesão à região acometida. O presente caso envolve um paciente do gênero masculino vítima de acidente motociclístico que evoluiu com uma sialocele pós-operatória devido à abordagem retromandibular para redução cruenta de fratura condilar. O tratamento realizado foi a instalação de um cateter provisório, criando um novo trajeto para secreção da glândula parótida.

The condition known as sialocele is an accumulation of salivary extravasation in a subcutaneous cavity occurring mainly after a traumatic or infectious episode in the parenchyma of the parotid gland, a parotid duct injury or stenosis with subsequent ductal dilatation. The correct diagnosis and treatment of traumatic lesions of the parotid gland are important in order to avoid complications. Several treatment options are mentioned in the literature and the choice will depend on the time elapsed since injury and the affected region. The patient in the case reported is a male victim of a motorcycle accident who developed a postoperative sialocele due to the use of the retromandibular approach for open reduction of a condylar fracture. The treatment performed was the insertion of a temporary catheter creating a new pathway for secretion of the parotid gland.

Analysis of two different surgical approaches for fractures of the mandibular condyle.

Background: Fractures of the condyle account for one third of all the mandibular fractures. Different surgical approaches to the condyle described hitherto testify to the advantages and disadvantages of the different surgical techniques used for approaching the condyle in such cases of fractures. We have described and compared two of such surgical techniques in this study. Aim: The aim of this study is to compare the outcome of dealing with condylar fractures by two different surgical techniques: the mini retromandibular approach, and the preauricular approach. Materials and Methods: A prospective study of 31 patients who had suffered with mandibular condylar fractures was carried out. Of these, 26 patients had unilateral condylar fractures, and 5 patients had a bilateral fracture. Further, 19 of these patients were treated by the mini retromandibular approach and 12 by the preauricular approach. The treated patients were followed up and evaluated for a minimum period of 1 year and assessed for parameters such as the maximum mouth opening, lateral movement on the fractured side, mandibular movements such as protrusion, dental occlusion, scar formation, facial nerve weakness, salivary fistula formation and time taken for the completion of the surgical procedure. Statistical Analysis: t- test was used for statistical analysis of the data obtained in the study. Results: Dental occlusion was restored in all the cases, and good anatomical reduction was achieved. The mean operating time was higher 63.53 (mean) ± 18.12 minutes standard deviation (SD) in the preauricular approach compared to 45.22 (mean) ± 18.86 minutes SD in the mini retromandibular approach. Scar formation was satisfactory in almost all the cases.

Post operative evaluation for retromandibular approach of subcondylar fractures

PURPOSE: The classic technique for open reduction of subcondylar fractures is the submandibular approach. The aim of this study was to evaluate clinical result of retromandibular approach to displaced subcondylar fractures. MATERIAL AND METHODS: During a period of 24months we perfomed a prospective study with a retromandibular approach in 23 paients with displaced subcondylar fractures. In this article we describe clinical result in 23 patients with follow ups for 3 months after surgery. Preoperatively all patients had malocclusion and radiology demonstrated displacement. RESULT: The retromandibularl approach for ORIF was good in all case. Mouth opening(M/O) was 49mm. Occlusion was good too. Permanent facial nerve palsy was not detected. CONCLUSION: Our findings indicate that the retromandibular approach is a safe technique for subcondylar fractures.

Retromandibular approach for open reduction & internal fixation of mandibular condylar neck fracture

Fractures of the mandibular condyle are account for between 26 percent and 57 percent of all mandibular fractures. Clinicians should decide how to treat the fractured condyle with many factors considered. Many surgical methods have been developed to reduction of fractured condyle and it's internal fixation. In open reduction of fractured condylar neck and subcondyle, retromandibular approach offers a safe and effective approach for direct fixation due to easy access and low surgical morbidity.

Retromandibular approach for open reduction of the mandibular condyle fracture

Most popular incisions for open reduction of mandibular condylar fractures are submandibular approach, preauricular approach, Risdon approach, and retromandibular approach etc. These methods are selected according to the location of condylar fracutre, condylar segments displacement, and preference of the surgeon. We performed the open reduction and rigid fixation by means of retromandibular approach for the treatement of mandibular condyle fracture in the 9 patients (8 cases were performed by direct reduction and rigid fixation, and 1 case was performed by Dr. Nam's method). The retromandibular approach has many advantages. This is more easier approach to the fracture site, better visibility and accessibility, less wound exposure, less muscle retraction, and more comfortable to patient because lesser sensory and motor nerve injury.