Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
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Transmasseteric Approach for Open Reduction and Internal Fixation of Mandible Subcondylar Fracture

깨물근을 통한 하악골 관절돌기하부골절의 관혈적 정복 및 내고정술

  • Kim, Hak-Soo (Pohang Semyeong Christianity Hospital, Department of Plastic and Reconstructive Surgery) ;
  • Kim, Seong-Eun (Pohang Semyeong Christianity Hospital, Department of Plastic and Reconstructive Surgery)
  • 김학수 (포항세명기독병원 성형외과) ;
  • 김성언 (포항세명기독병원 성형외과)
  • Received : 2009.12.30
  • Accepted : 2010.02.09
  • Published : 2010.03.10
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Abstract

Purpose: Surgical approaches to the condylar neck and subcondyle area can cause some morbidity such as, facial nerve injury, time-consuming nature and external scar etc. So many surgeons hesitate using open reduction and internal fixation for the treatment of subcondylar fractures. We report open reduction and internal fixation of subcondylar fractures in 13 adult patients via transmasseteric approach. Methods: From 2007 to 2009, 13 adults with subcondylar fracture of mandible were treated with open reduction and internal fixation via transmasseteric approach. A preauricular incision was extended downwards in a curvilinear fashion in the cervicomastoid skin crease. Skin flap was elevated above the SMAS layer. Masseter muscle was splitted at the anteroinferior edge of the parotid gland. After the fracture was reduced, fixed with appropriate plates and screws. All operation were performed under general anesthesia. Results: Mean follow-up period was 13.3 months. There were no signs and symptoms of facial nerve injury, difficulty in mouth opening, or malocclusion. Dissection time was roughly within 30 minutes. Conclusion: Transmasseteric open reduction and internal fixation of mandible subcondylar fracture can be performed with excellent visualization, and inconspicuous scar. It also offers swift access to the subcondylar area while substatially reducing the risk to the facial nerve and eliminating the complications associated with transparotid approaches.

Keywords

References

  1. Manisali M, Amin M, Aghabeigi B, Newman L: Retromandibular approach to the mandibular condyle: A clinical and cadaveric study. Int J Oral Maxillofac Surg 32: 253, 2003 https://doi.org/10.1054/ijom.2002.0270
  2. Vesnaver A, Gorjanc M, Eberlinc A, Dovsak DA, Kansky AA: The preauricular transparotid approach for open reduction and internal fixation of condylar fractures. J Craniomaxillofac Surg 33: 169, 2005 https://doi.org/10.1016/j.jcms.2005.01.008
  3. Zachariades N, Mezitis M, Mourouzis C, Papadakis D, Spanou A: Fractures of the mandibular condyle: A review of 466 cases. literature review, reflections on treatment and proposals. J Craniomaxillofac Surg 34: 421, 2006 https://doi.org/10.1016/j.jcms.2006.07.854
  4. Baker AW, McMahon J, Moos KF: Current consensus on the management of fractures of the mandibular condyle. A method by questionnaire. Int J Oral Maxillofac Surg 27: 258, 1998 https://doi.org/10.1016/S0901-5027(05)80507-7
  5. Bos RR, Ward Booth RP, de Bont LG: Mandibular condyle fractures: A consensus. Br J Oral Maxillofac Surg 37: 87, 1999 https://doi.org/10.1054/bjom.1998.0014
  6. Widmark G, Bagenholm T, Kanberg KE, Lindahl L: Open reduction of subcondylar fractures: A study of functional rehabilitation. Int J Oral Maxillofac Surg 25: 107, 1996 https://doi.org/10.1016/S0901-5027(96)80052-X
  7. Vural E: Treatment of adult subcondylar Mandibular fractures: Closed vs open vs endoscopic approach. Arch Otolaryngol Head Neck Surg 130: 1228, 2004 https://doi.org/10.1001/archotol.130.10.1228
  8. Bernstein L, Nelson RH: Surgical anatomy of the extraparotid distribution of the facial nerve. Arch Otolaryngol 110: 177, 1984 https://doi.org/10.1001/archotol.1984.00800290041009
  9. Wilson AW, Ethunandan M, Brennan PA: Transmasseteric antero-parotid approach for open reduction and internal fixation of condylar fractures. Br J Oral Maxillofac Surg 43: 57, 2005 https://doi.org/10.1016/j.bjoms.2004.09.011