7. Alkan A, Metin M, Mug˘lali M, Özden B, Nükhet Ç. Biomechanical comparison of plating techniques for fractures of the mandibular condyle. 2007;45:145-9
20. Ellis III E, Throckmorton GS. Facial Symmetry After Closed and Open Treatment of Fractures of the Mandibular Condylar Process. 2000;58:719-728
Surgical operations – UFRGS – Inicial — UFRGS
Nussbaum et al. (2008) published a critical analysis of the past studies that have directly compared if open or closed treatment of condylar fractures produces the best results. The results were inconclusive regarding whether open or closed treatment should be used for the management of mandibular condylar fractures. Because of the relatively poor quality of the available data and the lack of other important information, the question of preferred treatment still remains unanswered, and there is clearly a need for further research. The authors propose that in future investigations the patients need to be randomized into treatment groups, and the examiners need to be blinded to the manner in which the patients are treated. Similar methods of treatment need to be used. Standardized methods of fracture classification, as well as data collection and reporting, need to be established so that valid comparisons among studies can be made. Studies with adequate sample sizes to determine clinically meaningful effects should be undertaken.
Mandible Fracture image information
Mandibular fractures are the third most frequent maxillo-facial fractures after those of the nasal and zygomatic bones. Mandibular condylar neck fractures and subcondylar fractures constitute, 19-29% and 62-70% of all mandibular fractures, respectively .
Bones Of The Skull Diagram - HUMAN ANATOMY CHART
Mandibular condylar neck fractures and subcondylar fractures represent, respectively, 19-29% and 62-70% of all mandibular fractures; treatment involves some problems, common to both, concerning the choice of an adequate approach. Herewith, personal experience is reported related to the surgical treatment of some cases of mandibular condylar neck and subcondylar fractures by transparotid approaches with partial parotidectomy, removing the salivary tissue overlying the condylar neck and/or the subcondylar region. Over the last 5 years, we observed 22 fractures of the condylar neck and 10 fractures of the subcondylar region. In 13 patients (11 male, 2 female, age range 10-68 years, mean 33 years), 10 of whom had other mandibular and/or other maxillo-facial and skeleton fractures – 50% of these with dislocated condylar heads – and the other 3 for their free choice, regarding the different treatments, 18 transparotid approaches with partial parotidectomy (bilateral in 5 cases), were performed reducing and fixing 12 condylar neck fractures and 5 subcondylar region fractures with appropriate plates (2.0 mm) and screws. After surgery, no intermaxillary fixation was performed. Complications included 4 salivary fistulae (bilateral in 1 patient), which closed spontaneously after 4 or 5 weeks with a dressing, 1 case of Frey's syndrome, which healed after 2 treatments with botulin and 6 cases of transient facial palsy lasting 4-8 weeks (1 case bilateral) affecting zygomatic, buccal and marginal mandibular nerves. During follow-up, functional parameters considered were: restoration of original pre-injury occlusion; vertical, lateral and protrusion mandibular movements. All patients re-acquired the original pre-injury occlusion; the maximal post-operative intrinsical distance was at least 40 mm after a variable period of rehabilitation and lateral and protrusion movements also led to satisfactory final results. All patients were free of pain and had no deflection or clicking upon opening or chewing. None suffered from haematoma, miniplate fractures, bone resorption or condylar necrosis. In our experience, the Transparotid approaches with partial parotidectomy permits very good anatomical repositioning of the displaced condylar or subcondylar osseous segments in all cases, since isolation of the facial nerve branches and removal of a limited part of the parotid gland tissue overlying the lesion allow perfect exposure of the fracture site. The wide operation field allows the facial nerve to be preserved and permits easy internal rigid fixation with plates, as the drill, screws and screwdriver can be positioned exactly perpendicular to the bone surface instead of obliquely, as occurs with many different approaches.
Medicine Post 5 - Skull Fractures
33. Hlawitschka M, Eckelt U. Assessment of patients treated for intracapsular fractures of the mandibular condyle by closed techniques. 2002;60:784-91