J Korean Assoc Oral Maxillofac Surg.  2021 Dec;47(6):476-479. 10.5125/jkaoms.2021.47.6.476.

Intraoral reinsertion after extracorporeal fixation in condylar fracture

• Kim SM

• KMID: 2524708
• DOI: http://doi.org/10.5125/jkaoms.2021.47.6.476

Abstract

For treatment of mandibular condyle fracture, this article introduces the surgical protocol of intraoral reinsertion after extracorporeal fixation. This efficient, anatomically acceptable, extraoral scar-free, and relatively uncomplicated approach for condylar fracture can be compared with conventional extraoral fixation through various approaches. Clinical step-by-step procedures with a scientific basis were described in this technical strategy note.

Keyword

Mandibular condyle fracture; Intraoral reinsertion; Extracorporeal fixation; Intraoral reinsertion after extracorporeal fixation

Figure

• 

  Fig. 1 A-C. Clinical photos of extracorporeal fixation and reduction in condylar head fracture showing lateral (A), posterior (B), and medial (C) views after fixation of the fractured segments. D. Reinsertion through an intraoral approach and re-fixation to the original ostectomy site (white arrows) under intramaxillary fixation (black arrows).

• 

  Fig. 2 Radiograms of bilateral condylar head fracture. Preoperative (A), after arch bar application with intermaxillary fixation (B), postoperative day 1 (C), postoperative 1 month (D), postoperative 3 months (E), and postoperative 1 year (F).

• 

  Fig. 3 Schematic drawings of representative surgical approaches in mandibular condylar fracture. Direct reduction and fixation via the (A) endaural or (B) submandibular approach, (C) extracorporeal fixation with vertical ramus osteotomy, (D) intraoral direct reduction and fixation with an angled driver or (E) transbuccal fixation with or without endoscopic visualization, and (F) intraoral reinsertion after extracorporeal fixation of the fractured fragment.

Reference

References

1. Yao S, Zhou J, Li Z. 2014; Contrast analysis of open reduction and internal fixation and non-surgical treatment of condylar fracture: a meta-analysis. J Craniofac Surg. 25:2077–80. https://doi.org/10.1097/SCS.0000000000001010. DOI: 10.1097/SCS.0000000000001010. PMID: 25304143.

2. Hackenberg B, Lee C, Caterson EJ. 2014; Management of subcondylar mandible fractures in the adult patient. J Craniofac Surg. 25:166–71. https://doi.org/10.1097/SCS.0000000000000498. DOI: 10.1097/SCS.0000000000000498. PMID: 24406572.

3. Oruç M, Işik VM, Kankaya Y, Gürsoy K, Sungur N, Aslan G, et al. 2016; Analysis of fractured mandible over two decades. J Craniofac Surg. 27:1457–61. https://doi.org/10.1097/SCS.0000000000002737. DOI: 10.1097/SCS.0000000000002737. PMID: 27536913. PMCID: PMC5023768.

4. Shi J, Jiao F, Xu B, Yu H. 2015; Transparotid approach in the treatment of intracapsular condylar fracture. J Craniofac Surg. 26:495–7. https://doi.org/10.1097/SCS.0000000000001524. DOI: 10.1097/SCS.0000000000001524. PMID: 25692894.

5. Hong SO, Ohe JY, Lee DW. 2014; Salvage of the condylar fracture: complication management of mandibular angle ostectomy. J Craniofac Surg. 25:e582–4. https://doi.org/10.1097/SCS.0000000000001028. DOI: 10.1097/SCS.0000000000001028. PMID: 25376136.

6. Kim JH, Kim SM, Kwon GJ, Park YW. 2008; Clinical review of various surgical approaches in the treatment of mandibular condyle fracture. J Korean Assoc Maxillofac Plast Reconstr Surg. 30:72–82.

7. Kim SM, Kim JH. 2016; Commentary to "A follow-up study on extracorporeal fixation of condylar fractures using vertical ramus osteotomy". J Korean Assoc Oral Maxillofac Surg. 42:236–7. https://doi.org/10.5125/jkaoms.2016.42.4.236. DOI: 10.5125/jkaoms.2016.42.4.236. PMID: 27598264. PMCID: PMC5009200.

8. Park SY, Im JH, Yoon SH, Lee DK. 2014; A follow-up study on extracorporeal fixation of condylar fractures using vertical ramus osteotomy. J Korean Assoc Oral Maxillofac Surg. 40:76–82. https://doi.org/10.5125/jkaoms.2014.40.2.76. DOI: 10.5125/jkaoms.2014.40.2.76. PMID: 24868504. PMCID: PMC4028793.

9. Park JM, Jang YW, Kim SG, Park YW, Rotaru H, Baciut G, et al. 2010; Comparative study of the prognosis of an extracorporeal reduction and a closed treatment in mandibular condyle head and/or neck fractures. J Oral Maxillofac Surg. 68:2986–93. https://doi.org/10.1016/j.joms.2010.02.034. DOI: 10.1016/j.joms.2010.02.034. PMID: 20678847.

10. Kannadasan K, Shenoy KV, Kengagsubbiah S, Priya V. V S. 2014; Extra corporeal fixation of fractured mandibular condyle. J Clin Diagn Res. 8:ZD41–3. https://doi.org/10.7860/JCDR/2014/10484.4914. DOI: 10.7860/JCDR/2014/10484.4914. PMID: 25386546. PMCID: PMC4225998.

11. Gali R, Devireddy SK, Venkata KK, Kanubaddy SR, Nemaly C, Dasari M. 2016; Preauricular transmasseteric anteroparotid approach for extracorporeal fixation of mandibular condyle fractures. Indian J Plast Surg. 49:59–65. https://doi.org/10.4103/0970-0358.182254. DOI: 10.4103/0970-0358.182254. PMID: 27274123. PMCID: PMC4878246.

12. Fayazi S, Bayat M, Bayat-Movahed S, Sadr-Eshkevari P, Rashad A. 2013; Long-term outcome assessment of closed treatment of mandibular fractures. J Craniofac Surg. 24:735–9. https://doi.org/10.1097/SCS.0b013e3182801373. DOI: 10.1097/SCS.0b013e3182801373. PMID: 23714869.

13. Vajgel A, de Santana Santos T, Camargo IB, Filho JR, de Holanda Vasconcellos RJ. Moraes de Oliveira D. 2013; Management of subcondylar fracture by intraoral approach. J Craniofac Surg. 24:587–8. https://doi.org/10.1097/SCS.0b013e31827c86c4. DOI: 10.1097/SCS.0b013e31827c86c4. PMID: 23524749.

14. Neff A, Chossegros C, Blanc JL, Champsaur P, Cheynet F, Devauchelle B, et al. 2014; ; International Bone Research Association. Position paper from the IBRA Symposium on Surgery of the Head--the 2nd International Symposium for Condylar Fracture Osteosynthesis, Marseille, France 2012. J Craniomaxillofac Surg. 42:1234–49. https://doi.org/10.1016/j.jcms.2014.03.005. DOI: 10.1016/j.jcms.2014.03.005. PMID: 24831849.

15. Conci RA, Tomazi FH Jr, Kalaoun R, Fritscher GG, de Oliveira GR, Heitz C. 2015; Modified submandibular access for open reduction and internal rigid fixation in condylar fractures. J Craniofac Surg. 26:232–4. https://doi.org/10.1097/SCS.0000000000001099. DOI: 10.1097/SCS.0000000000001099. PMID: 25478980.

16. Pilanci Ö, Basaran K, Ceran F, Kuvat SV. 2014; Functional outcomes of preauricular underparotid retrograde approach for mandibular condyle fractures. J Craniofac Surg. 25:1078–81. https://doi.org/10.1097/SCS.0000000000000514. DOI: 10.1097/SCS.0000000000000514. PMID: 24717314.

17. Hwang K, Park JH, Lee HJ. 2005; Miniplate fixation of high condylar fracture and postoperative exercise regimen. J Craniofac Surg. 16:113–6. https://doi.org/10.1097/00001665-200501000-00021. DOI: 10.1097/00001665-200501000-00021. PMID: 15699655.