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Surgical evolution in the treatment of mandibular condyle fractures.

Belli E, Liberatore G, Mici E, Elidon M, Dell'Aversana Orabona G, Piombino P, Maglitto F, Catalfamo L, De Riu G - BMC Surg (2015)

Bottom Line: Out of the total number of patients, 28 reached an optimal result without the need for temporary immobilization of the temporal mandibular joint and pre-auricular cutaneous access, thanks to the decisive aid of the video-endoscope.The endoscope allows perfect control over both the positioning of the external fixator and the surgical reduction, restoring the normal movement of the mandible with a return to full anatomical functioning of the temporo-mandibular joint.The rigid external fixation system is better than an internal one, because it is less restrictive in precise anatomical reduction, since with an REF the condylar fragment is kept in the correct anatomical position but is not obliged to maintain that exact position, and therefore it is possible to carry out all the repair mechanisms listed above.

View Article: PubMed Central - PubMed

Affiliation: Maxillofacial Surgery Department, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy. evarbell@libero.it.

ABSTRACT

Background: In Literature fractures of the mandible that involve the condyle ranges from 20% to 35% and various possible surgical options are described according to the varying pathological situations. Up to the present, numerous techniques have been used for the surgical treatment of condylar fractures. In this article we are proposing the combination of two surgical techniques as therapy for extra-capsular condylar fractures with dislocation.

Methods: From June 2003 to July 2007 30 patients were treated for condylar fractures with the application of a Rigid External Fixator under endoscopic assistance. This method includes a surgical reduction of the fracture with the aid of an endoscope, performing a transcutaneous insertion of a Rigid External Fixator to stabilize the fracture.

Results: Out of the total number of patients, 28 reached an optimal result without the need for temporary immobilization of the temporal mandibular joint and pre-auricular cutaneous access, thanks to the decisive aid of the video-endoscope.

Conclusions: The endoscope allows perfect control over both the positioning of the external fixator and the surgical reduction, restoring the normal movement of the mandible with a return to full anatomical functioning of the temporo-mandibular joint. This approach avoids possible damages to the facial nerve branches. The rigid external fixation system is better than an internal one, because it is less restrictive in precise anatomical reduction, since with an REF the condylar fragment is kept in the correct anatomical position but is not obliged to maintain that exact position, and therefore it is possible to carry out all the repair mechanisms listed above. Endoscopic assistance allows a good positioning control of the REF although the endoscopy permits an optimal control of the condylemeniscal complex mobility after REF application.

No MeSH data available.


Related in: MedlinePlus

Endoscopic view of pins inserted into the condyle stump (a) and into the ramus (b).
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Fig4: Endoscopic view of pins inserted into the condyle stump (a) and into the ramus (b).

Mentions: The technique proposed envisages tracing the path of the condyle and then repositioning it under video-endoscopic control, by an endoral approach through an incision at the level of the homolateral retromolar trigone, as well as opening the jaw below the periosteum and the posterior border of the mandible to find the fracture focus. Endoscopes with 0°, 30°, 45° and 70° angulations were used according to the type of surgery, with the aid of a Xenon light source [5]. Traditional surgical equipment was used for the open surgical treatment of maxillary-facial traumas in combination with the kind of angled aspirator used in endoscopic nasal surgery. Once the fracture had been reduced, it was stabilized by using a rigid external fixation system produced by the Stryker company (Figure 3). This system is called Hoffmann II Micro Stryker HowMedica and consists of a series of pins, clamps and connecting rods in light and ultra-light biocompatible material which were used in conjunction with yet another system for mandibular bone distraction, produced by Leibinger-Stryker and called Multi-guide II Mandibular Distraction Device. By using two systems readily available on the market, a mixed system was created which is adaptable to any type of fracture. The Rigid External Fixator (REF) consists of a series of pins which are introduced through atraumatic subcutaneous incisions at a pretragic level until the fractured stump of the condyle is reached, while other two pins are inserted near the corner or into the ramus of the mandible, again through atraumatic subcutaneous incisions (Figure 4a and b). The instrumental examinations included CT scan (Figure 5) and EKG examination which shows the functioning of the mandible on the computer. Unfortunately it was not possible to carry out this examination in all cases, nor was it possible to do so during the diagnostic, pre-operative phase. However, in our opinion, this examination becomes fundamental in remote check-ups since it is non-invasive and repeatable every time it is deemed opportune to compare the clinical evolution of the mandibular movements. As of mid-2006, thanks to collaboration with the Department of Orthognathology and Gnathology in our hospitals, we have begun to offer a phase of post-surgery rehabilitation to all patients treated with our surgical method, featuring variable cycles of functional therapy that use mandibular activators, such as the Balters’ Bionator.Figure 3


Surgical evolution in the treatment of mandibular condyle fractures.

Belli E, Liberatore G, Mici E, Elidon M, Dell'Aversana Orabona G, Piombino P, Maglitto F, Catalfamo L, De Riu G - BMC Surg (2015)

Endoscopic view of pins inserted into the condyle stump (a) and into the ramus (b).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4365967&req=5

Fig4: Endoscopic view of pins inserted into the condyle stump (a) and into the ramus (b).
Mentions: The technique proposed envisages tracing the path of the condyle and then repositioning it under video-endoscopic control, by an endoral approach through an incision at the level of the homolateral retromolar trigone, as well as opening the jaw below the periosteum and the posterior border of the mandible to find the fracture focus. Endoscopes with 0°, 30°, 45° and 70° angulations were used according to the type of surgery, with the aid of a Xenon light source [5]. Traditional surgical equipment was used for the open surgical treatment of maxillary-facial traumas in combination with the kind of angled aspirator used in endoscopic nasal surgery. Once the fracture had been reduced, it was stabilized by using a rigid external fixation system produced by the Stryker company (Figure 3). This system is called Hoffmann II Micro Stryker HowMedica and consists of a series of pins, clamps and connecting rods in light and ultra-light biocompatible material which were used in conjunction with yet another system for mandibular bone distraction, produced by Leibinger-Stryker and called Multi-guide II Mandibular Distraction Device. By using two systems readily available on the market, a mixed system was created which is adaptable to any type of fracture. The Rigid External Fixator (REF) consists of a series of pins which are introduced through atraumatic subcutaneous incisions at a pretragic level until the fractured stump of the condyle is reached, while other two pins are inserted near the corner or into the ramus of the mandible, again through atraumatic subcutaneous incisions (Figure 4a and b). The instrumental examinations included CT scan (Figure 5) and EKG examination which shows the functioning of the mandible on the computer. Unfortunately it was not possible to carry out this examination in all cases, nor was it possible to do so during the diagnostic, pre-operative phase. However, in our opinion, this examination becomes fundamental in remote check-ups since it is non-invasive and repeatable every time it is deemed opportune to compare the clinical evolution of the mandibular movements. As of mid-2006, thanks to collaboration with the Department of Orthognathology and Gnathology in our hospitals, we have begun to offer a phase of post-surgery rehabilitation to all patients treated with our surgical method, featuring variable cycles of functional therapy that use mandibular activators, such as the Balters’ Bionator.Figure 3

Bottom Line: Out of the total number of patients, 28 reached an optimal result without the need for temporary immobilization of the temporal mandibular joint and pre-auricular cutaneous access, thanks to the decisive aid of the video-endoscope.The endoscope allows perfect control over both the positioning of the external fixator and the surgical reduction, restoring the normal movement of the mandible with a return to full anatomical functioning of the temporo-mandibular joint.The rigid external fixation system is better than an internal one, because it is less restrictive in precise anatomical reduction, since with an REF the condylar fragment is kept in the correct anatomical position but is not obliged to maintain that exact position, and therefore it is possible to carry out all the repair mechanisms listed above.

View Article: PubMed Central - PubMed

Affiliation: Maxillofacial Surgery Department, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy. evarbell@libero.it.

ABSTRACT

Background: In Literature fractures of the mandible that involve the condyle ranges from 20% to 35% and various possible surgical options are described according to the varying pathological situations. Up to the present, numerous techniques have been used for the surgical treatment of condylar fractures. In this article we are proposing the combination of two surgical techniques as therapy for extra-capsular condylar fractures with dislocation.

Methods: From June 2003 to July 2007 30 patients were treated for condylar fractures with the application of a Rigid External Fixator under endoscopic assistance. This method includes a surgical reduction of the fracture with the aid of an endoscope, performing a transcutaneous insertion of a Rigid External Fixator to stabilize the fracture.

Results: Out of the total number of patients, 28 reached an optimal result without the need for temporary immobilization of the temporal mandibular joint and pre-auricular cutaneous access, thanks to the decisive aid of the video-endoscope.

Conclusions: The endoscope allows perfect control over both the positioning of the external fixator and the surgical reduction, restoring the normal movement of the mandible with a return to full anatomical functioning of the temporo-mandibular joint. This approach avoids possible damages to the facial nerve branches. The rigid external fixation system is better than an internal one, because it is less restrictive in precise anatomical reduction, since with an REF the condylar fragment is kept in the correct anatomical position but is not obliged to maintain that exact position, and therefore it is possible to carry out all the repair mechanisms listed above. Endoscopic assistance allows a good positioning control of the REF although the endoscopy permits an optimal control of the condylemeniscal complex mobility after REF application.

No MeSH data available.


Related in: MedlinePlus