Limits...
Simultaneous surgery for subcondylar fracture and prominent angle of the mandible.

Jeong CH, Ryu JY, Lee WY, Kim HM - Maxillofac Plast Reconstr Surg (2015)

Bottom Line: Our patient was increasingly seeking esthetic improvement of the lower third of the face.But she did not want multi-stage operations.Thus, we decided and performed a one-stage mandibular angle ostectomy with fracture management.

View Article: PubMed Central - PubMed

Affiliation: Department of Oral & Maxillofacial Surgery, Gachon University Gil Medical Center, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 405-760 Republic of Korea.

ABSTRACT

We experienced a patient of subcondylar fracture who had a squared contour of the lower face with prominent angle of the mandible and masseter hypertrophy. Our patient was increasingly seeking esthetic improvement of the lower third of the face. But she did not want multi-stage operations. Thus, we decided and performed a one-stage mandibular angle ostectomy with fracture management. We have a stable and esthetic result simultaneously despite fractures of the fixation plates during follow-up period, so report a case.

No MeSH data available.


Related in: MedlinePlus

Postoperative 8-month 3D-CBCT, frontal and right lateral view, showing no distinct displacement of condylar fragment
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4551547&req=5

Fig3: Postoperative 8-month 3D-CBCT, frontal and right lateral view, showing no distinct displacement of condylar fragment

Mentions: The patient was operated under general anesthesia with nasotracheal intubation. Intermaxillary fixation (IMF) was installed using eight IMF screws during operation. Lidocaine with 1:100,000 epinephrine was infiltrated in the posterior vestibule and retromolar area of both lower sides. First, the fractured subcondyle was reduced transorally via a vestibular approach. After that, two 2.0-mm system plates and screws (Synthes Inc., West Chester, PA, USA) were used for fixation with the help of a trocar. The first plate was usually installed in the posterior border of the ramus. However, in this case, we placed the first plate in the anterior portion of the estimated ostectomy line, because the posterior border of the ramus would be resected to some extent. Then, the second plate was installed more anteriorly than the first plate. Two miniplates were positioned at the thickest part of subcondylar area in a surgeon’s preference. Then, the IMF was removed and the mouth was opened and the occlusion and mandibular movement were checked. After that, usual angle ostectomy of both sides was progressed using bur, oscillating and reciprocating saw in a condition of IMF to stabilize the mandible. In the immediate postoperative period, we recognized damage of the fixation plate. The damaged trace of the fixation plate was observed at postoperative radiograph (Fig. 2). It was assumed that the reciprocating saw was invaded to posterior plate. The patient was kept 5 days in IMF with elastics to keep the proper occlusion. After releasing the IMF, exercise was started with guiding elastics for 2 weeks. After that, only opening exercise was performed by herself for another 1 week. Then, she had a normal range of mouth opening. She had no difficulty or pain in mouth opening at the first month after the operation. But plate fractures were confirmed in a panoramic radiograph at that period. After that, we planned the closed observation without any intervention. Though more dislocated fragments of fractured plates were observed at the third month of postoperative period, there were no clinical symptoms. But the muscular strength of both masseters gradually increased, so botulinum toxin type A (BOTOX, Allergan Inc., Irvine, CA, USA) was applied at 3 months after the operation. Two 25-unit injections were applied on each masseter area of the face. Despite the fracture of plates, there was no clinical problem until 8 months after the operation and the result satisfied her esthetic demand (Fig. 3). This study was approved by the regional Ethical Review Board of the Gachon University Gil Medical Center (Certificate No.: GAIRB2015-66).Fig. 2


Simultaneous surgery for subcondylar fracture and prominent angle of the mandible.

Jeong CH, Ryu JY, Lee WY, Kim HM - Maxillofac Plast Reconstr Surg (2015)

Postoperative 8-month 3D-CBCT, frontal and right lateral view, showing no distinct displacement of condylar fragment
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4551547&req=5

Fig3: Postoperative 8-month 3D-CBCT, frontal and right lateral view, showing no distinct displacement of condylar fragment
Mentions: The patient was operated under general anesthesia with nasotracheal intubation. Intermaxillary fixation (IMF) was installed using eight IMF screws during operation. Lidocaine with 1:100,000 epinephrine was infiltrated in the posterior vestibule and retromolar area of both lower sides. First, the fractured subcondyle was reduced transorally via a vestibular approach. After that, two 2.0-mm system plates and screws (Synthes Inc., West Chester, PA, USA) were used for fixation with the help of a trocar. The first plate was usually installed in the posterior border of the ramus. However, in this case, we placed the first plate in the anterior portion of the estimated ostectomy line, because the posterior border of the ramus would be resected to some extent. Then, the second plate was installed more anteriorly than the first plate. Two miniplates were positioned at the thickest part of subcondylar area in a surgeon’s preference. Then, the IMF was removed and the mouth was opened and the occlusion and mandibular movement were checked. After that, usual angle ostectomy of both sides was progressed using bur, oscillating and reciprocating saw in a condition of IMF to stabilize the mandible. In the immediate postoperative period, we recognized damage of the fixation plate. The damaged trace of the fixation plate was observed at postoperative radiograph (Fig. 2). It was assumed that the reciprocating saw was invaded to posterior plate. The patient was kept 5 days in IMF with elastics to keep the proper occlusion. After releasing the IMF, exercise was started with guiding elastics for 2 weeks. After that, only opening exercise was performed by herself for another 1 week. Then, she had a normal range of mouth opening. She had no difficulty or pain in mouth opening at the first month after the operation. But plate fractures were confirmed in a panoramic radiograph at that period. After that, we planned the closed observation without any intervention. Though more dislocated fragments of fractured plates were observed at the third month of postoperative period, there were no clinical symptoms. But the muscular strength of both masseters gradually increased, so botulinum toxin type A (BOTOX, Allergan Inc., Irvine, CA, USA) was applied at 3 months after the operation. Two 25-unit injections were applied on each masseter area of the face. Despite the fracture of plates, there was no clinical problem until 8 months after the operation and the result satisfied her esthetic demand (Fig. 3). This study was approved by the regional Ethical Review Board of the Gachon University Gil Medical Center (Certificate No.: GAIRB2015-66).Fig. 2

Bottom Line: Our patient was increasingly seeking esthetic improvement of the lower third of the face.But she did not want multi-stage operations.Thus, we decided and performed a one-stage mandibular angle ostectomy with fracture management.

View Article: PubMed Central - PubMed

Affiliation: Department of Oral & Maxillofacial Surgery, Gachon University Gil Medical Center, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 405-760 Republic of Korea.

ABSTRACT

We experienced a patient of subcondylar fracture who had a squared contour of the lower face with prominent angle of the mandible and masseter hypertrophy. Our patient was increasingly seeking esthetic improvement of the lower third of the face. But she did not want multi-stage operations. Thus, we decided and performed a one-stage mandibular angle ostectomy with fracture management. We have a stable and esthetic result simultaneously despite fractures of the fixation plates during follow-up period, so report a case.

No MeSH data available.


Related in: MedlinePlus