Evaluation of Preauricular Retromandibular Anteroparotid Versus Retromandibular Through Parotid Approach
NCT ID: NCT03803150
Last Updated: 2022-08-02
Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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COMPLETED
NA
20 participants
INTERVENTIONAL
2019-02-01
2022-05-08
Brief Summary
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Although there is a developing preference for open reduction and internal fixation of mandibular condylar fractures, the optimal approach to the ramus condylar unit remains controversial. Various approaches have been proposed, and each has specific shortcomings and disadvantages. Retromandibular, submandibular, transoral, and through parotid approaches are generally performed and sometimes used with an endoscope. Limited access and injury to the facial nerve are the most common problems, while Wilson introduced a new through masseter anteroparotid approach, this technique offers excellent access to the ramus condylar unit, and facial nerve damage risk is reduced.
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Detailed Description
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When open treatment is selected, several surgical approaches can be used to expose, reduce, and stabilize the fracture site, each with its own set of advantages and disadvantages. Surgical approaches to the fractured mandibular condyle are broadly classified into intraoral and extraoral approaches. Intraoral approaches can be performed with or without endoscopic assistance. The most common extraoral approaches are submandibular, Risdon, preauricular, retroauricular, and retromandibular through parotid or through masseter approaches.
An intraoral approach is time consuming and requires special instruments such as an endoscope, and additional training. Furthermore, cases of high fractures and/or medially displaced condylar fractures are technically difficult to manage through an intraoral approach, incorrect anatomical reduction, condylar head resorption, myofascial pain, and malocclusions have been reported to be more common complications following the intraoral approach when compared to extraoral approaches.
In contrast, extraoral approaches are commonly used because they produce better visualization of the fracture site and therefore facilitate fracture reduction and fixation. However, extraoral approaches are complicated by the risk of injury to the facial, great auricular, and auriculotemporal nerves, visible scars, sialoceles, Frey syndrome and salivary fistulas.
Conditions
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Study Design
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RANDOMIZED
PARALLEL
PREVENTION
NONE
Study Groups
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PRA approach
PRA extends downward in curvilinear fashion in cervicomastoid skin crease
PRA approach
A preauricular incision will be made that extends downwards in a curvilinear fashion in the cervicomastoid skin crease, though any variation in this incision will suffice. The great auricular nerve will be preserved and the flap raised in the subdermal fat plane, superficial to the superficial musculoaponeurotic layer to allow access to the masseter adjacent to the anteroinferior edge of the parotid gland, just below the parotid duct. Branches of the facial nerve will be readily identified and avoided with or without loupe magnification, on the surface of the masseter muscle.
RT approach
RT begins 5mm below the ear lobe and continues 3 to 3.5cm inferiorly.
RT approach
The incision for the retromandibular approach begins 5mm below ear lobe and continues 3 to 3.5cm inferiorly. Initial incision begins through skin and subcutaneous tissues,platysma muscle ,(SMAS), parotid capsule Dissection is continued until the only tissue remaining on the posterior border of the mandible will be the periosteum of pterygomassetric sling,then the fracture site will exposed and reduced.
Interventions
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PRA approach
A preauricular incision will be made that extends downwards in a curvilinear fashion in the cervicomastoid skin crease, though any variation in this incision will suffice. The great auricular nerve will be preserved and the flap raised in the subdermal fat plane, superficial to the superficial musculoaponeurotic layer to allow access to the masseter adjacent to the anteroinferior edge of the parotid gland, just below the parotid duct. Branches of the facial nerve will be readily identified and avoided with or without loupe magnification, on the surface of the masseter muscle.
RT approach
The incision for the retromandibular approach begins 5mm below ear lobe and continues 3 to 3.5cm inferiorly. Initial incision begins through skin and subcutaneous tissues,platysma muscle ,(SMAS), parotid capsule Dissection is continued until the only tissue remaining on the posterior border of the mandible will be the periosteum of pterygomassetric sling,then the fracture site will exposed and reduced.
Eligibility Criteria
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Inclusion Criteria
2. Patients with subcondylar fracture and need to open reduction and internal fixation using titanium miniplates.
3. Patients should be free from any traumatic injuries to facial nerve or parotid gland.
4. Availability of preoperative and postoperative panoramic radiographs and/or computed tomography (CT) images.
5. Mental status permitting an adequate neuromotor examination.
6. Regular clinical follow-up, documented in our clinical and radiographic evaluation charts, at 1 week, 1 month, 3 months and 6 months postoperatively
Exclusion Criteria
2. Incooperative patients.
18 Years
ALL
Yes
Sponsors
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Cairo University
OTHER
Responsible Party
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Hani Taher Hibatullah Ali
Principle Investigator
Locations
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Faculty of dental and oral medicine / Cairo University
Cairo, , Egypt
Countries
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References
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Tang W, Gao C, Long J, Lin Y, Wang H, Liu L, Tian W. Application of modified retromandibular approach indirectly from the anterior edge of the parotid gland in the surgical treatment of condylar fracture. J Oral Maxillofac Surg. 2009 Mar;67(3):552-8. doi: 10.1016/j.joms.2008.06.066.
Lutz JC, Clavert P, Wolfram-Gabel R, Wilk A, Kahn JL. Is the high submandibular transmasseteric approach to the mandibular condyle safe for the inferior buccal branch? Surg Radiol Anat. 2010 Dec;32(10):963-9. doi: 10.1007/s00276-010-0663-z. Epub 2010 May 12.
Guerrissi JO. A transparotid transcutaneous approach for internal rigid fixation in condylar fractures. J Craniofac Surg. 2002 Jul;13(4):568-71. doi: 10.1097/00001665-200207000-00018.
Ozkan HS, Sahin B, Gorgu M, Melikoglu C. Results of transmasseteric anteroparotid approach for mandibular condylar fractures. J Craniofac Surg. 2010 Nov;21(6):1882-3. doi: 10.1097/SCS.0b013e3181f4aef7.
Wilson AW, Ethunandan M, Brennan PA. Transmasseteric antero-parotid approach for open reduction and internal fixation of condylar fractures. Br J Oral Maxillofac Surg. 2005 Feb;43(1):57-60. doi: 10.1016/j.bjoms.2004.09.011.
Zachariades N, Papavassiliou D. The pattern and aetiology of maxillofacial injuries in Greece. A retrospective study of 25 years and a comparison with other countries. J Craniomaxillofac Surg. 1990 Aug;18(6):251-4. doi: 10.1016/s1010-5182(05)80425-1.
Villarreal PM, Monje F, Junquera LM, Mateo J, Morillo AJ, Gonzalez C. Mandibular condyle fractures: determinants of treatment and outcome. J Oral Maxillofac Surg. 2004 Feb;62(2):155-63. doi: 10.1016/j.joms.2003.08.010.
Choi BH, Yoo JH. Open reduction of condylar neck fractures with exposure of the facial nerve. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999 Sep;88(3):292-6. doi: 10.1016/s1079-2104(99)70030-2.
Salgarelli AC, Anesi A, Bellini P, Pollastri G, Tanza D, Barberini S, Chiarini L. How to improve retromandibular transmasseteric anteroparotid approach for mandibular condylar fractures: our clinical experience. Int J Oral Maxillofac Surg. 2013 Apr;42(4):464-9. doi: 10.1016/j.ijom.2012.12.012. Epub 2013 Feb 8.
Jensen T, Jensen J, Norholt SE, Dahl M, Lenk-Hansen L, Svensson P. Open reduction and rigid internal fixation of mandibular condylar fractures by an intraoral approach: a long-term follow-up study of 15 patients. J Oral Maxillofac Surg. 2006 Dec;64(12):1771-9. doi: 10.1016/j.joms.2005.12.069.
Schmidseder R, Scheunemann H. Nerve injury in fractures of the condylar neck. J Maxillofac Surg. 1977 Sep;5(3):186-90. doi: 10.1016/s0301-0503(77)80103-3.
Weinberg S, Kryshtalskyj B. Facial nerve function following temporomandibular joint surgery using the preauricular approach. J Oral Maxillofac Surg. 1992 Oct;50(10):1048-51. doi: 10.1016/0278-2391(92)90488-l.
Handschel J, Ruggeberg T, Depprich R, Schwarz F, Meyer U, Kubler NR, Naujoks C. Comparison of various approaches for the treatment of fractures of the mandibular condylar process. J Craniomaxillofac Surg. 2012 Dec;40(8):e397-401. doi: 10.1016/j.jcms.2012.02.012. Epub 2012 Mar 21.
Other Identifiers
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TMAP in subcondylar fracture
Identifier Type: -
Identifier Source: org_study_id
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