Trasmassetric open approch for condylar /certified fixed orthodontic courses by Indian dental academy

INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com


TRANSMASSETRIC ANTERO – PAROTID
APPROACH FOR OPEN REDUCTION
AND INTERNAL FIXATION OF
CONDYLAR FRACTURES

- BJOMFS
- 2005 , 43
- A.W.WILSON , M.ETHUNANDAN
- QUEEN ALEXANDERA HOSPITAL
- PORTSMOUTH , UK

AIM :
Technique offering swift access to
condylar
neck fracture with reduced risk of facial
nerve injury eliminating complications
associated with transparotid approach


SHORT COMINGS :
- Limited access
- Injury to facial nerve


TECHNIQUE :
- Pre auricular incision extending to cervico
mastiod skin crease
- Great auricular nerve preserved
- Flap raided in sub dermal fat plane
- Superficial to musculoaponeurotic layer
- Allows access to masseter adjacent to
parotid gland at is anteroinferior edge

FLAP

INCISION


CONT…
- Branches of facial nerve identified avoided
on surface of masseter
- Nerve stimulator
- Buccal branch – mostly seen

- Area next to anterior edge is free of branches
- This an ideal point to dissect down
- Buccal branch – easily retracted

CONT…
- Masseter split in direction of fibres
- Sever the fibres in deeper plane , change of
direction
- Periosteum over ramus in condylar region
incised – fracture site exposed
- If not retract the upper edge

- Fracture reduced and fixed,closure with drain

- Duration about 20 – 25 min

FRACTURE


FIXATION

CASE REPORTS :
- 3 patients with bilateral condylar fracture

- 2 patients – pre auricular with retromandibular
extension
- 1 patient – lazy – s incision with inferior
extension to hairline


Results :
- Excellent functional and cosmetic outcome
- No facial nerve weakness
- No paresthesia of great auricular nerve
- No Frey’s syndrome


DISCUSSION :
OTHER APPROACHES ;
- Access difficulty
- Forceful retraction
- Non reduction of medially displaced condyle
- Facial nerve injury – 30 %– 48%


CONT…
SUBMANDIBULAR APPROACH ;
- Injury to marginal mandibular nerve

PREAURICULAR APPROACH ;
- Injury to temporal and zygomatic
branches


CROSS ANASTOMOSIS :
- Zygomatic and buccal – 87% - 90%
- Marginal mandibular – 0% - 16%
-Vulnerability in both approaches


TMAP :
- Only buccal branch encountered
- Easily identified and retracted
- Excellent anastomosis – less risky
- Cosmetically acceptable


Trasmassetric open approch for condylar /certified fixed orthodontic courses by Indian dental academy

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Trasmassetric open approch for condylar /certified fixed orthodontic courses by Indian dental academy