Does a retromandibular transparotid approach for the open treatment of condylar fractures result in facial nerve injury?

Publication date: Available online 26 May 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Takahiro Kanno, Shintaro Sukegawa, Hiroto Tatsumi, Masaaki Karino, Yoshiki Nariai, Eiji Nakatani, Yoshihiko Furuki, Joji Sekine
PurposeThe retromandibular transparotid approach (RMA) to condylar fractures of the mandible provides excellent access but may increase the risk of complications. The aim of this study was to estimate the frequency of facial nerve paralysis (FNP) and associated postoperative complications following open reduction and rigid internal fixation (ORIF) of subcondylar fractures via RMA.Materials and MethodsThis was a retrospective cohort study of patients with condylar fractures requiring ORIF via RMA. The inclusion criteria were 1) a medical record of surgical treatment of a subcondylar fracture by RMA; 2) preoperative and postoperative radiographs; 3) mental status permitting an adequate neuromotor examination; 4) absence of a post-injury/pre-treatment functional facial nerve deficit; and 5) regular postoperative follow-up of more than 6 months with documentation of complications, functional results, and fixation stability. The predictive variables were age, sex, fracture site, fracture pattern, concomitant fractures, etiology, and type of plates. The outcome variable was FNP. Univariate, bivariate, and multiple logistic regression statistics were computed.ResultsFifty patients with 55 displaced mandibular subcondyle fractures (35 men, 15 women; mean age, 44.5 years; range, 17–87 years) met the inclusion criteria. The condylar fracture involved the neck in 35 patients (63.6%) and the base in 20 patients (36.4%). The fracture pattern was deviation in 11 patients (20.0%), displacement in 23 (41.8%), and dislocation in 21 (38.2%). Precise ORIF with double-buttress fixation resulted in immediate functional recovery in all the patients. Seven fractures (12.7%) were associated with FNP that resolved completely within 6 months. Further statistical analysis revealed dislocated and dislocated condylar neck fractures were significant risk factors for postoperative FNP (p<.05). Other postoperative complications were minimal.ConclusionRMA for subcondylar fractures is feasible and safe. Dislocated condylar neck fractures are associated with a highly increased risk of temporary postoperative FNP as a surgical complication.



from #ENT via xlomafota13 on Inoreader http://ift.tt/1RuJA9I
via IFTTT