Analysis of complications following endoscopically assisted treatment of mandibular condylar fractures.

BACKGROUND: Within the field of facial reconstructive surgery, minimally invasive procedures are used for the treatment of temporomandibular joint disorders, traumas, and salivary glands and base of skull tumors. The recent report of endoscopic approach for treating subcondylar fractures of the mandible is designed to provide a new method for the treatment of subcondylar fractures using an endoscope through a limited transoral incision. To the best of our knowledge, the advantages and the disadvantages of an endoscopically assisted approach to mandibular condylar fracture have not been verified in studies with a high level of evidence. The objective of this article was to present our experience regarding the endoscopically assisted reduction of subcondylar mandibular fractures with a special focus on complications. METHODS: The records of 14 patients who underwent surgical repair of subcondylar fractures by transoral endoscopic-assisted technique from January 2005 to December 2008 at the Maxillofacial Surgery Unit of Novara Major Hospital were reviewed retrospectively. The measures for the surgical objectives included the following outcome variables: (1) operation time, (2) cosmetic outcome, (3) salivary fistulas, (4) infection, (5) delayed wound healing, (6) facial nerve damage, (7) hemorrhage, (8) repeat interventions, (9) bone consolidation, (10) occlusion changes, and (11) temporomandibular joint dysfunction. RESULTS: Our data show that we have had 4 complications (28%) experienced by 4 different patients: (1) arterial hemorrhage, (2) facial nerve injury, (3) nonunion, and (4) partial condylar reabsorption. CONCLUSIONS: Although we cannot draw statistically significant conclusions, we think that further randomized clinical trials should be necessary to analyze this method; we believe that there is not an ideal approach for a fracture, but each patient needs to be fully evaluated carefully preoperatively, and the more convenient approach needs to be selected for each case.

Retroauricular transmeatal approach to manage mandibular condylar head fractures.

BACKGROUND: There is a multitude of reported surgical approaches and technical variants with some unresolved technical problems to gain direct access to mandibular condylar head fractures; they can be divided into 2 groups: intraoral and extraoral. In 2005, Neff et al (Mund Kiefer Gesichtschir 2005;9:80), supported by a previous experimental work, reported a successful clinical study of condylar head fractures treated by a retroauricular approach; this article is in German, and the later English-language literature does not mention about this approach to open reduction and internal fixation of mandibular condylar fractures. The retroauricular transmeatal access, selected and performed by the senior author to treat 14 patients affected by highly located condylar head fracture, is illustrated in details. METHODS: We collected data of 14 consecutive adult patients who, after the discussion about all options, had consented to have 16 mandibular condylar head fractures treated with open reduction and internal fixation by miniplates and screws via a retroauricular transmeatal approach. We exposed the temporomandibular joint area easily and better by dissecting via a retroauricular route with identification, ligation, and transection of the retromandibular vein; because of the posterior access, the frontal branch of the facial nerve and the auriculotemporal nerve are located and protected within the substance of the anteriorly retracted flap, superficial to the retromandibular vein. The follow-up clinical examination showed temporary weakness of the frontal branch of the facial nerve in 1 case with a recovery to normal function of 1.6 months; no patients had permanent weakness of the facial nerve or injury of the auriculotemporal nerve. There was absence of any salivary fistula, sialocele, and Frey syndrome; hearing was preserved in all cases, without any auditory stenosis or aesthetic deformity, and there was absence of any infections, hematoma, or scarring. CONCLUSIONS: Retroauricular approach provides good exposure of the temporomandibular joint and satisfactory protection from nerve injuries and vascular lesions, allowing an adequate osteosynthesis. The scar is hidden behind the ear, and the morbidity is low in terms of auditory stenosis, aesthetic deformity, and salivary fistulas.

The use of teleradiology for triaging of maxillofacial trauma.

PURPOSE: The aim of this study was to assess and discuss our experience with a teleradiology technique applied to facial trauma patients referred to an oral and maxillofacial surgery hub center. MATERIALS AND METHODS: All trauma patients with maxillofacial fractures from the hospitals of Vercelli, Biella, Borgosesia, Borgomanero, Verbania, and Domodossola who were referred between July 2014 and September 2018 to the hub maxillofacial center of Novara were reviewed. The following data were recorded for each patient: sex, age, referral hospital, etiology, etiology mechanisms, site of facial fractures, date of injury, indications for surgery according to teleradiology consultation, indications for surgery following clinical maxillofacial assessment, date of eventual surgery, timing of surgery from trauma, type of surgical intervention. RESULTS: A total of 467 patients with a total of 605 fractures were triaged and managed by the Tempore telemedicine system. The most frequent cause of maxillofacial injury was fall. The most frequently observed fracture involved the zygoma. Following remote computed tomography assessment, surgical indications were suggested in 68 patients; 223 patients were not considered suitable candidates for surgery; and 176 patients needed a clinical assessment for the establishment of definitive eventual indications for surgery. Following clinical assessment, the absence and presence of surgical indications was confirmed in all 223 and 68 patients, respectively. Within the 176 patients with "possible" surgical indications, only 27 patients were referred for surgery. CONCLUSION: Teleradiology may be helpful for an appropriate triaging of trauma patients from peripheral hospitals for the correct referral to a maxillofacial trauma hub center.