2017-18 HSC Section 3 Green Book

Reprinted by permission of J Craniomaxillofac Surg. 2015; 43(8):1595-1601.

Journal of Cranio-Maxillo-Facial Surgery 43 (2015) 1595 e 1601

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Journal of Cranio-Maxillo-Facial Surgery

journal homepage: www.jcmfs.com

Experience with the transparotid approach via a mini-preauricular incision for surgical management of condylar neck fractures Han-Tsung Liao a , b , * , Po-Fang Wang a , Chien-Tzung Chen c a Division of Trauma Plastic Surgery, Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, 5, Fu-Shing Street, Kuei-Shan, Taoyuan, 333, Taiwan b College of Medicine, Chang Gung University, Kuei-shan, Taoyuan, Taiwan c Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Keelung, College of Medicine, Chang Gung University, Craniofacial Research Center, 222, Maijin Road, Keelung, Taiwan

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Article history: Paper received 28 February 2015 Accepted 23 July 2015 Available online 31 July 2015

Introduction: The aim of this study was to describe our experiences of a mini-preauricular transparotid approach for direct reduction and plating of condylar neck fractures. Materials and methods: A retrospective study was conducted on 58 patients from 2009 to 2011 with 69 condylar neck fractures in Chang Gung Memorial Hospital. The fractures were treated surgically either with a 2-cm mini-preauricular and transparotid approach in 29 patients with 36 fractures, or via endoscope-assisted intraoral, or facelift or retromandibular approaches in a control group of 29 patients with 32 fractures. The postoperative hospital stay, occlusion status, mouth opening and facial nerve and parotid gland related complications were compared between the two groups. Results: In both groups around 90% of patients had good restoration of preinjury occlusion. Postoperative mouth opening was 39.8 mm and 39.9 mm in the mini-preauricular approach and the other approaches group, respectively. Facial symmetry was achieved in all of the patients. There was no incidence of facial nerve palsy, infection or hemorrhage in the mini-preauricular group. One patient in the control group had a persistent weakness due to frontal nerve palsy. Conclusion: Based on the results, the mini-preauricular approach can be an alternative, safe and effective method in the management of condylar neck and high subcondylar fractures. © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Keywords: Condylar neck fracture Mini-preauricular Transparotid approach

1. Introduction

2005 ). He also described a so-called Loukota line which is the perpendicular line through the sigmoid notch to the tangent of the ramus. The diacapitular fracture line starts in the articular surface andmay extend outside the temporomandibular joint (TMJ) capsule. The condylar neck fracture starts somewhere above the Loukota line and in more than half runs above the Loukota line in the lateral view. The fracture line of condylar base runs behind the mandibular fo- ramen and, in more than half, below the Loukota line. Neff et al. (2014b) further modi fi ed the Loukota classi fi cation and introduced a new one-third to two-thirds rule with regard to the proportion of the fracture line above and below the level of Loukota line. A condylar neck fracture is identi fi ed when more than a third of the fracture line lies above the Loukota line (assessed on the lateral view) and the line remains below the TMJ capsule. When more than two- thirds of the fracture line runs below the Loukota line in the lateral view, the fracture involves the base of the condylar process. There are several approaches in the management of condylar fractures. A preauricular incision is usually used to approach

Condylar process fracture is one of the most commonmandibular fractures. It involves about 25 e 30% of all mandibular fractures ( Colletti et al., 2014; Ellis et al.,1985; Eulert et al., 2007 ). Although the surgical management of condylar head fracture remains controver- sial, anatomic reduction with rigid fi xation is usually required for condylar neck and subcondylar fracture, especially in situations such as angulation or displacement which result in vertical ramus short- ening or malocclusion. Loukota et al. described the subclassi fi cation of condylar process fractures into diacapitular fractures, condylar neck fractures and fractures of the condylar base ( Loukota et al.,

* Corresponding author. Division of Traumatic Plastic Surgery, Department of Plastic and Reconstructive Surgery, Craniofacial Center, Chang Gung Memorial Hospitals, Chang Gung University, College of Medicine, 5, Fu-Shing Street, Kuei- Shan, Taoyuan 333, Taiwan. Tel.: þ 886 3 328 1200x2946; fax: þ 886 3 328 9582. E-mail address: lia01211@gmail.com (H.-T. Liao).

http://dx.doi.org/10.1016/j.jcms.2015.07.023 1010-5182/ © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

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