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Related Experiment Video

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The high sub-mandibular approach: Our experience about 496 procedures.

A Louvrier1, A Barrabé2, E Weber2

  • 1Department of Oral and Maxillofacial Surgery, University Hospital of Besançon, 3, boulevard Fleming, 25030 Besançon cedex, France; Host-Graft Interactions Lab-Tumor - Cell and Tissue engineering (UMR 1098 INSERM/UFC/EFS), University of Franche-Comté, 1, boulevard Fleming, 25020 Besançon cedex, France.

Journal of Stomatology, Oral and Maxillofacial Surgery
|March 25, 2020
PubMed
Summary
This summary is machine-generated.

The high sub-mandibular approach (HSMA) for mandibular condyle fractures is safe and efficient. This surgical technique offers good access, minimal scarring, and a low rate of facial nerve complications.

Keywords:
Fracture fixationMandibular condyle injuriesMaxillofacial proceduresOperative surgical procedures

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Area of Science:

  • Oral and Maxillofacial Surgery
  • Surgical Anatomy
  • Trauma Surgery

Background:

  • Surgical treatment of mandibular condyle fractures can be limited by concerns over visible scarring and facial nerve injury.
  • The high sub-mandibular approach (HSMA) was developed to address these drawbacks in treating neck and base fractures of the mandibular condyle.

Purpose of the Study:

  • To evaluate the efficacy and safety of the HSMA for treating mandibular condyle neck and base fractures.
  • To analyze surgical access, scar quality, and complication rates over a 12-year period using the HSMA.

Main Methods:

  • A retrospective review of 434 patients who underwent HSMA for condylar neck and base fractures between 2006 and 2018.
  • Data collected included patient demographics, fracture type, osteosynthesis materials, operating time, surgeon experience, and postoperative complications related to the approach.
  • Scar quality was assessed at a minimum 6-month follow-up.

Main Results:

  • The study included 496 approaches in 434 patients, with 78.8% base fractures and 21.2% neck fractures.
  • The mean operating time was 40 minutes per side, with 97.6% of fractures stabilized using 3D plates.
  • Complications included temporary facial nerve paresis (2.2%), hematoma (0.2%), abscess (0.2%), and unaesthetic scars (1%).

Conclusions:

  • The HSMA is a safe, quick, and effective surgical approach for mandibular condyle fractures, providing excellent access to base fractures and most neck fractures.
  • The technique's plane-by-plane dissection minimizes facial nerve injury risk.
  • HSMA is particularly well-suited for use with TCP plates and remains a preferred approach for condylar process fractures.