• Archives of Craniofacial Surgery
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• v.19 no.2
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• pp.157-161
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• 2018

A sialocele is a subcutaneous cavity containing saliva, most often caused by facial trauma or iatrogenic complications. In subcondylar fractures, most surgeons are conscious of facial nerve injury; however, they usually pay little attention to the parotid duct injury. We report the case of a 41-year-old man with a sialocele, approximately $5{\times}3cm$ in size, which developed 1 week after subcondylar fracture reduction. The sialocele became progressively enlarged despite conservative management. Computed tomography showed a thin-walled cyst between the body and tail of the parotid gland. Fluid leakage outside the cyst was noted where the skin was thin. Sialography showed a cutting edge of the inferior interlobular major duct before forming the common major duct that seemed to be injured during the subcondylar fracture reduction process. We decided on prompt surgical treatment, and the sialocele was completely excised. A duct from the parotid tail, secreting salivary secretion into the cyst, was ligated. Botulinum toxin was administrated to block the salivary secretion and preventing recurrence. Treatment was successful. In addition, we found that parotid major ducts are enveloped by the deep lobe and extensive dissection during the subcondylar fracture reduction may cause parotid major duct injury.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.44 no.2
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• pp.73-78
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• 2018

Objectives: The goal of this study was to evaluate the rates of complications, morbidity, and safety with the transparotid approach. Materials and Methods: A retrospective study was conducted and consisted of 53 surgically treated patients in the past five years for low condylar neck and subcondylar fractures. Only patients with malocclusion and who underwent open reduction with internal fixation with the retromandibular transparotid approach were included. The examined parameters were postoperative suboptimal occlusion, deflection, saliva fistula, and facial nerve weakness. Results: Fifty-three patients had an open reduction with internal fixation on 55 sides (41 males, 77.4%; mean age, 42 years [range, 18-72 years]). Four patients (7.5%) experienced transient facial nerve weakness of the marginal mandibular branch, but none was permanent. Four patients had a salivary fistula, and 5 patients showed postoperative malocclusion, where one needed repeat surgery after one year. One patient showed long-term deflection. No other complications were observed. Conclusion: The retromandibular transparotid approach is a safe procedure for open reduction and internal fixation of low condylar neck and subcondylar fractures, and it has minimal complications.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.47 no.5
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• pp.403-406
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• 2021

The dilemma regarding the management of condylar fractures generally revolves around the surgical approach, implant design, and the surgeon's experience. Zide and Kent's guidelines streamlined the decision making process for condylar fractures. However, there exists no standardized protocol for reduction and fixation of condylar fractures. Here, we have described a detailed and stepwise protocol, common to any surgical approach, that would lead to predictable, reproducible, and repeatable results in every surgeon's hands.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.33 no.6
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• pp.497-504
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• 2011

Purpose: Patients who had a subcondylar fracture with a displaced or deviated condylar segment were treated with a retromandibular approach (RMA) or an endoscope-assisted transoral approach (EATA) in our department of oral and maxillofacial surgery. The clinical results of the approaches were compared. A comparative study of specific approaches for subcondylar fractures has not been published before in Korea. Methods: Twenty-one patients with subcondylar fractures of the mandible were included. Ten patients were treated with the retromandibular approach and 11 were treated with an endoscope-assisted transoral approach. We examined patient age, gender, fracture sites, classifications, period of maxillomandibular fixation, facial nerve (FN) or greater auricular nerve (GAN) injuries, maximal mouth opening, deflection, occlusal changes, number of plates, follow-up period, and other complications. Preoperative computed tomography and pre-operative, post-operative, and follow-up panoramic views were taken of each patient. Results: Mean maximal mouth openings were similar between the two approaches. FN and GAN injuries were more frequent in the RMA group but the deflective rate with mouth opening was higher in the EATA than that in RMA group. Two cases of post-operative infection occurred in the EATA group, and occlusal changes were observed in one case for both approaches. Conclusion: The RMA offers more direct access and visualization of the surgical field but it can cause scars and retractive injuries of the FN and GAN. But, EATA did not result in consequent nerve injuries or scars postoperatively, but unfavorable fractures such as $medial$ $override$ condyles were more difficult to reduce endoscopically. Except cases of an expected difficult reduction, the treatment of choice for a displaced subcondylar fracture may be an EATA.

• Archives of Craniofacial Surgery
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• v.9 no.2
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• pp.51-54
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• 2008

Purpose: The choice of open versus closed reduction for mandibular subcondylar fracture is a debatable issue. To evaluate the advantage of open approach to closed method with IMF(intermaxillary fixation), we conducted a retrospective study to compare the outcomes of each method. Methods: From 2002 to 2006, 29 patients with mandibular subcondylar fractures were treated by open or closed reduction. 17 patients were treated by open reduction and 12 patients by closed reduction and IMF. Each group was assessed for duration of mandibular immobilization, incidences of buccal palsy, malocclusion, TMJ(temporomandibular joint) pain, and deviation of the mandible on mouth opening. Results: All cases showed accurate reduction in anatomical position, no significant displacement and no deviation on mouth opening during the follow-up period. IMF period is statistically shorter in open reduction (p<0.05). Differences in incidence of other complications were not significant statistically. Conclusion: As there are significant independent morbidities associated with IMF which requires postoperative rehabilitation, prolonged temporomandibular immobilization should not be overlooked. Some patients with poor compliances will not tolerate IMF in nonsurgical treatment. In the aspect of patient's convenience and early recovery by short IMF period, open reduction would be recommended as a better treatment method.

• The Journal of the Korean dental association
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• v.55 no.10
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• pp.696-705
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• 2017

Condylar fractures account for one-third of all mandibular fractures. There are many surgical methods for the open reduction of condylar fractures, such as the transoral, submandibular, preauricular, and retromandibular approaches. Two patients suffering from condylar fractures, a 45-year-old man and a 25-year-old man, were admitted to our hospital. Both patients' condylar fractures were positioned too high for us to use the transoral approach. Therefore, we employed the retromandibular method to expedite the approach to the fracture site and minimize the size of the incision. After the surgical procedures in both cases, we experienced complications in the form of parotid gland fistulae, which rarely result from the retromandibular approach. A combination of botulinum toxin injection and amitriptyline medication was effective for the management of these parotid gland fistulae. Here, we report these two cases and offer a review of the literature on this article.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.40 no.6
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• pp.297-300
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• 2014

Objectives: To compare the clinical and radiological outcomes after closed reduction (CR) and open reduction and internal fixation (ORIF) in the management of subcondylar fractures. Materials and Methods: Forty-eight patients presenting with subcondylar fracture between January 2010 and March 2013 were evaluated retrospectively. Fifteen patients were treated with CR and 33 patients with ORIF. The clinical and radiologic parameters were evaluated during follow-up (mean, 7.06 months; range, 3 to 36 months). Results: In the CR group, no patients had any problems with regard to the clinical parameters. The average period of maxillomandibular fixation (MMF) was 5.47 days. The preoperative average tangential angulation of the fractured fragment was $3.67^{\circ}$, and loss of ramus height was 2.44 mm. In the ORIF group, no clinical problems were observed, and the average period of MMF was 6.33 days. The preoperative average tangential angulation of the subcondylar fragment was $8.66^{\circ}$, and loss of ramus height was 3.61 mm. Conclusion: CR provided satisfactory clinical results, though ORIF provided more accurate reduction of the fractured fragment. So there is no distinct displacement of fractured fragment, CR should be selected than ORIF because of no need for surgery.

• Imaging Science in Dentistry
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• v.40 no.1
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• pp.33-38
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• 2010

Purpose : The purpose of this study was to evaluate the diagnostic efficacy of panoramic radiographs for detection of mandibular fractures. Materials and Methods : The sample was comprised of 65 patients (55 fractured, 10 non-fractured) with 92 fracture sites confirmed by multi-detector computed tomography (CT). Panoramic radiographs were evaluated for mandibular fractures by six examiners; two oral & maxillofacial radiologists (observer A&B), two oral & maxillofacial surgeons (observer C&D), and two general dentists (observer E&F). Results : Sensitivity of panoramic radiography for mandibular fractures was 95.7% in observer A&B, 93.5% in observer C&D and 80.4% in observer E&F. The lowest sensitivity was shown in symphyseal/parasymphyseal areas, followed by subcondylar/condylar regions. Conclusion : Panoramic radiography is adequate for detection of mandibular fractures. However, additional multidetector CT is recommended to ascertain some indecisive fractures of symphysis and condyle, and in complicated fractures.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.37
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• pp.26.1-26.4
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• 2015

We experienced a patient of subcondylar fracture who had a squared contour of the lower face with prominent angle of the mandible and masseter hypertrophy. Our patient was increasingly seeking esthetic improvement of the lower third of the face. But she did not want multi-stage operations. Thus, we decided and performed a one-stage mandibular angle ostectomy with fracture management. We have a stable and esthetic result simultaneously despite fractures of the fixation plates during follow-up period, so report a case.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.47 no.4
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• pp.327-334
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• 2021

A transparotid approach, with a retromandibular or preauricular incision, is an alternative surgical approach for treating a subcondylar fracture and reducing the potential for complications such as injury to the facial nerves. However, retromandibular and preauricular incisions are both created far away from the parotid gland-dissection area. Thus, it is necessary to undermine the skin and retract it anteriorly to access the surgical field. Here, we introduce a modified approach wherein the incision allows for direct access to the fracture site. This approach may be adopted to shorten the incision length, reduce the retraction trauma at the surgical site, and help prevent injury to the facial nerve.