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Article

Condylar Neck and Sub-Condylar Fractures: Surgical Consideration and Evolution of the Technique with Short Follow-Up on Five Cases

1
Unit of Maxillofacial Surgery, Department of Medicine and Surgery, University of Salerno, 84084 Fisciano (Salerno), Italy
2
Department of BioMolecular Sciences, National Center for Natural Product Research, University of Mississippi, University, MS 38677, USA
3
Department of Maxillofacial Surgery, University of Mississippi Medical Center, Jackson, MS 39216, USA
4
Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, MS 39216, USA
*
Authors to whom correspondence should be addressed.
Dent. J. 2020, 8(4), 125; https://doi.org/10.3390/dj8040125
Received: 2 September 2020 / Revised: 28 October 2020 / Accepted: 29 October 2020 / Published: 3 November 2020
(This article belongs to the Section Restorative Dentistry and Traumatology)
Condylar neck and sub-condylar fractures of the mandible are a frequent occurrence in maxillofacial surgery. The indication for surgical treatment of these fractures has changed over time, and several techniques have been developed with different results in the attempt to avoid the most worrisome adverse event, i.e., facial nerve injury. In this study, we present a new technique that combines an intraoral and a cutaneous pre-auricular access, which allows for easy and safe access to the surgical site, preventing facial nerve injury and avoiding surgical scars in high-impact aesthetic areas of the neck. Five consecutive patients affected by condylar neck or sub-condylar fractures were treated at a single institution using a combined intraoral and pre-auricular access. Results were evaluated after three months from surgery in terms of mandibular mobility, occurrence of complications, and patient’s satisfaction. All five patients had good outcome, with complete healing of the fracture and no occurrence of complications, including no facial nerve palsy. A key point of the technique is the safe reduction of the two mandibular fragments realized by a combined intraoral and a cutaneous pre-auricular surgical access. The periosteal plan of the ramus can be widely and safely elevated with the intraoral approach and connected to the condylar bone plane by the pre-auricular cutaneous approach without any need for soft tissue dissection at the fracture rim, thereby avoiding facial nerve injuries. Wide ramus periosteum elevation creates an “optical space”, allowing fragment reduction and fixation under direct oblique view without any endoscopic need. Our results strongly suggest that with our technique it is possible to treat sub-condylar and condylar neck fractures safely, avoiding facial nerve injury, which is an unacceptable complication due to its heavy impact on a patient’s life. View Full-Text
Keywords: condylar fractures; surgery; surgical access; facial nerve injury condylar fractures; surgery; surgical access; facial nerve injury
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MDPI and ACS Style

Cortese, A.; Borri, A.; Bergaminelli, M.; Bergaminelli, F.; Claudio, P.P. Condylar Neck and Sub-Condylar Fractures: Surgical Consideration and Evolution of the Technique with Short Follow-Up on Five Cases. Dent. J. 2020, 8, 125. https://doi.org/10.3390/dj8040125

AMA Style

Cortese A, Borri A, Bergaminelli M, Bergaminelli F, Claudio PP. Condylar Neck and Sub-Condylar Fractures: Surgical Consideration and Evolution of the Technique with Short Follow-Up on Five Cases. Dentistry Journal. 2020; 8(4):125. https://doi.org/10.3390/dj8040125

Chicago/Turabian Style

Cortese, Antonio, Antonio Borri, Marco Bergaminelli, Fabrizio Bergaminelli, and Pier P. Claudio 2020. "Condylar Neck and Sub-Condylar Fractures: Surgical Consideration and Evolution of the Technique with Short Follow-Up on Five Cases" Dentistry Journal 8, no. 4: 125. https://doi.org/10.3390/dj8040125

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