The choice of surgical approaches in patients with fractures of mandibular condyloid process

Fractures of the mandible (MF) are more common than other fractures of facial bones, which is explained by anatomical features of scull’s structure. According to the world literature data, condylar fractures accounts for up to 37% among the MF. Due to their high and steadily growing incidence all around the world and increasing traumatization of the population mandible fractures seem to be a topical problem of maxillofacial surgery. Our task was to improve the treatment outcomes of patients with MF, to reduce the complications rate, and to diminish the rate of surgical injuries during osteosynthesis by defining the most appropriate surgical approach.

Material and methods. 41 patients with MF were treated and followed up. All patients were divided into two groups. The first group (19 people) consisted of patients with fractures of mandible conlyloid process (MCP) head fractures. The second group (22 people) were patients with fractures of the cervix and base of MCP. The first group of patients underwent surgical MCP osteosynthesis which was performed from improved pre-terminal access. Patients from second group were operated from intraoral approch with the use of endovideo-assistance. All patients underwent a CT scan both before and after surgery and subsequently were observed at the Department of Maxillofacial and Plastic Surgery at the Moscow State Medical University named after. A.I. Evdokimov in the early and late postoperative periods.

Results. According to the CT examination in the postoperative period, all the observed patients showed the restoration of the anatomical integrity of the mandibular condylar process and the mandible branch. During the observation, the patients did not show any neuropathy and paresthesia caused by the facial nerve damage in the postoperative period. The first group of patients did not reveal the cicatricial changes in the soft tissues of the postoperative region or any parotid gland fistulas. Сonclusion. The use of the improved pre-aural and intraoral access with endovideo-assistance during the surgical osteosynthesis in patients with various MCP fractures allows not only to prevent, but also to reduce the risk of complications and to minimize intraoperative traumatization. Endovideo-assistance also contributes to better control the surgical intervention, more accurate reposition and fixation of fragments, which can affect the prognosis of treatment.

Keywords: condylar process of the mandible, mandibular fracture, condylar process fracture, surgical access, maxillofacial surgery

The authors declare no conflict of interest. Source of financing: not specified.

For citation: Izotov O.I., Sviridov E.G., Drobyshev A.Yu. The choice of surgical approaches in patients with fractures of mandibular condyloid process. Head and neck Head and neck Russian Journal. 2018;6(3):12–19 (in Russian).

The authors are responsible for the originality of the data presented and the possibility of publishing illustrative material – tables, figures, photographs of patients.