The Clinical Analysis Of Different Approaches For Mandibular Condylar Fracture

Objective:The aim of study is to record the surgical approaches and postoperative complications for different classification of condylar fracture,in order to provide a theoretical surport and clinical guidance.Methods: We collect 59 patients(70 sides) of mandibular condyle fracture in department of oral and maxillofacial surgery of the general hospital of ningxia medical university from October 2013 to December 2015.The three dimensional CT were taken in all cases prior to surgery to assess pattern of condylar fracture.We divided the cases into 4 groups,namely preauricular approach, temporoauricular approach,retromandibular approach and submandibular approacch.Patients with treated more than 6 months were investigated for a long-term follow-up,by being asked for maximum mouth opening(MMO),occlusion,parasymphysis,complications,and satisfaction with the incision.Results:Of 70 sides fractures,25 were performed by preauricular approaches,16 temporoauricular approaches,11 retromandibular approaches and 18 submandibular approaches.There were 10 sides with intracapsular fracture cases,10 sides with neck fractures and 5 sides with base fractures in preauricular group. There were 7 sides with intracapsular fracture,5 sides with neck fractures and 4 sides with base fractures in the temporoauricular group.Among 11 sides of retromandibular group, 4 had a intracapsular fracture.3 had a neck fracture and 4 had a base fracture. Among 18 sides of submandibular approaches,2 had a neck fracture and 16 had a base fracture.1.MMO on 6 months after the surgery has been significantly improved compared to that before the surgery( P<0.05).2.There were 23 cases of facial nerve injury,including 10 cases in temporoauricular group,6 in preauricular group,1 in retromandibular group and 6 in submandibular group.On the facial nerve injury rates,the patients treated by retromandibular approach showed significant differences with temporoauricular approaches by the lowest rate.Among 70 sides fractures,there were 61 satisfactory incisions with rate of 87.1%.Conclusion:1.In terms of MMO,preauricular and temporoauricular group give better improvement to intracapsular fracture than retromandibular group.Both approaches have good results in managing condylar neck fracture.For base fracture,submandibular and retromandibular approach improve the degree of mouth opening was better than preauricular and temporoauricular approach.2. The rate of retromandibular group is lower than temporoauricular group.3. Temporoauricular group show the highest satisfactory rate because of less conspicuous scar.