Modified tragus edge incision and transmasseteric anteroparotid approach to condyle reconstruction

doi:10.7518/hxkq.2023.2022496

Abstract

Abstract:

Objective This study aimed to analyze the application value of a modified tragus edge incision and transmasseteric anteroparotid approach to condyle reconstruction. Methods Condyle reconstruction was performed in 16 patients (9 females and 7 males) with modified tragus edge incision and transmasseteric anteroparotid approach. After regular follow-up, the function of condyle reconstruction was evaluated by clinical indicators, such as parotid salivary fistula, facial nerve function, mouth opening, occlusal relationship, and facial scar. The morphology of rib graft rib cartilage was evaluated by imaging indicators, such as panoramic radiography, CT, and three-dimensional CT image reconstruction. Results At 6-36 months postoperative follow-up, all patients had good recovery of facial appearance, concealed incisional scar, no parotid salivary fistula, good mouth opening, and occlusion. One case had temporary facial paralysis and recovered after treatment. Radiographic evaluation further showed that costochondral graft survived in normal anatomic locations. Conclusion The modified tragus edge incision and transmasseteric anteroparotid approach can effectively reduce parotid salivary fistula and facial nerve injury in condylar reconstruction. The surgical field was clearly exposed, and the incision scar was concealed without increasing the incidence of other complications. Thus, this approach is worthy of clinical promotion.

Key words: modified tragus edge incision, transmasseteric anteroparotid approach, costochondral graft, condylar reconstruction, facial nerve injury, parotid salivary fistula, incision scar

CLC Number:

R 782.6

Tang Hui, Wang Lang, Wang Lei, Rao Pengcheng, Luo Daowen, Fu Guangxin, Xiao Jingang. Modified tragus edge incision and transmasseteric anteroparotid approach to condyle reconstruction[J]. West China Journal of Stomatology, 2023, 41(3): 290-296.

Figures/Tables 8

Fig 1

Fig 2

Tab 1

Fig 3

Fig 4

Fig 5

Fig 6

Fig 7

References 21

1	Dowgierd K, Pokrowiecki R, Kulesa Mrowiecka M, et al. Protocol for multi-stage treatment of temporomandibular joint ankylosis in children and adolescents[J]. J Clin Med, 2022, 11(2): 428.
2	陈浩哲, 祝颂松. 利用自体下颌骨重建下颌髁突的研究进展[J]. 临床口腔医学杂志, 2018, 34(3): 183-186.
	Chen HZ, Zhu SS. Progress in reconstruction of mandibular condyle with autogenous mandible[J]. J Clin Stomatol, 2018, 34(3): 183-186.
3	Güzel MZ, Arslan H, Saraç M. Mandibular condyle reconstruction with inlay application of autogenous costochondral graft after condylectomy: Cerrahpaşa’s techni-que[J]. J Oral Maxillofac Surg, 2007, 65(4): 615-620.
4	Koneru G, Bhargava D, Somuri AV, et al. Temporomandibular joint alloplastic reconstruction of post-traumatic joint degeneration with Sawhney Type Ⅰ ankylosis using 3D-custom GD-condylar cap prosthesis to restore condylar form and function[J]. J Stomatol Oral Maxillofac Surg, 2021, 122(3): 315-318.
5	Qiu YT, Yang C, Chen MJ. Endoscopically assisted reconstruction of the mandibular condyle with a costochondral graft through a modified preauricular approach[J]. Br J Oral Maxillofac Surg, 2010, 48(6): 443-447.
6	MacIntosh RB, Henny FA. A spectrum of application of autogenous costochondral grafts[J]. J Maxillofac Surg, 1977, 5(4): 257-267.
7	Al-Moraissi EA, Louvrier A, Colletti G, et al. Does the surgical approach for treating mandibular condylar fractures affect the rate of seventh cranial nerve injuries? A systematic review and meta-analysis based on a new classification for surgical approaches[J]. J Craniomaxillofac Surg, 2018, 46(3): 398-412.
8	Koirala U, Subedi S. Retromandibular transparotid approach for subcondylar mandibular fracture: a retrospective study[J]. Dent Traumatol, 2021, 37(2): 314-320.
9	Kumar P, Jeyaraman B, Rajiah D, et al. Evaluation of mini-preauricular incision in the surgical management of condylar fracture[J]. Cureus, 2022, 14(11): e31725.
10	Mandal J, Bhutia O, Roychoudhury A, et al. Does the retromandibular transparotid approach provide quicker access to fracture of mandibular subcondyle compared with the retromandibular transmasseteric anterior paro-tid approach[J]. J Oral Maxillofac Surg, 2021, 79(3): 644-651.
11	Parihar VS, Bandyopadhyay TK, Chattopadhyay PK, et al. Retromandibular transparotid approach compared wi-th transmasseteric anterior parotid approach for the ma-nagement of fractures of the mandibular condylar process: a prospective randomised study[J]. Br J Oral Maxillofac Surg, 2019, 57(9): 880-885.
12	Li H, Zhang G, Cui J, et al. A modified preauricular approach for treating intracapsular condylar fractures to prevent facial nerve injury: the supratemporalis approa-ch[J]. J Oral Maxillofac Surg, 2016, 74(5): 1013-1022.
13	Singh PK, Singh G, Vignesh U, et al. Comparative eva-luation of modified tragus edge approach and retromandibular approach to mid- or low-level mandibular condylar fractures[J]. J Maxillofac Oral Surg, 2022, 21(1): 184-190.
14	Girhe V, Patil V, Bhujbal R, et al. Pre-auricular transparotid approach for the management of mandibular condylar fracture: an experience of 82 cases[J]. J Maxillofac Oral Surg, 2022, 21(3): 916-922.
15	Robiony M, Sembronio S. Comment on “A modified preauricular approach for treating intracapsular condylar fractures to prevent facial nerve injury: the supratemporalis approach”[J]. J Oral Maxillofac Surg, 2016, 74(11): 2114-2115.
16	Tang M, Wang L, Zhang M, et al. Modified tragus edge and transmasseteric anteroparotid approach for intracapsular and condylar neck fractures[J]. J Craniofac Surg, 2020, 31(6): 1822-1826.
17	Kochhar A, Larian B, Azizzadeh B. Facial nerve and parotid gland anatomy[J]. Otolaryngol Clin North Am, 2016, 49(2): 273-284.
18	Anderson SR, Pak KY, Vincent AG, et al. Reconstruction of the mandibular condyle[J]. Facial Plast Surg, 2021, 37(6): 728-734.
19	Goerke D, Sampson DE, Tibesar RJ, et al. Rib reconstruction of the absent mandibular condyle in children[J]. Otolaryngol Head Neck Surg, 2013, 149(3): 372-376.
20	Prasad C, Uma Maheswari G, Karthikeyan D. Fate of costochondral graft in temporomandibular joint reconstruction: a histological study[J]. J Maxillofac Oral Surg, 2016, 15(2): 179-183.
21	Awal DH, Jaffer M, Charan G, et al. Costochondral graf-ting for paediatric temporomandibular joint reconstruction: 10-year outcomes in 55 cases[J]. Int J Oral Maxillofac Surg, 2018, 47(11): 1433-1438.

序号	年龄/岁	性别	髁突病变	单侧/双侧	张口度/mm			面瘫	涎瘘	咬合错乱	曼彻斯特瘢痕评分	移植物
序号	年龄/岁	性别	髁突病变	单侧/双侧	术前	术后1周	术后3月	面瘫	涎瘘	咬合错乱	曼彻斯特瘢痕评分	骨不连/骨坏死	明显吸收	移位
1	40	男	颞下颌关节强直	单侧	7	30	35	无	无	无	7	无	无	无
2	34	女	颞下颌关节强直	单侧	8	32	36	无	无	无	8	无	无	无
3	51	男	肿瘤	单侧	15	34	39	无	无	无	7	无	无	无
4	35	女	肿瘤	单侧	21	30	34	无	无	无	5	无	无	无
5	20	男	颞下颌关节强直	双侧	5	33	38	无	无	无	8	无	无	无
6	53	女	肿瘤	单侧	12	36	42	暂时性面瘫	无	无	7	无	无	无
7	29	女	颞下颌关节强直	单侧	9	32	37	无	无	无	5	无	无	无
8	35	女	颞下颌关节强直	单侧	11	33	37	无	无	无	5	无	无	无
9	41	女	肿瘤	单侧	8	21	26	无	无	无	7	无	无	无
10	37	男	骨关节病	单侧	14	32	36	无	无	无	8	无	无	无
11	26	男	髁突粉碎性骨折	单侧	6	32	41	无	无	无	6	无	无	无
12	24	男	颞下颌关节强直	单侧	9	32	37	无	无	无	7	无	无	无
13	46	男	肿瘤	单侧	15	31	35	无	无	无	5	无	无	无
14	50	女	髁突粉碎性骨折	单侧	11	33	38	无	无	无	5	无	无	无
15	51	女	肿瘤	单侧	17	32	37	无	无	无	6	无	无	无
16	28	女	颞下颌关节强直	单侧	9	31	36	无	无	无	5	无	无	无

[1]	Yanan Wang, Yanli Huang, Dilxat Dilnur, Weilong Liu, Hui Li, Yi Wang, Lei Liu. Complications of supratemporalis approach with scalp coronal incision for orbital-zygomatic fracture [J]. West China Journal of Stomatology, 2017, 35(1): 73-76.
[2]	WANG Yu-liang1, YANG Chi2, QIU Ya-ting2, CHEN Min-jie2, ZHANG Shan-yong2. The clinical application of arthroscope-assisted reconstruction of the mandibular condyle with costochondral graft [J]. West China Journal of Stomatology, 2008, 26(05): 534-536.
[3]	WANG Yu - liang1, YANG Chi2, FANG Bing2, CHEN Min- jie2, ZHANG Wei- jie2. Condylar Resorption of Unknown Reason: Diagnosis and Tr eatment [J]. West China Journal of Stomatology, 2007, 25(03): 272-274.