الفهرس | Only 14 pages are availabe for public view |
Abstract Mandibular fractures, including fractures of the subcondylar and condylar regions, are common facial fractures . Sub condylar fractures account for 20–62% of all mandibular fractures. But their management remains controversial . Although closed reduction is the most useful method, it can be difficult to achieve anatomical reduction with this technique compared with open reduction and internal fixation (ORIF). Among the numerous surgical methods that can be used in the treatment of subcondylar fracture ,, extraoral rather than intraoral approaches are generally preferred because they can be provided a sufficient surgical vision. However, compared with intraoral approaches, extraoral approaches commonly have a high rate of postoperative complications, such as salivary fistula formation, visible scarring, and facial nerve injury. The most surgeons agreed the consensus that the proper surgical indications for ORIF are the displaced bilateral or unilateral fractures of the mandibular condylar neck or subcondyle. Therefore, in this study we will compare the clinical results achieved with different intraoral approach using an angulated screwdriver,transparotid and retromandibular approaches in patients with subcondylar fractures of the mandible The main results of the study revealed that: As demonstrated in Figure 2, male patients accounted for 71.4%, 57.1%, and 66.7% of groups A, B, and C, respectively. On the other hand, female patients accounted for 28.6%, 42.9%, and 33.3% of groups A, B, and C, respectively. As shown in Table 3, no statistically significant difference was found between groups regarding gender distribution (Chi-square test, P = 0.850). As demonstrated in Figure 3, right side was involved in four (57.1%), five (71.4%), and four (66.7%) patients in groups A, B, and C, respectively. Left side was involved in two (28.6%)in group A, one (14.3%) in group B, and two (33.3%) patients in group C. Bilateral involvement was reported in one (14.3%) patient in group A, and one (14.3%) patient in group B. As shown in Table 4, no statistically significant difference was found between groups regarding side distribution (Chi-square test, P = 0.828). As demonstrated in Figure 4, RTA was reported in five (74.1%), four (57.1%), and three (50%) patients in groups A, B, and C, respectively. FFH was reported in two (28.6%) patients in group A, two (28.6%) in group B, and two (33.3%) in group C. Assault was reported in one (14.3%) patient in group B, and one (14.3%) patient in group C. As shown in Table 5, no statistically significant difference was found between groups regarding mechanism of injury (Chi-square test, P = 0.846). As demonstrated in Figure 5, deviated fracture was observed in two (28.6%), three (42.9%), and two (28.6%) patients in groups A, B, and C, respectively. Displaced fractures were reported in four (57.1%) patients in group A, two (28.6%) in group B, and three (50%) in group C. Dislocation was reported in one (14.3%) patient in group A, two (28.6%) patients in group B, and one (16.7%) patient in group C. As shown in Table 6, no statistically significant difference was found between groups regarding Lindahl classification (Chi-square test, P = 0.862). As demonstrated in Figure 6, closed fracture accounted for 71.4%, 57.1%, and 66.7% of groups A, B, and C, respectively. On the other hand, open fracture was reported in 28.6%, 42.9%, and 33.3% of groups A, B, and C, respectively. As shown in Table 7, no statistically significant difference was found between groups regarding fracture type (Chi-square test, P = 0.776). As demonstrated in Figure 7, isolated subcondylar mandibular fractures were reported in three (42.9%), three (42.9%), and three (50%) patients in groups A, B, and C, respectively. Associated symphyseal fractures were reported in two (28.6%) patients in group A, one (14.3%) patient in group B, and one (16.7%) patient in group C. Associated parasymphyseal fractures were reported in two (28.6%) patients in group A, three (42.9%) patients in group B, and two (33.3%) patients in group C. |