RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE KARNATAKA
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. NAME OF THE CANDIDATE AND ADDRESS
DR. JADHAV AJINATH N.
2. NAME OF THE INSTITUTION
P.M.N.M. DENTAL COLLEGE AND HOSPITAL BAGALKOT-587101
3. COURSE OF STUDY AND SUBJECT
Master of Dental Surgery (M.D.S.) Oral And Maxillofacial Surgery
4. DATE OF ADMISSON TO COURSE
3 May 2010
5. TITLE OF THE TOPIC
Comparison of different approaches for open reduction and fixation of condylar fracture.
6. BRIEF RESUME OF THE INTENDED WORK
6.1. NEED FOR THE STUDY
One of the relatively difficult fractures to reduce in mandible is fracture of condyle and there are various treatment modalities for the same but no consistent treatment of condylar fracture has gained universal acceptance.
Treatment of condylar fracture remains one of the most controversial issues whether it should be managed by open or closed reduction?
The intraoral approach to condylar fracture has become more popular in recent years, with advantages like a nonvisible scar and the risk of damage to facial nerve is minimized.
But certain disadvantages of intraoral approach like it is reserved for low subcondylar fracture because of access difficulty, extensive soft tissue reflection, difficulty in plate adaptation, and plate placement makes it less feasible.
We are conducting this study on various approaches for open reduction of condylar fracture to study feasibility of various approaches.
6.2. REVIEW OF LITERATURE
One of the study conducted using extraoral transmassetric antero-parotid approach for open reduction and internal fixation of condylar fracture. In which 2 patients treated by preauricular incision with retromandibular extension and third patient treated with a lazy- s incision, taking inferior extension in to the hairline. Post operatively the functional and cosmetic outcome was excellent with no evidence of weakness of facial neve, paraesthesia of great auricular nerve or frey’s syndrome1
In one of the study 40 patients with displaced or dislocated fractures of mandible, condyles were treated by open reduction and internal fixation. In 20 patients (21 fractures) an intraoral approach and in other 20(24 fracture) an extraoral approach was used. The results were compared by means of clinical, axiographical and radiological evaluation; with regard to function 6 month post operatively. While almost all fractures were correctly reduced following application of an extraoral approach, reduction was correct in only 50% of the patient treated with an intraoral approach. Redisplacement and complications during osteosynthesis were the reasons.2
In other study ten identical synthetic mandibles were used. Simulated bilateral condyle neck fracture were fixed with lag screw plate system on one side and miniplate system on other. The mandibles were loaded with an MTS SERVOHYDRAULIC testing machine at a rate of 1cm/min until failure was reached. Data for resistance to motion and ultimate strength for each fixation device were compared by pared student T-test. In lab testing lag screw fixation system proved superior to a 4 hole mini plate system in regard to resistance to motion and failure strength. Clinical trials are necessary to substantiate these lab data and determine whether the system can be effectively applied by surgeon.3
In another study the authors reviewed the anatomy and surgical approaches for treating fractures of the mandibular condyle with plate and screw fixation. Advantage and disadvantage of preauricular, submandibular and intraoral approaches were also presented. They documented that accessibility and exposure of fracture site was good with retromandibular approach and also injury to facial nerve was less than that of preauricular approach .Two advantages of intraoral approach were, firstly, scar was avoided and secondly, the risk of damage to facial nerve was minimized. But major disadvantage was limited access4.
In other study open reduction and miniplate osteosynthesis was performed in 57 joints of 55 dentate patients (37 male,18 female) with a total of 64 fractures of condylar head and neck. 7 remaining patients were treated either with lag screw or pin osteosynthesis. In this study, they concluded that intraoral approach was indicated when scars in the head and neck regions and facial nerve injury were to be avoided5
In this study about 300 patients with mandibular fracture were treated each year. Of these slightly less than one third had condylar fracture. The absolute indication for open reduction were, displacement in to middle cranial fossa, impossibility of obtaining adequate occlusion by close reduction , lateral extracapsular displacement of condyle and invasion by a foreign body. Factors influencing the selection of method of open reduction were, position of condyle, location of condyle, duration of fracture, and amount of oedema. Cases were approached with face lift approach combined with preauricular incision in some cases6
In one of the study carried out to assess the morbidity of the retro-mandibular approach in the management of condylar fractures 20 patients underwent open reduction and internal fixation using this technique . Branches of facial nerve encountered in 6 cases temporary weakness of facial nerve in 6 patients which resolved completely within 3 months without permanent damage.2 patients had temporary deficit of greater auricular nerve with resolution7.
6.3. OBJECTIVES OF THE STUDY
1) To evaluate the viability of different approach and to compare these approaches for the management of condylar fracture.
2) To assess the risk and benefits associated with these approaches.
7. MATERIAL AND METHODS
7.1. SOURCE OF DATA
Patient reporting to Department of Oral and Maxillofacial surgery, PMNM Dental College, Bagalkot for the treatment of condylar fracture.
7.2. METHOD OF COLLECTION OF DATA
A total of 10 cases with condylar fracture requiring open reduction and fixation reporting to the Department Oral and Maxillofacial Surgery P.M.N.M. Dental College Bagalkot and will be treated by one of the extraoral or intraoral approach randomly.
A detailed history with clinical examination, orthopantomogram (OPG), computed tomography scan and preoperatively will be done.
Post operative clinical evaluation will include assessment of mouth opening (inter incisal distance), occlusion and deviation of mandible on mouth opening will be done six week post operatively.
Inclusion criteria:
1. Unilateral/bilateral condylar fracture without gross comminution of fracture segments.
2. Unilateral/bilateral condylar fracture with/without associated mandibular fracture.
3. Patient willing to participate in study.
Exclusion criteria:
1. Severely infected fractures with large hematoma
2. Grossly comminuted fractures with extensive damage of fractured bony segment
3. Medically compromised patient.
7.3. DOES OUR STUDY REQUIRE ANY INVESTIGATION INTERVATION TO BE CONDUCTED ON PATIENT ON OTHER HUMAN OR ANIMALS? Yes
Investigation required:
1) Complete blood examination.
2) Serum bio-chemistry.
3) Clinical examination of the fractured segment.
4) Radiographic examination (orthopantomogram).
5) Computed tomography scan.
6) 3-D facial reconstruction CT scan.
7.4. HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF 7.3?
Yes
8. LIST OF REFERENCES
1. A. W. WILSON, M. ETHUNANDAN, P. A. BRENNAN Transmassetric anteroparotid approach for open reduction and internal fixation of condylar fracture. British journal of oral and maxillofacial surgery(2005)43,57-60.
2.Matthias,Schneider,gunter lauer, uwe ecaelt -a comparison of long term result following different approaches-functional axiographical and radiological findings journal of cranio maxillofacial surgery(2007) 35,151-160
3.Vincent v,ziccardi dds,Ronald e Schneider dds, fred j. kaummers phd journal of oral maxillofacial surgey(1997) 55, 602-607
4.Edward ellisIII dds,jeffrey dean dds dallas Rigid fixation of mandibular condyle fractures journal of oral surgery oral medicine oral pathology(1993) 76, 6-15
5.Jerhard undt,Christian karmar,Michael rasse,Klaus sinko,rolf ewers Trans oral miniplate osteosynthesis of condylar neck fracture oral surgery oral medicine oral pathology oral radiology endodontics(1999) 88,534-543
6.michael f.zide dds,john kent dds indication for open reduction of mandible condylar fracture journal oral maxillofacial surgery(1983) 41,89
7. M. Manisali, M. Amin, L. Newman, Retromandibular approach to the mandibular condyle: a clinical and cadaveric study, Int. Journal of Oral and Maxillofacial Surgery (2003), 32; 253-256
9. SIGNATURE OF THE CANDIDATE
10. REMARKS OF THE GUIDE
11.1. NAME AND DESIGNATION OF GUIDE
DR. S.S. GUDI
M.D.S.
PROFESSOR ,
DEPARTMENT OF ORAL AND MAXILLOFACIAL SURGERY
P.M.N.M. DENTAL COLLEGE AND HOSPITAL,
BAGALKOT – 587101 (KARNATAKA)
11.2. SIGNATURE OF THE GUIDE
11.3. NAME AND DESIGNATION OF THE CO -GUIDE
11.4. SIGNATURE OF THE CO GUIDE
11.5. HEAD OF THE DEPARTMENT
DR B.C.SIKKERIMATH MDS
PROFESSOR AND HEAD,
DEPARTMENT OF ORAL AND MAXILLOFACIAL SURGERY,
P.M.N.M. DENTAL COLLEGE AND HOSPITAL,
BAGALKOT – 587101(KARNATAKA)
11.6. SIGNATURE OF THE HEAD OF THE DEPARTMENT
12.1. REMARKS OF THE PRINCIPAL
12.2. SIGNATURE OF THE PRINCIPAL