INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

www.indiandentalacademy.com
TRANSMASSETRIC ANTERO – PAROTID
APPROACH FOR OPEN REDUCTION
AND INTERNAL FIXATION OF
CONDYLAR FRACTURES
www.indiandentalac...
- BJOMFS
- 2005 , 43
- A.W.WILSON , M.ETHUNANDAN
- QUEEN ALEXANDERA HOSPITAL
- PORTSMOUTH , UK
www.indiandentalacademy.com
AIM :
Technique offering swift access to
condylar
neck fracture with reduced risk of facial
nerve injury eliminating compl...
SHORT COMINGS :
- Limited access
- Injury to facial nerve

www.indiandentalacademy.com
TECHNIQUE :
- Pre auricular incision extending to cervico
mastiod skin crease
- Great auricular nerve preserved
- Flap rai...
FLAP

INCISION

www.indiandentalacademy.com
CONT…
- Branches of facial nerve identified avoided
on surface of masseter
- Nerve stimulator
- Buccal branch – mostly see...
CONT…
- Masseter split in direction of fibres
- Sever the fibres in deeper plane , change of
direction
- Periosteum over r...
FRACTURE

www.indiandentalacademy.com

FIXATION
CASE REPORTS :
- 3 patients with bilateral condylar fracture

- 2 patients – pre auricular with retromandibular
extension
...
Results :
- Excellent functional and cosmetic outcome
- No facial nerve weakness
- No paresthesia of great auricular nerve...
DISCUSSION :
OTHER APPROACHES ;
- Access difficulty
- Forceful retraction
- Non reduction of medially displaced condyle
- ...
CONT…
SUBMANDIBULAR APPROACH ;
- Injury to marginal mandibular nerve

PREAURICULAR APPROACH ;
- Injury to temporal and zyg...
CROSS ANASTOMOSIS :
- Zygomatic and buccal – 87% - 90%
- Marginal mandibular – 0% - 16%
-Vulnerability in both approaches
...
TMAP :
- Only buccal branch encountered
- Easily identified and retracted
- Excellent anastomosis – less risky
- Cosmetica...
www.indiandentalacademy.com
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Trasmassetric open approch for condylar /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in

continuing dental education , training dentists

in all aspects of dentistry and offering a wide

range of dental certified courses in different

formats.

Indian dental academy provides dental crown &

Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit

www.indiandentalacademy.com ,or call
0091-9248678078

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Trasmassetric open approch for condylar /certified fixed orthodontic courses by Indian dental academy

  1. 1. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. TRANSMASSETRIC ANTERO – PAROTID APPROACH FOR OPEN REDUCTION AND INTERNAL FIXATION OF CONDYLAR FRACTURES www.indiandentalacademy.com
  3. 3. - BJOMFS - 2005 , 43 - A.W.WILSON , M.ETHUNANDAN - QUEEN ALEXANDERA HOSPITAL - PORTSMOUTH , UK www.indiandentalacademy.com
  4. 4. AIM : Technique offering swift access to condylar neck fracture with reduced risk of facial nerve injury eliminating complications associated with transparotid approach www.indiandentalacademy.com
  5. 5. SHORT COMINGS : - Limited access - Injury to facial nerve www.indiandentalacademy.com
  6. 6. TECHNIQUE : - Pre auricular incision extending to cervico mastiod skin crease - Great auricular nerve preserved - Flap raided in sub dermal fat plane - Superficial to musculoaponeurotic layer - Allows access to masseter adjacent to parotid gland at is anteroinferior edge www.indiandentalacademy.com
  7. 7. FLAP INCISION www.indiandentalacademy.com
  8. 8. CONT… - Branches of facial nerve identified avoided on surface of masseter - Nerve stimulator - Buccal branch – mostly seen - Area next to anterior edge is free of branches - This an ideal point to dissect down - Buccal branch – easily retracted www.indiandentalacademy.com
  9. 9. CONT… - Masseter split in direction of fibres - Sever the fibres in deeper plane , change of direction - Periosteum over ramus in condylar region incised – fracture site exposed - If not retract the upper edge - Fracture reduced and fixed,closure with drain www.indiandentalacademy.com - Duration about 20 – 25 min
  10. 10. FRACTURE www.indiandentalacademy.com FIXATION
  11. 11. CASE REPORTS : - 3 patients with bilateral condylar fracture - 2 patients – pre auricular with retromandibular extension - 1 patient – lazy – s incision with inferior extension to hairline www.indiandentalacademy.com
  12. 12. Results : - Excellent functional and cosmetic outcome - No facial nerve weakness - No paresthesia of great auricular nerve - No Frey’s syndrome www.indiandentalacademy.com
  13. 13. DISCUSSION : OTHER APPROACHES ; - Access difficulty - Forceful retraction - Non reduction of medially displaced condyle - Facial nerve injury – 30 %– 48% www.indiandentalacademy.com
  14. 14. CONT… SUBMANDIBULAR APPROACH ; - Injury to marginal mandibular nerve PREAURICULAR APPROACH ; - Injury to temporal and zygomatic branches www.indiandentalacademy.com
  15. 15. CROSS ANASTOMOSIS : - Zygomatic and buccal – 87% - 90% - Marginal mandibular – 0% - 16% -Vulnerability in both approaches www.indiandentalacademy.com
  16. 16. TMAP : - Only buccal branch encountered - Easily identified and retracted - Excellent anastomosis – less risky - Cosmetically acceptable www.indiandentalacademy.com
  17. 17. www.indiandentalacademy.com

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