My new approach

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My new approach

  1. 1. SURGICAL APPROACHES TO THE CONDYLE<br />Dr.S.Shanmugasundaram<br />READER<br />SRM DENTAL COLLEGE, RAMAPURAM<br />
  2. 2. SURGICAL ANATOMY<br />Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari<br />FACIAL NERVE – 2 TRUNKS<br />RETROMANDIBULAR VEIN<br />GREATER AURICULAR NERVE<br />PAROTID GLAND<br />
  3. 3. LOCATING THE FACIAL NERVE<br />A modified pre-auricular approach to the TMJ and malar arch, BJOMS 17(1979), 91-103.<br />Postglenoid tubercle<br />Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari<br />
  4. 4. Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari<br />
  5. 5. VARIOUS APPROACHES<br />RETROMANDIBULAR<br />PREAURICULAR <br />RHYTIDECTOMY<br />ENDAURAL<br />SUBMANDIBULAR<br />INTRAORAL<br />Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari<br />
  6. 6. Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari<br />RETROMANDIBULAR APPROACH<br />HINDS & GIROTTI 1958<br />
  7. 7. Courtesy :Edward Ellis<br />Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari<br />
  8. 8. Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari<br />
  9. 9. Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari<br />
  10. 10. Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari<br />
  11. 11. Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari<br />
  12. 12. VESNAVER – PERIAURICULAR APPROACH 2005<br />Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari<br />
  13. 13. RETROMANDIBULAR WITH MODIFIED TRANSPAROTID APPROACH<br />Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari<br />
  14. 14. Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari<br />
  15. 15. Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari<br />
  16. 16. Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari<br />
  17. 17. Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari<br />
  18. 18. Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari<br />
  19. 19. Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari<br />
  20. 20. PREAURICULAR APPROACH<br />History –<br />Early description by Blair – Inverted L incision<br />Dingman and Grabb modified – Making the angle between vertical and superior portions of incision more obtuse and rounding the angle of intersection.<br />Lempert and Shambaugh modified – Carrying the incision to varying degrees behind the tragus and into EAC , creating Endaural incision.<br />Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari<br />
  21. 21. Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari<br />Courtesy : Edward Ellis<br />
  22. 22. INCISIONS<br />Blair’s inverted hockey stick<br />Thoma’s Angulated Incision<br />Dingman’s Incision<br />Endaural Incision<br />Dingman’s incision<br />Endauralincison<br />Popowich and Crane incision<br />Post ramal<br />Posterior Auricular Incision<br />Popowich & Crane Incision<br />Posterior auricular<br />Submandibular<br />Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari<br />
  23. 23. THOMA’S ANGULATED INCISION<br />Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari<br />
  24. 24. Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari<br />
  25. 25. Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari<br />
  26. 26. AL-KAYAT BRAMLEY<br />A modified pre-auricular approach to the TMJ and malar arch, BJOMS 17(1979), 91-103.<br />Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari<br />
  27. 27. Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari<br />
  28. 28. Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari<br />
  29. 29. Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari<br />
  30. 30. MODIFIED ENDAURAL<br />Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari<br />
  31. 31. RHYTIDECTOMY APPROACH<br />Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari<br />
  32. 32. CERVICO FASCIAL RHYTIDECTOMY<br />Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari<br />
  33. 33. Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari<br />
  34. 34. LAZY S INCISION<br />Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari<br />
  35. 35. Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari<br />
  36. 36. Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari<br />
  37. 37. Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari<br />
  38. 38. SUBMANDIBULAR INCISION<br />Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari<br />
  39. 39. Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari<br />Courtesy: Edward Ellis<br />
  40. 40. Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari<br />
  41. 41. INTRAORAL APPROACH<br />Steinhauser (1964) was the first to report a successful osteosynthesis following intraoral approach.<br />Since then it has been used by Pape et al(1980), Horch et al (1983), Kitayama (1989)<br />It requires an incision through the vestibular<br /> mucosa along the anterior edge of the ascending ramus and the periosteum and masseter are reflected.<br />Miniplates are fixed by means of a transbuccaltrocar or an angled screwdriver.<br />Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari<br />
  42. 42. Intraoral Incision<br />Endoscopic <br />Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari<br />
  43. 43. ENDOSCOPIC APPROACH <br />Equipment–<br />30° angle 4mm diameter endoscope<br /> ( Karl Storz , Tuttlingen , Germany ) <br />Xenon light source <br />Suction and Irrigation device<br />Contra-angled handpiece<br />Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari<br />
  44. 44. COMPLICATIONS<br />Nerve injury<br /> -temporary <br /> -permanent<br />Sialocele<br />Infection<br />Hematoma<br />Bad scar.<br />Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari<br />
  45. 45. Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari<br />
  46. 46. POINTS TO REMEMBER<br />PREAURICULAR APPROACH :<br />High condylar fractures<br />Incision within 8mm<br />Temporal extension<br />Facial nerve identification<br />RETROMANDIBULAR APPROACH :<br />Subcondylar fractures<br />Modified transparotid dissection<br />Horizontal mattress suture.<br />Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari<br />
  47. 47. ACKNOWLEDGEMENT<br />FACULTY OF THE DEPT OF OMFS, SRMDC, RAMAPURAM, CHENNAI.<br />Dr. GUNASEELAN RAJAN, DIRECTOR, RAJAN DENTAL INSTITUTE, MYLAPORE, CHENNAI.<br /> BONE & JOINT HOSPITAL, <br /> ANNA NAGAR, CHENNAI. <br />Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari<br />
  48. 48. THANK YOU<br />Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari<br />

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