Abstract
Purpose
The purpose of this anatomic study was to compare the retraction force necessary to expose the mandibular neck in the Risdon and the high cervical anteroparotid transmasseteric (HAT) approaches.
Methods
An anatomic study was performed on 18 formalin-embalmed cadavers. We performed a Risdon approach on the left side, and an HAT approach on the right side in all the cases. The subjects were placed in a normative frame and the force necessary to maintain a satisfactory exposure of the condyle was measured with a system of cables, pulleys, and mechanical dynamometer. The statistical comparison between the two sides was carried out using the Wilcoxon signed-rank test for paired series.
Results
In all the cases, the region of interest was exposed as in the operating room. In the Risdon approach, the mean force was 32 Newtons (4–47). In the HAT approach, the mean force was 19 Newtons (4–33). The difference was statistically significant (p < 0.001). The age, gender, and duration of conservation had no influence on the retraction force.
Conclusion
In the HAT approach, the retraction of the soft tissues was significantly lower than in the Risdon approach. This study gave an additional explanation to the remarkable safety of the HAT approach. Our results were in favor of the generalization of this technique.
Similar content being viewed by others
References
Arcuri F, Bruccoli M, Baragiotta N, Benech R, Ferrero S, Benech A (2012) Analysis of complications following endoscopically assisted treatment of mandibular condylar fractures. J Craniofac Surg 23:196–198. doi:10.1097/SCS.0b013e31824de328
Al-Moraissi EA, Ellis E 3rd (2015) Surgical treatment of adult mandibular condylar fractures provides better outcomes than closed treatment: a systematic review and meta-analysis. J Oral Maxillofac Surg 73:482–493. doi:10.1016/j.joms.2014.09.027
Benkhadra M, Bouchot A, Gérard J, Genelot D, Trouilloud P, Martin L, Girard C, Danino A, Anderhuber F, Feigl G (2011) Flexibility of Thiel’s embalmed cadavers: the explanation is probably in the muscles. Surg Radiol Anat 33:365–368. doi:10.1007/s00276-010-0703-8
Bhutia O, Kumar L, Jose A, Roychoudhury A, Trikha A (2014) Evaluation of facial nerve following open reduction and internal fixation of subcondylar fracture through retromandibular transparotid approach. Br J Oral Maxillofac Surg 52:236–240. doi:10.1016/j.bjoms.2013.12.002
Cheynet F, Aldegheri A, Chossegros C, Bourezak Z, Blanc JL (1997) The retromandibular approach in fractures of the mandibular condyle. Rev Stomatol Chir Maxillofac 98:288–294
Chrcanovic BR (2015) Surgical versus non-surgical treatment of mandibular condylar fractures: a meta-analysis. Int J Oral Maxillofac Surg 44:158–179. doi:10.1016/j.ijom.2014.09.024
Cranin AN, Brooklyn NY (1975) Comparison of two submandibular incisions on the motor function of lower lip. Oral Surg Oral Med Oral Pathol 40:327–332
Eckelt U, Gerber S (1981) Draw-screw osteosynthesis with a novel osteosynthesis instrument set in mandibular condyle fractures. Zahn Mund Kieferheilkd Zentralbl 69:485–490
Ellis E 3rd, McFadden D, Simon P, Throckmorton G (2000) Surgical complications with open treatment of mandibular condylar process fractures. J Oral Maxillofac Surg 58:950–958
Ellis E III, Zide MF (1995) Surgical approaches to facial skeleton. LWW, Philadelphia
Kadlub N, Trost O, Duvernay A, Parmentier J, Wirth C, Malka G (2008) Orthopaedic treatment of extraarticular condylar fractures of the mandible: retrospective study of 39 unilateral cases. Rev Stomatol Chir Maxillofac 109:301–305. doi:10.1016/j.stomax.2008.05.005
Lee L, Mueller RV, Lee K, Mathes SJ (1998) Endoscopic subcondylar fracture repair: functional, aesthetic and radiographic outcomes. Plast Reconstr Surg 102:1434–1443
Meyer C, Zink S, Chatelain B, Wilk A (2008) Clinical experience with osteosynthesis of subcondylar fractures of the mandible using TCP plates. J Craniomaxillofac Surg 36:260–268. doi:10.1016/j.jcms.2008.01.002
Meyer C, Zink S, Wilk A (2006) Modified Risdon approach for the treatment of subcondylar fractures of the mandible. Rev Stomatol Chir Maxillofac 107:449–454
Nassif PS, Kokoska MS, Homan S, Cooper MH, Thomas JR (1998) Comparison of subperiosteal vs subgaleal elevation techniques used in forehead lifts. Arch Otolaryngol Head Neck Surg 124:1209–1215
Rastogi S, Sharma S, Kumar S, Reddy MP, Niranjanaprasad Indra B (2015) Fracture of mandibular condyle—to open or not to open: an attempt to settle the controversy. Oral Surg Oral Med Oral Pathol Oral Radiol 119:608–613. doi:10.1016/j.oooo.2015.01.012
Risdon F (1933) Ankylosis of the temporomaxillary joint. Am Dent Assoc 21:933
Shi D, Patill PM, Gupta R (2015) Facial nerve injuries associated with the retromandibular transparotid approach for reduction and fixation of mandibular condyle fracture. J Craniomaxillofac Surg 43:402–407. doi:10.1016/j.jcms.2014.12.009
Tang W, Gao C, Long J, Lin Y, Wang H, Liu L, Tian W (2009) Application of modified retromandibular approach indirectly from the anterior edge of the parotid gland in the surgical treatment of condylar fracture. J Oral Maxillofac Surg 67:552–558. doi:10.1016/j.joms.2008.06.066
Throckmorton GS, Ellis E 3rd (2000) Recovery of mandibular motion after closed and open treatment of unilateral mandibular condylar process fractures. Int J Oral Maxillofac Surg 29:421–427
Trost O, Abu El-Naaj I, Trouilloud P, Danino A, Malka G (2008) High cervical transmasseteric anteroparotid approach for open reduction and internal fixation of condylar fracture. J Oral Maxillofac Surg 66:201–204
Trost O, Trouilloud P, Malka G (2009) Open reduction and internal fixation of low subcondylar fractures of mandible through high cervical transmasseteric anteroparotid approach. J Oral Maxillofac Surg 67:2446–2451. doi:10.1016/j.joms.2009.04.109
Trost O, Péron JM (2013) Latest trends in the surgical management of mandibular condyle fractures in France, 2005–2012. Rev Stomatol Chir Maxillofac Chir Orale 114:341–348. doi:10.1016/j.revsto.2013.05.004
Wang TM, Lin CL, Kuo KJ, Shih C (1991) Surgical anatomy of the mandibular ramus of the facial nerve in Chinese adults. Acta Anat (Basel) 142:126–131
Woltmann M, Faveri Rd, Sgrott EA (2006) Anatomosurgical study of the marginal mandibular branch of the facial nerve for submandibular surgical approach. Braz Dent J 17:71–74
Ziarah HA, Atkinson ME (1981) The surgical anatomy of the cervical distribution of the facial nerve. Br J Oral Surg 19:171–179
Zrounba H, Lutz JC, Zink S, Wilk A (2014) Epidemiology and treatment outcome of surgically treated mandibular condyle fractures. A five years retrospective study. J Craniomaxillofac Surg 42:879–884. doi:10.1016/j.jcms.2014.01.002
Acknowledgements
We thank Mr. Belloncle, technician in the laboratory of anatomy, for his help and support, and Dr. Mher Berje Joulakian, MD, for his experience in biostatistics.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare no conflicts of interest as far as this study is concerned.
Rights and permissions
About this article
Cite this article
Adnot, J., Feuss, A., Duparc, F. et al. Retraction force necessary to expose the mandibular neck in Risdon and high cervical anteroparotid transmasseteric approaches: an anatomic comparative study. Surg Radiol Anat 39, 1079–1084 (2017). https://doi.org/10.1007/s00276-017-1853-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00276-017-1853-8