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Longitudinal study of risk for facial nerve injury in mandibular condyle fracture surgery: marginal mandibular branch-traversing classification of percutaneous approaches

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Abstract

Objective

This study aimed to longitudinally assess the risk of facial nerve injury (FNI) in the surgical repair of mandibular condylar neck and subcondylar fractures (CN/SCFs) and to explore its predictors.

Materials and methods

In a retrospective cohort study, the outcome was defined as FNI at 1 week and 1, 3, and 6 months postoperatively. Potential predictors included age, sex, etiology, fracture site and pattern (dislocation/non-dislocation), concomitant facial fractures, interval to surgery, surgeons’ experience, plate types, and the marginal mandibular branch-traversing approach (deep/superficial group). We employed generalized estimating equations (GEEs) for repeated measurements throughout the 6-month follow-up period.

Results

Among 102 patients with 114 fractures, 27 patients (26.5%) developed FNI within 1 week. Prolonged FNI (≥ 1 month) occurred in 19 (19.2%) of 99 patients. Multivariate GEE analyses revealed that deep surgical approaches (i.e., traditional submandibular and retroparotid approaches; odds ratio [OR], 18.90; p = 0.011), fractures with dislocation (OR, 3.60; p = 0.025), and female gender (OR, 2.71; p = 0.040) were independently associated with the overall FNI risk. Additionally, the deep approaches (OR, 15.91; p = 0.014) and female gender (OR, 3.41; p = 0.035) were correlated with a prolonged FNI risk. Sensitivity analyses for the outcomes identified the same predictors.

Conclusion

The predictors longitudinally associated with FNI in CN/SCF surgeries included a deep MMB-traversing approach, dislocated fracture, and female gender.

Clinical relevance

The superficial surgical approaches (i.e., transparotid, transmasseteric anteroparotid, and high perimandibular approaches) should be adopted for CN/SCF treatment to minimize postoperative morbidity, especially for female patients with dislocated condyles.

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Acknowledgments

The authors thank Dr. Hiroyuki Kuragami in the Data Coordinating Center, Translational Research Center for Medical Innovation, Osaka University Hospital, for statistical consultation.

Author information

Authors and Affiliations

  1. Department of Oral and Maxillofacial Surgery II, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan

    Tomoaki Imai, Yoshiyuki Ota, Mitsuhiro Nakazawa & Narikazu Uzawa

  2. Department of Oral and Maxillofacial Surgery, Saiseikai Senri Hospital, Suita, Osaka, Japan

    Tomoaki Imai & Tomohiko Kanesaki

  3. Department of Oral and Maxillofacial Surgery, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan

    Yusei Fujita, Tomohiko Kanesaki & Tetsuro Sumi

  4. Department of Oral and Maxillofacial Surgery, Higashiosaka City Medical Center, Higashiosaka, Osaka, Japan

    Hiroo Takaoka & Hirohisa Chisoku

  5. Department of Oral and Maxillofacial Surgery, Rinku General Medical Center, Izumisano, Osaka, Japan

    Ayako Motoki & Masatoshi Ohmae

  6. Department of Oral and Maxillofacial Surgery, Itami City Hospital, Itami, Hyogo, Japan

    Yoshiyuki Ota

Authors
  1. Tomoaki Imai
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Contributions

Tomoaki Imai participated in all aspects of the development and completion of this research, including literature search, study design, data collection and analysis, and drafting of the manuscript. Yusei Fujita participated in literature search, data collection and analysis, and drafting of the manuscript. Hiroo Takaoka, Ayako Motoki, Tomohiko Kanesaki, Yoshiyuki Ota, and Masatoshi Ohmae collected data and critical revision of the manuscript. Hirohisa Chisoku, Tetsuro Sumi, Mitsuhiro Nakazawa, and Narikazu Uzawa contributed to data interpretation and critical revision of the manuscript. All the authors approved the final manuscript.

Corresponding author

Correspondence to Tomoaki Imai.

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The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the internal review boards of Osaka University Graduate School of Dentistry and was conducted in accordance with the Declaration of Helsinki.

Informed consent

The requirement to obtain informed consent was waived by the internal review boards because of the retrospective design.

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Imai, T., Fujita, Y., Takaoka, H. et al. Longitudinal study of risk for facial nerve injury in mandibular condyle fracture surgery: marginal mandibular branch-traversing classification of percutaneous approaches. Clin Oral Invest 24, 1445–1454 (2020). https://doi.org/10.1007/s00784-019-03163-w

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