Tomoaki Imai1,2, Yusei Fujita3, Hiroo Takaoka4, Ayako Motoki5, Tomohiko Kanesaki6,3, Yoshiyuki Ota7,8, Hirohisa Chisoku4, Masatoshi Ohmae5, Tetsuro Sumi3, Mitsuhiro Nakazawa7, Narikazu Uzawa7. 1. Department of Oral and Maxillofacial Surgery II, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan. hsc12@hotmail.com. 2. Department of Oral and Maxillofacial Surgery, Saiseikai Senri Hospital, Suita, Osaka, Japan. hsc12@hotmail.com. 3. Department of Oral and Maxillofacial Surgery, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan. 4. Department of Oral and Maxillofacial Surgery, Higashiosaka City Medical Center, Higashiosaka, Osaka, Japan. 5. Department of Oral and Maxillofacial Surgery, Rinku General Medical Center, Izumisano, Osaka, Japan. 6. Department of Oral and Maxillofacial Surgery, Saiseikai Senri Hospital, Suita, Osaka, Japan. 7. Department of Oral and Maxillofacial Surgery II, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan. 8. Department of Oral and Maxillofacial Surgery, Itami City Hospital, Itami, Hyogo, Japan.
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.
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.
Authors: T Imai; Y Fujita; A Motoki; H Takaoka; T Kanesaki; Y Ota; S Iwai; H Chisoku; M Ohmae; T Sumi; M Nakazawa; N Uzawa Journal: Int J Oral Maxillofac Surg Date: 2019-03-02 Impact factor: 2.789
Authors: Howard D Wang; Srinivas M Susarla; Gerhard S Mundinger; Benjamin D Schultz; Robin Yang; Branko Bojovic; Michael R Christy; Paul N Manson; Eduardo D Rodriguez; Amir H Dorafshar Journal: Plast Reconstr Surg Date: 2016-06 Impact factor: 4.730