My new approach

SURGICAL APPROACHES TO THE CONDYLE

Dr.S.ShanmugasundaramREADER

SRM DENTAL COLLEGE, RAMAPURAM

Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari

SURGICAL ANATOMY

GREATER AURICULAR NERVEPAROTID GLAND

FACIAL NERVE – 2 TRUNKSRETROMANDIBULAR VEIN

LOCATING THE FACIAL NERVE

Postglenoid tubercleA modified pre-auricular approach to the TMJ and malar arch, BJOMS 17(1979), 91-103.

VARIOUS APPROACHES

• RETROMANDIBULAR• PREAURICULAR • RHYTIDECTOMY• ENDAURAL• SUBMANDIBULAR• INTRAORAL

HINDS & GIROTTI 1958

RETROMANDIBULAR APPROACH

Dr.S.Shanmugasundaram, 15th AOMSI, KanyakumariCourtesy :Edward Ellis

VESNAVER – PERIAURICULAR APPROACH 2005

RETROMANDIBULAR WITH MODIFIED TRANSPAROTID APPROACH

PREAURICULAR APPROACH

History –

• Early description by Blair – Inverted L incision

• Dingman and Grabb modified – Making the angle between vertical and superior portions of incision more obtuse and rounding the angle of intersection.

• Lempert and Shambaugh modified – Carrying the incision to varying degrees behind the tragus and into EAC , creating Endaural incision.

Courtesy : Edward Ellis

INCISIONS

Thoma’s Angulated Incision

Dingman’s Incision

Popowich & Crane Incision

Endaural Incision

Posterior Auricular Incision

Post ramal

Submandibular

Blair’s inverted hockey stick

Dingman’s incision

Endaural incison

Popowich and Crane incision

Posterior auricular

THOMA’S ANGULATED INCISION

AL-KAYAT BRAMLEY

A modified pre-auricular approach to the TMJ and malar arch, BJOMS 17(1979), 91-103.

MODIFIED ENDAURAL

RHYTIDECTOMY APPROACH

CERVICO FASCIAL RHYTIDECTOMY

LAZY S INCISION

SUBMANDIBULAR INCISION

Dr.S.Shanmugasundaram, 15th AOMSI, KanyakumariCourtesy: Edward Ellis

INTRAORAL APPROACH

• Steinhauser (1964) was the first to report a successful osteosynthesis following intraoral approach.

• Since then it has been used by Pape et al(1980), Horch et al (1983), Kitayama (1989)

• It requires an incision through the vestibular mucosa along the anterior edge of the ascending ramus and

the periosteum and masseter are reflected.• Miniplates are fixed by means of a transbuccal trocar or an

angled screwdriver.

Intraoral Incision

Endoscopic

ENDOSCOPIC APPROACH

Equipment – • 30° angle 4mm diameter endoscope ( Karl Storz , Tuttlingen , Germany ) • Xenon light source • Suction and Irrigation device• Contra-angled handpiece

COMPLICATIONS• Nerve injury -temporary -permanent• Sialocele• Infection• Hematoma• Bad scar.

POINTS TO REMEMBER

PREAURICULAR APPROACH :• High condylar fractures• Incision within 8mm• Temporal extension• Facial nerve identification

RETROMANDIBULAR APPROACH :• Subcondylar fractures• Modified transparotid dissection• Horizontal mattress suture.

ACKNOWLEDGEMENT

• FACULTY OF THE DEPT OF OMFS, SRMDC, RAMAPURAM, CHENNAI.

• Dr. GUNASEELAN RAJAN, DIRECTOR, RAJAN DENTAL INSTITUTE, MYLAPORE, CHENNAI.

• BONE & JOINT HOSPITAL, ANNA NAGAR, CHENNAI.

THANK YOU

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