My new approach
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Transcript of My new approach
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SURGICAL APPROACHES TO THE CONDYLE
Dr.S.ShanmugasundaramREADER
SRM DENTAL COLLEGE, RAMAPURAM
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Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
SURGICAL ANATOMY
GREATER AURICULAR NERVEPAROTID GLAND
FACIAL NERVE – 2 TRUNKSRETROMANDIBULAR VEIN
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Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
LOCATING THE FACIAL NERVE
Postglenoid tubercleA modified pre-auricular approach to the TMJ and malar arch, BJOMS 17(1979), 91-103.
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Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
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VARIOUS APPROACHES
• RETROMANDIBULAR• PREAURICULAR • RHYTIDECTOMY• ENDAURAL• SUBMANDIBULAR• INTRAORAL
Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
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Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
HINDS & GIROTTI 1958
RETROMANDIBULAR APPROACH
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Dr.S.Shanmugasundaram, 15th AOMSI, KanyakumariCourtesy :Edward Ellis
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Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
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Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
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Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
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Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
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Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
VESNAVER – PERIAURICULAR APPROACH 2005
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Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
RETROMANDIBULAR WITH MODIFIED TRANSPAROTID APPROACH
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Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
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Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
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Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
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Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
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Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
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Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
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Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
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.
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Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
Courtesy : Edward Ellis
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Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
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
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Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
THOMA’S ANGULATED INCISION
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Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
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Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
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Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
AL-KAYAT BRAMLEY
A modified pre-auricular approach to the TMJ and malar arch, BJOMS 17(1979), 91-103.
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Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
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Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
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Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
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Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
MODIFIED ENDAURAL
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Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
RHYTIDECTOMY APPROACH
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Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
CERVICO FASCIAL RHYTIDECTOMY
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Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
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Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
LAZY S INCISION
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Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
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Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
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Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
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Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
SUBMANDIBULAR INCISION
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Dr.S.Shanmugasundaram, 15th AOMSI, KanyakumariCourtesy: Edward Ellis
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Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
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Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
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.
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Intraoral Incision
Endoscopic
Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
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Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
ENDOSCOPIC APPROACH
Equipment – • 30° angle 4mm diameter endoscope ( Karl Storz , Tuttlingen , Germany ) • Xenon light source • Suction and Irrigation device• Contra-angled handpiece
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Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
COMPLICATIONS• Nerve injury -temporary -permanent• Sialocele• Infection• Hematoma• Bad scar.
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Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
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Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
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.
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Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
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.
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Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
THANK YOU