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CASE REPORT
Ahead of print publication  

A technique for mandibular distraction to reduce medially dislocated condylar fracture


1 Department of Oral and Maxillofacial Surgery, Army Dental Centre (Research and Referral), Delhi, India
2 Oral and Maxillofacial Surgeon, 303 Field Hospital, New Delhi, India

Date of Submission31-Mar-2020
Date of Decision26-Apr-2020
Date of Acceptance21-May-2020
Date of Web Publication04-Nov-2020

Correspondence Address:
Himanshu Thukral,
Department of Oral and Maxillofacial Surgery, Army Dental Centre (Research and Referral), Delhi
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/sjos.SJOralSci_19_20

  Abstract 


The treatment of condylar fractures in oral and maxillofacial trauma, where an open reduction and internal fixation has to be done, is still a controversial note. However, when taken a decision by the surgeon to operate, there are many difficulties on the operation theatre table, reducing the proximal condylar stump and applying mini fixtures. The techniques to reduce the condylar stump are endorsed in the medical literature. We report a different technique with the use of simple armamentarium, a 24G intravenous catheter, which facilitates better visualization of the proximal segment by distracting the distal segment for open reduction and internal fixation of condylar fractures.

Keywords: Condylar fractures, distal segment, temporomandibular joint



How to cite this URL:
Thukral H, Jose A, Roy ID, Chattopadhyay P K, Nagori SA. A technique for mandibular distraction to reduce medially dislocated condylar fracture. Saudi J Oral Sci [Epub ahead of print] [cited 2020 Nov 25]. Available from: https://www.saudijos.org/preprintarticle.asp?id=299964




  Introduction Top


Condylar fractures are sometimes difficult to reduce, especially when the proximal condylar segment is dislocated medially. Disturbance of occlusal function, deviation of the mandible, internal derangements of the temporomandibular joint, and ankylosis of the joint with the resultant inability to move the jaw are all sequelae of condylar fractures.[1] To prevent the complications of condylar fracture, our center deem to treat these fractures by anatomical reduction and stabilizing it by two plates as per fixation principle by Meyer et al.[2] Many methods have been suggested and documented in the literature for better visualization and retrieval of the proximal segment. The distal segment has to be pulled down by using many methods. This report describes a technique using a 24 gauge intravenous (IV) catheter, which facilitates better visualization of the proximal segment by distracting the distal segment for open reduction and internal fixation of condylar fractures.


  Technique Top


We propose a simple and minimally invasive technique [Figure 1] which facilitate anatomic reduction of medially displaced proximal fractured condylar segment. This technique uses 24-gauge intravenous catheter, 10 cm 26-gauge stainless steel wire and a 3 cm portion of cut suction tube.
Figure 1: Passing of 24-gauge cannula from outside to medial side of posterior mandibular region

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  • The cannula is passed from sub-mandibular region [Figure 2] and taken out intra-orally on the medial side of the posterior molar region [Figure 3]. The needle from the cannula is retracted and a 26-gauge wire is inserted through it.
  • The wire is taken intra-orally and the cannula is pulled out while maintaining wire in position. The wire is then passed through a 3 cm piece of cut suction tube
  • The cannula is re-inserted from the same point in the sub-mandibular region, taken out from the buccal vestibule. The top end of the wire is taken out from the cannula extra-orally
  • The piece of the suction tube is stabilized on the occlusal table of the last posterior molars.
  • The two wires are rolled together extra-orally and pulled down mechanically [Figure 4]
  • The distal segment is pulled down for better visualization of the proximal segment.
Figure 2: Entry point of insertion of cannula in sub mandibular region

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Figure 3: Pictograph of procedure on medial side of mandible

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Figure 4: Pictograph of whole procedure of this technique

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The primary advantage of this technique is that it is minimally invasive, less operator fatigue, minimal armamentarium, and its ease to perform. This technique may take a little extra time vis-à-vis other distraction methods. A new method[3] using IV cannula, 26G stainless steel wire, and transcutaneous miniplates reported in literature gave us an idea to explore the same armamentarium which is much lighter and safe to use in the distraction of mandible. A similar technique is being used very commonly as circum-mandibular wiring for treating children with cap splints. Pitfall of this technique is the surgeon has to be careful while inserting the 24G catheter as the facial artery can rupture in the region of the first molar. This is the same precaution taken while doing treatment of circum-mandibular wiring. To perform this technique, there are limitations where mobility of teeth in the mandibular posterior region can arise more difficulty for retraction of wire downward to pull the mandible down. We found this to be an easy way for treating condylar fractures where the difficulty arises to reduce the proximal condylar stump.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ellis E, Throckmorton GS. Treatment of mandibular condylar process fractures: Biological considerations. J Oral Maxillofac Surg 2005;63:115-34.  Back to cited text no. 1
    
2.
Meyer C, Serhir L, Boutemi P. Experimental evaluation of three osteosynthesis devices used for stabilizing condylar fractures of the mandible. J Cranio Maxillofac Surg 2006;34:173-81.  Back to cited text no. 2
    
3.
Jose A, Nagori SA, Agarwal B, Roychoudhury A. Closed technique for naso-orbito-ethmoid fracture management: Technical note. J Stomatol Oral Maxillofac Surg 2017. Doi: 10.1016/j.jormas.2017.12.004.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

 
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