Purpose The purpose of this study was to determine the rate of facial nerve injury (FNI) when performing (ORIF) of mandibular condylar fractures by different surgical approaches. Materials and methods A systematic review and meta-analysis were performed that included several databases with specific keywords, a reference search, and a manual search for suitable articles. The inclusion criteria were all clinical trials, with the aim of assessing the rate of facial nerve injuries when (ORIF) of mandibular condylar fractures was performed using different surgical approaches. The main outcome variable was transient facial nerve injury (TFNI) and permanent facial nerve injury (PFNI) according to the fracture levels, namely: condylar head fractures (CHFs), condylar neck fractures (CNFs), and condylar base fractures (CBFs). For studies where there was no delineation between CNFs and CBFs, the fractures were defined as CNFs/CBFs. The dependent variables were the surgical approaches. Results A total of 3873 patients enrolled in 96 studies were included in this analysis. TFNI rates reported in the literature were as follows: A) For the transoral approach: a) for strictly intraoral 0.72% (1.3 in CNFs and 0% for CBFs); b) for the transbuccal trocar instrumentation 2.7% (4.2% in CNFs and 0% for CBFs); and c) for endoscopically assisted ORIF 4.2% (5% in CNFs, and 4% in CBFs). B) For low submandibular approach 15.3% (26.1% for CNFs, 11.8% for CBFs, and 13.7% for CNFs/CBFs). C) For the high submandibular/angular subparotid approach with masseter transection 0% in CBFs. D) For the high submandibular/angular transmassetric anteroparotid approach 0% (CNFs and CBFs). E) For the transparotid retromandibular approach a) with nerve facial preparation 14.4% (23.9% in CNFs, 11.8% in CBFs and 13.7% for CNFs/CBFs); b) without facial nerve preparation 19% (24.3% for CNFs and 10.5% for CBFs). F) For retromandibular transmassetric anteroparotid approach 3.4% in CNFs/CBFs. G) For retromandibular transmassetric anteroparotid approach with preauricular extension 2.3% for CNFs/CBFs. H) For preauricular approach a) deep subfascial dissection plane 0% in CHFs b) for subfascial approach using traditional preauricular incision 10% (8.5% in CHFs and 11.5% in CNFs). I) For retroauricular approach 3% for CHFs. PFNI rates reported in the literature were as follows: A) for low submandibular approach 2.2%, B) for retromandibular transparotid approach 1.4%; C) for preauricular approach 0.33%; D) for high submandibular approach 0.3%; E) for deep retroparotid approach 1.5%. Conclusion According to published data for CHFs, a retroauricular approach or deep subfascial preauricular approach was the safest to protect the facial nerve. For CNFs, a transmassetric anteroparotid approach with retromandibular and preauricular extension was the safest approach to decrease risk of FNI. For CBFs, high submandibular incisions with either transmassetric anteroparotid approach with retromandibular or transmassetric subparotid approach, followed by intraoral (with or without endoscopic/transbuccal trocar) were the safest approaches with respect to decreased risk of FNI.

Does the surgical approach for treating mandibular condylar fractures affect the rate of seventh cranial nerve injuries? A systematic review and meta-analysis based on a new classification for surgical approaches.

Closed treatment of unilateral mandibular condyle fractures in adults: a systematic review

Postoperative complications associated with the retromandibular approach: a retrospective analysis of 118 subcondylar fractures.

The retromandibular transparotid approach for reduction and rigid internal fixation using two locking miniplates in mandibular condylar neck fractures

Background There is considerable controversy about whether condylar fractures should be treated open or closed. Even when there is a clear indication for open treatment, the appropriate approach opens another debate. Purpose To provide a clear overview on the complications of extraoral approaches to condylar fractures. Methods Systematic literature search of all indexed years on PubMed, Medline, and Embase. For detailed analysis, we selected 70 studies. Results Of the 2783 patients who were studied with respect to facial nerve function, 338 (12%) experienced some form of weakness. Most (95%) achieved full recovery. In 17 of the 338 patients (5%), these paralyses were permanent. A hematoma occurred in 1.7%, an infection of the wound in ≥2.9%, Frey syndrome in 1.1%, a sialocele in 2.6%, a salivary fistula in ≥4.8%, sensory disturbance of the great auricular nerve in 7.9%, and an unsatisfactory scar in ≥1.6% of the patients. Conclusion Due to the great diversity in fractures, approaches, and surgical techniques, it is difficult to objectively compare surgical techniques for condylar fractures and their complications. Based on the literature studied in this review, we propose a treatment protocol with respect to open treatment approaches.

Open treatment of condylar fractures via extraoral approaches: A review of complications.

Purpose
To evaluate surgical complications associated with open reduction and internal fixation of condylar fractures using retromandibular approach in terms of intraoperative and postoperative complications.

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Management of Mandibular Sub Condylar and Condylar Fractures Using Retromandibular Approach and Assessment of Associated Surgical Complications

Aim: The aim of this study was to describe the characteristics of the mandibular third molar at highest risk for acute pericoronitis using clinical and radiographic analysis. Materials and Methods: A total of 120 patients ranging in age from 18 to 55 years suffering from pericoronitis were examined. Subjective and objective observations were recorded that included the age, gender, angulation of partially impacted mandibular third molar, the frequency of pericoronitis in a year, the presence of impinging maxillary third molar, the extent of soft tissue coverage over the impacted mandibular third molar, the clinical signs evaluated in the patient, the class and position of the impacted mandibular third molar, and the presence of distal radiolucency with respect to the impacted mandibular third molar. Results: The results obtained in the study indicate that pericoronitis is associated more in the age group of 26–35 years and is more commonly reported in the female gender. Distoangular partially impacted mandibular third molars impacted at Class II and position B seem to be at the highest risk of developing pericoronitis. Conclusion: The results obtained in the study indicate that pericoronitis is associated more in the age group of 26-35 years and is more commonly reported in the female gender.Distoangular partially impacted mandibular third molars impacted at class II and position B seem to be at the highest risk of developing pericoronitis.

The predictivity of mandibular third molar position as a risk indicator for pericoronitis: A prospective study.

Oral submucous fibrosis (OSMF) is a chronic disease of the oral cavity which presents clinically with burning sensation, leathery consistency of oral mucosa with palpable fibrous bands leading to reduced mouth opening. Though the evaluation of quality of life (QOL) in health care is gaining importance, researches regarding the evaluation of QOL in OSMF individuals are very sparse.
 The aim of the present study is to evaluate the QOL assessment in OSMF patients through WHOQOL-BREF questionnaire.
 The study includes a total of 300 participants recruited from the outpatient department. The quality of life was assessed using the WHOQOL-BREF questionnaire. The raw scores for the physical health, psychological health, social relationships and environmental health domains were done on 4–20 scale suggested by the WHOQOL procedural manual. The analysis of variance (ANOVA) was used for the simultaneous comparison of mean scores for the four domains, and independent t test was used for the comparison of two means of domain scores.
 The participants with OSMF have a significant negative impact on the quality of life when compared with the participants without OSMF (P = 0.002). The environmental factors in the WHOQOL-BREF have shown a significant difference in the QOL of participants with OSMF than without OSMF (P = 0.001). The oral submucous fibrosis has a negative impact on the quality of life in participants with OSMF specifically in social and environmental domains of the WHOQOL-BREF questionnaire.

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Impact of Oral Submucous Fibrosis on Quality of Life: A Cross-Sectional Study.

The present study aims to assess the knowledge and attitude about needle stick injuries and sharps disposal. A self designed questionnaire of 15 questions was handed out to 200 participants including undergraduate students (group 1), postgraduate students (group 2), faculty members (group 3) and auxiliary staff members (group 4). The data was collected and analyzed using Chi square test. Sixty-one percent of total participants reported of experiencing needle stick injury and 25.5 % knew that there could be several causes for this. Only 22 % of total population studied got the source tested. Immunization status of group 4 was very low and they also lacked the knowledge of sharps disposal and hepatitis C being spread by needle stick injuries. 57 % participants confirmed that there was no reporting facility and 66 % were not familiar with the guidelines of reporting. There is a definite scope of improvement in terms of reporting and prevention of needle stick injuries. There is a need to improve knowledge and awareness of dental health care workers about the post exposure protocol.

Awareness About Needle Stick Injures and Sharps Disposal: A Study Conducted at Army College of Dental Sciences

Background: Hypertension is an important worldwide public health challenge because of its high frequency and risk of cardiovascular and renal disease. Objective: The objective of this study was to investigate the prevalence of undiagnosed hypertension as well as inadequately controlled hypertension among general population who sought tooth extraction at Army College of Dental Sciences, Secunderabad. Materials and Methods: Only 1200 patients in the age group of 20–60 years who sought tooth extraction were included in the study. Blood pressure (BP) was measured for three times in all patients. The readings were quantized into four categories which included normal, prehypertensive stage, and Stage 1 and Stage 2 of hypertension. The BP was assessed for the following variables – gender, habits of gutkha chewing, smoking and alcohol, regular exercise, age, and effect of local anesthesia. Results: Nearly 24.4% of new cases of hypertension were diagnosed among all participants reported to the dental clinic. After giving local anesthesia, 16.71% increase in BP was observed in Stage 1 and 2.35% increase in Stage 2 hypertension. Conclusion: This study reveals that dentists play an important role in the early diagnosis of hypertension of many dental patients who are unaware of being hypertensive. This role should be emphasized in our specialty as a standard of care to prevent life-threatening complications.

Sukhvinder Bindra

Papers

Management of Mandibular Sub Condylar and Condylar Fractures Using Retromandibular Approach and Assessment of Associated Surgical Complications

The predictivity of mandibular third molar position as a risk indicator for pericoronitis: A prospective study.

Impact of Oral Submucous Fibrosis on Quality of Life: A Cross-Sectional Study.

Awareness About Needle Stick Injures and Sharps Disposal: A Study Conducted at Army College of Dental Sciences

Is screening in dental office an effective method of detecting undiagnosed hypertension