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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
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.
Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
VARIOUS APPROACHES
• RETROMANDIBULAR• PREAURICULAR • RHYTIDECTOMY• ENDAURAL• SUBMANDIBULAR• INTRAORAL
Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
HINDS & GIROTTI 1958
RETROMANDIBULAR APPROACH
Dr.S.Shanmugasundaram, 15th AOMSI, KanyakumariCourtesy :Edward Ellis
Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
VESNAVER – PERIAURICULAR APPROACH 2005
Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
RETROMANDIBULAR WITH MODIFIED TRANSPAROTID APPROACH
Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
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.
Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
Courtesy : Edward Ellis
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
Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
THOMA’S ANGULATED INCISION
Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
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.
Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
MODIFIED ENDAURAL
Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
RHYTIDECTOMY APPROACH
Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
CERVICO FASCIAL RHYTIDECTOMY
Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
LAZY S INCISION
Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
SUBMANDIBULAR INCISION
Dr.S.Shanmugasundaram, 15th AOMSI, KanyakumariCourtesy: Edward Ellis
Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
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.
Intraoral Incision
Endoscopic
Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
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
Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
COMPLICATIONS• Nerve injury -temporary -permanent• Sialocele• Infection• Hematoma• Bad scar.
Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
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.
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.
Dr.S.Shanmugasundaram, 15th AOMSI, Kanyakumari
THANK YOU