Facial Nerve Injuries, Mandibular Fractures, Surgical Incision
Conditions
Keywords
Facial Nerve Injuries, Mandibular Fractures, Mandibular Angle Fractures, Iatrogenic Injury, Surgical Incision
Brief summary
The goal of this study is to investigate the efficacy of a safety-zone that is anatomically landmarked on the face of patients with mandibular fractures that are approached transbuccally (through cheek) on postoperative intactness of facial nerve.
Detailed description
Mandibular fractures, in particular mandibular angle fractures, can be fixed with various techniques. Of all, open reduction and internal fixation (with titanium plates and screws) stands as one of the most commonly used techniques for mandibular angle fracture management. Different approaches could be followed to access the mandibular angle. Transbuccal approach is considered one of the most conservative approaches for such goal. Conjoined with a transoral access for fracture reduction and plates adaptation, a small incision is made extraorally on the cheek opposite to the fracture line to facilitate application of a transbuccal trocar, through which drilling and screws fixation can be done into the plates. A reported risk of facial nerve injury raises fears towards this extraoral cheek incision, even being considerably small. That's why a safety-zone was proposed as a triangle between three lines drawn cross each other. The first is drawn from the ear tragus to the facial notch. The second is drawn from the outer eye canthus to the mandibular angle. The third is on the lower mandibular border. This safety-zone triangle was suggested beforehand in a cadeveric study to be a safe land for cheek incisions without endangering the facial nerve branches, in particular buccal and marginal mandibular branches. This study aims at testing whether the implementation of this safety-zone may decrease the risk of facial nerve affection among patients in whom these landmarks were followed, or there may not be such difference between these patients and other patients who underwent same fracture pattern management with the same approach but without implementing these safety-zone landmarks.
Interventions
PROCEDURELandmarking Safety-zone
A safety-zone triangle for transbuccal incision is encased between three lines: the first is a line drawn from the ear tragus to the facial notch. The second is drawn from the outer eye canthus to the mandibular angle. The third is on the lower mandibular border.
Sponsors
Delta University for Science and Technology
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE (Subject, Investigator)
Eligibility
Sex/Gender
ALL
Age
20 Years to 45 Years
Healthy volunteers
Yes
Inclusion criteria
* Healthy patients (American Society of Anesthesiologists Class I) * Patients with mandibular fracture that require open reduction and internal fixation with miniplates and screws. * Mandibular fractures that couldn't be accessed transorally only. * Non-comminuted fractures
Exclusion criteria
* Patients with neurological disorders. * Patients who take nerve-supporting supplements (such as Vitamin B12 or Vitamin B complex) prior to surgery. * Presence of facial laceration. * Infected fractures
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative Facial Nerve Affection Using Sunnybrook Facial Grading System (in numbers from 0 to 100) | First postoperative week, and third postoperative week. | Facial nerve function is tested after surgery through subjective facial expressions by the patient and judged by two different investigators grading them on Sunnybrook Facial Grading System |
Countries
Egypt
Contacts
CONTACTMohammad Abdelhamid, PhD
PRINCIPAL_INVESTIGATORMohammad Abdelhamid, PhD
Department of Oral and Maxillofacial Surgery, Faculty of Oral and Dental Medicine, Delta University for Science and Technology
Outcome results
None listed