Re: “Treatment of low subcondylar fractures—a 5-year retrospective study”

First we would like to thank the authors of the previous letter, related to our article “Treatment of low subcondylar fractures—a 5-year retrospective study”, for sharing their valuable knowledge and experience in the surgical approach to subcondylar fractures using the high cervical transmasseteric (HCTM) approach.

We would like to clarify some of the points that were raised.

We agree with the first point raised by the authors regarding the original article, however that article was originally published in French and is unavailable for us to read. Since the authors are more familiar with the evolution of this technique we thank them for the correction.

Second point, the authors will probably agree that regardless of the fact that a 5-cm incision is almost invisible after 6 months, a shorter incision would be a better choice if it is practical to perform the reduction in a shorter incision, which we were able to show. Of course, as pointed out by the authors, regardless of the size of the incision, Langer’s lines should be followed in the planning of the incision line.

With regard to the third point, we used only local anaesthesia in the incision line area supra SMAS (superficial muscular aponeurotic system) infiltrations, and in the condylar area; so far we have treated 25 cases using this technique (unpublished data), and in all of the cases presented and done so far, both the buccal and marginal mandibular nerves were active and functionally tested during the operation. So even though local anaesthesia was used, there was no temporary palsy of the facial branches since the infiltration was shallow and in small quantities.

Fourth point, we agree with the authors that this is a reproducible technique, but the learning curve is steep and case selection is essential; as the authors pointed out, an obese patient with a hypertrophic masseter would be a challenge for an oral and maxillofacial resident with limited experience of this technique and its benefits and pitfalls.

We appreciate the authors’ letter and thank them for the constructive remarks and wisdom shared in the evolution of the anteroparotid transmasseteric approach.



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Jan 20, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Re: “Treatment of low subcondylar fractures—a 5-year retrospective study”

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