PMC5853048_01
Orthopantomogram
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F1
Radiographic and computed tomography revealed a right-side subcondylar fracture with an associated left parasymphyseal fracture [Figure 1] and a right zygomaticomaxillay complex (ZMC) fracture.
Fixation of the subcondylar fracture by the periangular approach
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F2
After adequate preparation, we approached the condylar fracture through a periangular approach, and this was followed by an intraoral vestibular approach to reduce and fix the parasymphyseal fracture [Figures 2-4].
Fixation of the parasymphyseal fracture
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F3
After adequate preparation, we approached the condylar fracture through a periangular approach, and this was followed by an intraoral vestibular approach to reduce and fix the parasymphyseal fracture [Figures 2-4].
Postoperative orthopantomogram
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F4
After adequate preparation, we approached the condylar fracture through a periangular approach, and this was followed by an intraoral vestibular approach to reduce and fix the parasymphyseal fracture [Figures 2-4].
PMC5853048_02
Preauricular approach
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F5
A preauricular approach was advocated to retrieve the medially displaced fractured condyle [Figure 5].
Use of Hegar's uterine dilator
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F6
We used Hegar's uterine dilators in sequence to create an accessible working space for reduction and fixation, passing it through the retromandibular incision, and exiting through the preauricular incision [Figure 6].
Postoperative orthopantomogram (Case 2)
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F7
Postoperative radiograph was taken to assess the surgical outcome [Figure 7].
PMC5853048_03
Three-dimensional computed tomography scan showing bilateral condylar fractures
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F8
He was diagnosed with a panfacial fracture which included a LeFort 3, ZMC, naso-orbital-ethmoid, bilateral condylar, and symphysis fractures [Figures 8 and 9].
Three-dimensional computed tomography scan showing symphysis fracture
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F9
He was diagnosed with a panfacial fracture which included a LeFort 3, ZMC, naso-orbital-ethmoid, bilateral condylar, and symphysis fractures [Figures 8 and 9].
Postoperative orthopantomogram showing two-plate fixation of the fractured condyles
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F10
This was followed by a postoperative orthopantomogram for assessment [Figure 10].
PMC5853048_04
Retromandibular approach
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F11
We decided to restore the vertical ramus height first and addressed the left subcondylar fracture through a retromandibular approach [Figure 11].