30° PA view of mandible: towne view
-30 degress PA view: reverse towne view
Masseterand medial pterygoid
Use of nerve stimulation
Muscle relaxants should be avoided
Identify facial nerve
Use of nerve stimulation
Muscle relaxants should be avoided
Identify facial nerve
skin, subcutaneous fat, parotid-massetric fascia,superficial and the deep bellies of the masseter and lastly the periostium of the mandible
Incision starts in the pre auricular area
1-1.5 cm lateral to the root of helix of the ear
Continues in front of the tragus
Till the ear lobe
Post auricular
Marginal mandibular branch is just above the inferior border of the mandible
Nerve stimulator with the absence of muscle relaxants to identify the marginal mandibular n
If no nerve is encountered, a sharp dissection is done –in case a nerve is encountered a blunt dissection is done
Obswegger retractor is used to identify the fracture fragments
Lastly for sigmoid noth visualization a channel retractor is used
Notch retractor is used to retract the tissues from the sigmoid notch
Masseter and temporalis is stripped using a subperiosteal approach
Endoscope is inserted through a transoral or submandibular incision
Fractured sites are identified
1 or 2 , 4-hole or 2-hole mini plates are used for fracture fixation
The bigger fragment is wired first to improve the access