Analysis of facial nerve function after open reduction of mandibular condylar fracture via a retromandibular approach

Abstract

Mandibular condylar fractures account for a sizeable segment amongst facial fractures. Previously most of these fractures were managed conservatively with periods of Intermaxillary fixation(IMF). Shortcomings of such an approach such as prolonged pain, Tmj dysfunction and delayed return to function has shifted the discourse to open reduction and internal fixation of the fractured mandibular condyle.ORIF is the universally accepted and mainstay of intervention. Numerous extra oral approaches have been employed with various modifications. The retromandibular transparotid approach is a relatively simple and direct approach to the posterior mandible, enabling the surgeon to deal with sub condylar and condylar neck fractures with relative ease. This approach is a safe approach and does not result in permanent palsy of any of the branches of the facial nerve. Aims: To analyse facial nerve function after ORIF of mandibular sub condylar fractures through the retromandibular transparotid approach. Materials and Methods: 25 patients reporting with unilateral condylar fractures, sub condylar (16) and neck fracture (9) (Ellis classification)consenting for the study were taken up. All patients were followed up for 8 months. Post-operative nerve function was evaluated at 24 hours after surgery, 1,4,12 weeks and at the end of 8 months. Results: 4(16%) patients presented with weakness of the facial nerve. Buccal branch (3) and zygomatic branch (1). In all cases the weakness was temporary and no permanent deficit was noted.

Study of Facial Nerve Function Following Retromandibular Open Reduction of Mandibular Condylar Fracture

“…7,8 These maneuvers would have increased the nerve's transient palsy-causing retractive pressures. According to the literature, the transient facial nerve injury ranges from 12 to 25 percent [9][10][11][12][13][14][15] , our 18% finding is in line with the same. In all of these cases of neurological damage, mecobalamin 1500mg was recommended for 3 weeks (once daily) 16 to help in rehabilitation.…”