Comparison of Approaches for the Rigid Fixation of Sub-Condylar Fractures

Abstract

Aim The objective of this study was to compare the rate of complications encountered on using different incisions to access the fracture site for the open reduction and internal fixation of isolated subcondylar fractures. The parameters evaluated are: the occurrence of salivary fistula, infection, and injuries to the seventh facial nerve. An assessment of the surgical scar was also undertaken. Materials and Methods 20 patients who met the previous criteria and were willing to participate in the study were placed (five each) into the pre-auricular, submandibular, retromandibular transparotid or retromandibular transmassetric group based on the incision scar they selected after a description of the operation and being explained about the possible complications. Results and Conclusion Comparison of the complications could not ascertain the superiority of any approach over the other since the outcomes were not statistically significant. However, judging by operator and assistants' subjective assessment, the retromandibular approaches seem to provide a more direct visual field and an almost straight line access for the fixation of the fracture. The transmassetric approach seems to be a safer approach since the nerves encountered can be visualized and avoided.

Facial nerve injuries associated with the retromandibular transparotid approach for reduction and fixation of mandibular condyle fractures

“…The anteroparotid transmasseteric approach is challenging in obese patients with fat cheeks (Bhutia et al, 2014). Moreover, facial nerve buccal branches are encountered in 50% of cases (Ebenezer and Ramalingam, 2011), similar to what we experienced with the retromandibular approach. Trost et al (2009) advocated the high cervical anteroparotid transmasseteric approach to the condyle, wherein he reported 100 cases with no FN injury, even transient.…”

Outcome of Comminuted Mandibular Fracture Repair Using an Intraoral Approach for Osteosynthesis

“…Because an incision at the lateral neck is made to access the mandibular bone, several important structures are endangered: the marginal mandibular branch of the facial nerve, the lingual and the hypoglossal nerve, the facial vessels, and the submandibular and parotid glands. [8][9][10][11][12] Damage to any of these structures may result in severe and permanent functional or aesthetic consequences.…”

“…Although the extraoral approach inherits significant advantages regarding overview, simplifying fracture reduction, plate positioning, and fixation, it bears considerable risks of damaging important neurovascular and glandular structures, or even visible facial scarring, respectively. [8][9][10][11][12] This retrospective study was designed to objectively analyze the outcome of comminuted mandibular fracture treatment by an intraoral approach. We hypothesized that this treatment protocol is a comparable alternative to the extraoral approach but inheriting a reduced complication rate while still allowing proper reduction and osteosynthesis.…”

Conventional versus Modified Preauricular Incision Approaches to the Management of Temporomandibular Joint Ankylosis in Sana’a City, Yemen: A Comparative Clinical Study

“…Then, the temporal fascia can be separated into superficial and deep layers approximately two centimeters above the zygomatic arch (13). However, the modified preauricular approach is performed by making a skin incision starting about a pinna's length away from the ear, proceeding antero-superiorly just within the hairline and then curving backwards and downwards till it meets the upper attachment of the ear (14).…”