Complications of the retromandibular transparotid approach for low condylar neck and subcondylar fractures: a retrospective study

Abstract

ObjectivesThe goal of this study was to evaluate the rates of complications, morbidity, and safety with the transparotid approach.Materials and MethodsA retrospective study was conducted and consisted of 53 surgically treated patients in the past five years for low condylar neck and subcondylar fractures. Only patients with malocclusion and who underwent open reduction with internal fixation with the retromandibular transparotid approach were included. The examined parameters were postoperative suboptimal occlusion, deflection, saliva fistula, and facial nerve weakness.ResultsFifty-three patients had an open reduction with internal fixation on 55 sides (41 males, 77.4%; mean age, 42 years [range, 18–72 years]). Four patients (7.5%) experienced transient facial nerve weakness of the marginal mandibular branch, but none was permanent. Four patients had a salivary fistula, and 5 patients showed postoperative malocclusion, where one needed repeat surgery after one year. One patient showed long-term deflection. No other complications were observed.ConclusionThe retromandibular transparotid approach is a safe procedure for open reduction and internal fixation of low condylar neck and subcondylar fractures, and it has minimal complications.

Complications of the Transmasseteric Anteroparotid Approach for Subcondylar Fractures: A Retrospective Study

“…No facial palsy occurred in this study, including transient facial palsy. Similar studies have shown a rate of facial nerve palsy of 7.5% to 17.2% with the retromandibular approach, 20,24 14% to 33% with the pre-auricular approach, 1,25 and 8% to 16% with the submandibular/Risdon approach. 26,27…”

“…The only relatively serious complications we observed were salivary fistulae/sialocele, due to the opening of the parotid capsule; though these all resolved with conservative management in a short period of time. Similar studies have shown a rate of sialocele/parotidocutaneous fistula of 2.3% to 7.3% with the retromandibular approach 20,24 and 5% to 22% with the pre-auricular approach. 1,25 No other complications, including surgical site infection, plate breakage, hypertrophic scaring, hematoma, or Frey’s syndrome were experienced by participants in this study.…”

Direct transparotid approach via a modified mini-preauricular incision for open reduction and internal fixation of subcondylar fractures

“…Hematoma, facial nerve weakness, salivary fistula, and wound infection have been reported as complications in mandibular condylar fracture surgery conducted using the conventional transparotid approach 7,8,16,17 . Similarly, the novel…”

“…In contrast, various extraoral approaches, including the retromandibular, Risdon, and periauricular approaches 6 , also exist, yet the drawbacks of an extraoral approach are that it can leave a significant facial scar and/or cause facial nerve damage 2 . Meanwhile, treating a subcondylar fracture with a transparotid approach may reduce the probability of complications such as facial nerve injuries [7][8][9] . Using this method, the parotid gland is dissected in the area where the facial nerve branches diverge.…”

Fractures of the Mandibular Condyle

“…In a study by Van Hevele and Nout, 7.5% of patients who underwent ORIF of condylar fractures using a retromandibular approach developed salivary fistula. 26 Temporary injury to the facial nerve is estimated to occur in 0 to 21% of cases, 2,19,[27][28][29] though the incidence of permanent nerve injury is less than 1%. 29 Commonly, it is believed that tissue retraction causes a stretch injury to the nerve branches or the nerve trunk, which recovers over several months.…”