Preauricular transmasseteric anteroparotid approach for extracorporeal fixation of mandibular condyle fractures

Abstract

Introduction:Free grafting or extracorporeal fixation of traumatically displaced mandibular condyles is sometimes required in patients with severe anteromedial displacement of condylar head. Majority of the published studies report the use of a submandibular, retromandibular or preauricular incisions for the access which have demerits of limited visibility, access and potential to cause damage to facial nerve and other parotid gland related complications.Purpose:This retrospective clinical case record study was done to evaluate the preauricular transmasseteric anteroparotid (P-TMAP) approach for open reduction and extracorporeal fixation of displaced and dislocated high condylar fractures of the mandible.Patients and Methods:This retrospective study involved search of clinical case records of seven patients with displaced and dislocated high condylar fractures treated by open reduction and extracorporeal fixation over a 3-year period. The parameters assessed were as follows: a) the ease of access for retrieval, reimplantation and fixation of the proximal segment; b) the postoperative approach related complications; c) the adequacy of anatomical reduction and stability of fixation; d) the occlusal changes; and the e) TMJ function and radiological changes.Results:Accessibility and visibility were good. Accurate anatomical reduction and fixation were achieved in all the patients. The recorded complications were minimal and transient. Facial nerve (buccal branch) palsy was noted in one patient with spontaneous resolution within 3 months. No cases of sialocele or Frey's syndrome were seen.Conclusion:The P-TMAP approach provides good access for open reduction and extracorporeal fixation of severely displaced condylar fractures. It facilitates retrieval, transplantation, repositioning, fixing the condyle and also reduces the chances of requirement of a vertical ramus osteotomy. It gives straight-line access to condylar head and ramus thereby permitting perpendicular placement of screws with minimal risk of damage to the facial nerve.

Analysis between retromandibular and periangular transmasseteric approach for fixation of condylar fracture - A prospective study

“…[ 35 ] It is commonly associated with complications such as avascular necrosis, condylar resorption, arthrosis due to the loss of periosteal blood supply, detachment from the lateral pterygoid muscle, and injury to the disc. [ 36 ] In the present study, one case with a condylar head fracture in retromandibular group required an extracorporeal approach and later presented with clinical and radiographic sign of TMJ ankylosis.…”

Correlation of Impacted Mandibular Third Molar With Incidence of Ipsilateral Angle and Condylar Fractures in Mandibular Trauma

“…Even when closed reduction is performed, prolonged period of intermaxillary fixation have adverse effects on quality of patient's life 20 . Furthermore, open reduction of condylar fracture is very technique sensitive procedure as it is highly difficult to perform accurate reduction of condylar fragments and place plates and screws maintaining accurate condylar fragments reduction 21 and simultaneously correct occlusion. On the other hand, accurate reduction and fixation of mandibular angle fracture is comparatively easier owing to greater access and visibility to fix the plates at angle area.…”

The Preauricular Transmasseteric Approach: A Novel Option for the Exposure of Mandibular Condyle Fracture

“…In our experience with this approach, no persistent paralysis was observed, as observed in other similar studies. 9,10 The contra-indications or limitations of this technique are the comminuted fractures and the fractures associated with the posterior border of the mandibular ramus. Together with that, some operational and technical features should be considered when choosing for this approach.…”