Retromandibular transparotid approach for subcondylar mandibular fracture: A retrospective study

Abstract

Introduction The retromandibular transparotid approach provides the shortest and the most direct access to mandibular sub‐condylar fractures. However, this approach is less preferred due to the fear of facial nerve injury. The aim of this study was to evaluate the safety and morbidity of the retromandibular transparotid approach for open reduction and internal fixation of sub‐condylar mandibular fractures. Methods A retrospective cohort study of 29 patients with 35 sub‐condylar mandibular fractures who underwent open reduction and internal fixation through the retromandibular transparotid approach was conducted. The primary study variable was facial nerve palsy, whereas the secondary variables were infection, sialocele, salivary fistula, stability of the fractured segments, post‐operative malocclusion, Frey's syndrome, and unesthetic scar. All patients were followed up for 6 months. Predictor variables included age, gender, side, location, displacement, etiology, concomitant maxillofacial fractures, and healing status. Fisher's exact test was calculated to find the association between primary variables and predictor variables. Result Out of 35 sub‐condylar fractures (29 patients; 23 male, 6 female), four (11.42%) developed transient facial nerve palsy. Fractures at the condylar neck level (P = .045) and with displacement (P = .026) were significantly associated with the development of facial nerve palsy. Four patients (13.8%) developed slight malocclusion, two had surgical site infections, two developed sialoceles, and one had a salivary fistula. Conclusion The retromandibular transparotid approach is safe and effective with rare major complications in the management of sub‐condylar fractures of the mandible. Condylar neck fractures and displaced fractured segments are associated with an increased risk of development of facial nerve palsy.

Manejo cirúrgico de fratura mandibular cominutiva por projétil de arma de fogo / Surgical management of comminuted mandibular fracture by firearm projectile

“…Um outro ponto importante, consiste no fato de que lesões penetrantes na glândula parótida podem gerar sialoceles, as quais são definidas como coleção salivar em tecido subcutâneo 17 . A paciente apresentou tal condição no pós-operatório, que são consideradas complicações comuns não só em indivíduos acometidos por PAF na região, mas também naqueles tratadas por meio de acessos extraorais em região submandibular e retromandiular, por exemplo 19,20,21 . Seu diagnóstico pode ser feito por uma série de exames complementares, mas nesse caso o exame físico foi soberano em detrimento dos sinais que se tornavam mais evidentes durante as refeições.…”

Comparison of Preauricular Approach Versus Retromandibular Approach in Management of Condylar Fractures

“…As internal fixation errors are frequently reported when fixing the condyle to a single plate, a single 3D trapezoidal plate versus a single mini-plate is also highly recommended. In addition, when a single plate is used to repair a fractured condyle, the reduction of a mandibular symphysis fracture after condyle fixation may adversely affect the internal stabilization of the condyle [21][22] . In this review, the condylar fractures were immobilized with two mini plates along the stress line or with one 3D trapezoidal plate for good stabilization.…”

Current Management of Subcondylar Fractures: A Systematic Review

“…The most common was the RM transparotid (RMTP) approach, which was described in 7 studies. [11][12][13][14][15][16]18 MO Ten studies evaluated MO as a primary outcome. Göçmen et al 13 and Liu et al 15 reported an average MIO of 44.4 and 37.4 mm, respectively.…”

“…Twelve studies evaluated postoperative outcomes after ORIF using a variety of surgical approaches as outlined in Table 3. The most common was the RM transparotid (RMTP) approach, which was described in 7 studies 11‐16,18 …”

“…Three studies that used the RMTP approach reported no cases of malocclusion 11,13,15 . Koirala et al 14 reported malocclusion occurred in 4 patients. Nam et al 18 found zero cases of malocclusion in both the intraoral or RMTP groups.…”