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.

KEY WORDS

Access - approach - condylar fracture - extracorporeal fixation

 

Conflicts of interest

There are no conflicts of interest.

• REFERENCES

• 1 Ellis 3rd E, Moos KF, el-Attar A. Ten years of mandibular fractures: An analysis of 2,137 cases. Oral Surg Oral Med Oral Pathol 1985; 59: 120-9
• 2 Gupta MV, Sahoo CN. Extracorporeal fixation of displaced mandibular condylar fracture: Viable option. Med J Armed Forces India 2009; 65: 229-31
• 3 Boyne PJ. Free grafting of traumatically displaced or resected mandibular condyles. J Oral Maxillofac Surg 1989; 47: 228-32
• 4 Ellis 3rd E, Reynolds ST, Park HS. A method to rigidly fix high condylar fractures. Oral Surg Oral Med Oral Pathol 1989; 68: 369-74
• 5 Mikkonen P, Lindqvist C, Pihakari A, Iizuka T, Paukku P. Osteotomy-osteosynthesis in displaced condylar fractures. Int J Oral Maxillofac Surg 1989; 18: 267-70
• 6 Nam IW. The condylar head and upper condylar neck fractures treated by Nam's method (III). J Korean Acad Oral Surg 1981; 7: 81-90
• 7 Park SY, Im JH, Yoon SH, Lee DK. A follow-up study on extracorporeal fixation of condylar fractures using vertical ramus osteotomy. J Korean Assoc Oral Maxillofac Surg 2014; 40: 76-82
• 8 Choi BH, Yoo JH. Open reduction of condylar neck fractures with exposure of the facial nerve. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999; 88: 292-6
• 9 Özkan HS, Sahin B, Görgü M, Melikoglu C. Results of transmasseteric anteroparotid approach for mandibular condylar fractures. J Craniofac Surg 2010; 21: 1882-3
• 10 Kempers KG, Quinn PD, Silverstein K. Surgical approaches to mandibular condylar fractures: A review. J Craniomaxillofac Trauma 1999; 5: 25-30
• 11 Bernstein L, Nelson RH. Surgical anatomy of the extra parotid distribution of the facial nerve. Arch Otolaryngol 1984; 110: 177-83
• 12 Wilson AW, Ethunandan M, Brennan PA. Transmasseteric antero-parotid approach for open reduction and internal fixation of condylar fractures. Br J Oral Maxillofac Surg 2005; 43: 57-60
• 13 Trost O, Abu El-Naaj I, Trouilloud P, Danino A, Malka G. High cervical transmasseteric anteroparotid approach for open reduction and internal fixation of condylar fracture. J Oral Maxillofac Surg 2008; 66: 201-4
• 14 Trost O, Trouilloud P, Malka G. Open reduction and internal fixation of low subcondylar fractures of mandible through high cervical transmasseteric anteroparotid approach. J Oral Maxillofac Surg 2009; 67: 2446-51
• 15 Lutz JC, Clavert P, Wolfram-Gabel R, Wilk A, Kahn JL. Is the high submandibular transmasseteric approach to the mandibular condyle safe for the inferior buccal branch?. Surg Radiol Anat 2010; 32: 963-9
• 16 Hammond D, Arafat A, Bainton R. Revisiting the Boyne procedure. Med J Armed Forces India 2012; 68: 39-41
• 17 Christian K. Biomechanics and Osteosynthesis of Condylar Neck Fractures of the Mandible. 1st ed.. Illinois, USA: Quintessence Publishing Co; 1994: p. 68-70