A simple technique to aid open reduction and internal fixation of condylar fractures approached via retromandibular incision

The "low preauricular" transmasseteric anteroparotid (TMAP) technique as a standard way to treat extracapsular condylar fractures

Condylar fracture treatment is a debated topic among maxillofacial surgeons. Various surgical techniques are used today, each one with advantages and disadvantages. The aim of this study is to present and evaluate our technique adopted for treatment of any type of extracapsular condylar fractures. Between 2020 and 2022, 16 condylar fractures were treated. In two patients with bilateral condylar fractures, the present technique was compared to the mini-retromandibular approach. All the patients were checked for clinical and radiological outcomes, facial nerve injury, scar visibility and presence of salivary complications. Dental occlusion was always restored, and facial nerve damage or salivary disorders were not observed. The skin incision, limited to the caudal two-thirds of the auricle, made the scar almost invisible and greatly improved the surgical field in the condylar neck area, facilitating the treatment. The proposed technique provides easier internal fixation for both neck and base condylar fractures with good cosmetic results, ensuring better protection of the facial nerve and parotid gland. The surgical technique described has not shown disadvantages in terms of operational difficulty, results, and complications. This novel surgical technique could represent a new choice in the treatment of extracapsular condylar fractures, although further studies are needed to support this new proposal.

“Trans-zygomatic approach” for reduction & internal fixation of a malunited, medially dislocated condyle fracture in a geriatric patient with cervical spine injury

The open reduction and internal fixation of medially displaced/dislocated condyle fracture is challenging due to inadequate visibility and access to the dislocated condyle. The common approach to reduction of such condyles is by inferior distraction of the mandible which facilitates visualization as well as instrumentation. However, this maneuver may be difficult, or contraindicated in patients with concomitant cervical spine injury where excessive manipulation of the mandible may predispose the spine to further trauma. Ramus osteotomies which are used when conventional reduction methods fail, facilitate reduction but are associated with additional incision, complications and surgical time. This case report presents an alternative method, the "trans-zygomatic approach" which was used effectively to reduce a dislocated and malunited condyle fracture in a geriatric patient with co-existent cervical spine injury. The approach facilitated precise reduction of condyle fracture with minimal impact on the cervical spine.

Use of a modified high submandibular approach to treat condylar base fractures: Experience with 44 consecutive cases treated in a single institution

PURPOSE

The aim of this article is to present our experience treating fractures of the condylar base with a modification of the high submandibular approach (HSA).

MATERIALS AND METHODS

Between June 2012 and April 2015, 44 fractures of the condylar base were treated in the Department of Oral and Maxillofacial Surgery of the Medical Hospital of Graz using the modified HSA.

RESULTS

We did not observe any damage (even transient) to the facial nerve or any complication related to violation of the parotid capsule (such as a salivary fistula, Frey syndrome, or a sialocele).

CONCLUSIONS

This approach provides good access to the condylar base, ensuring easier internal fixation, excellent protection of the facial nerve and parotid gland, and good cosmetic results.