Effectiveness of ‘Preauricular-Retroparotid' and ‘Retromandibular-Transparotid' approaches in the management of displaced and dislocated condylar head and neck fractures.

Abstract

Introduction: Management of fractures of the condylar head, neck and base regions can be quite tricky, owing to differences in the morphology and location of the fracture, degree & direction of displacement, extent of comminution, and position of condylar head in relation to glenoid fossa. Hence, choosing an ideal surgical approach for each individual case, is both difficult as well as important. Aim: To assess the effectiveness of two major surgical approaches, the ‘Preauricular-Retroparotid’ and ‘Retromandibular-Transparotid’ approaches in the management of different types of displaced and dislocated condylar head and neck fractures. Patients and Methods: This retrospective study includes 56 patients operated over a period of four years from Jan 2016 to Dec 2019, of whom 14 had bilateral and 42 had unilateral displaced condylar head or neck fractures. 22 surgeries were for condylar head or high condylar neck fractures, treated using the Preauricular-Retroparotid approach. 48 surgeries were for low condylar neck fractures, managed using the Retromandibular-Transparotid approach. Intraoperative and postoperative complications, and detailed objective, subjective and functional treatment outcome assessments, were recorded over a postoperative follow up period ranging from one to three years. Results & Conclusion: Both surgical approaches were found effective in achieving good esthetic and functional results with no major complications, other than occasional transient neurological deficits and few instances of salivary fistulas and sialocoeles. Depending upon the level of the condylar fractures, a preauricular approach is ideal for the condylar head and high condylar neck fractures, providing direct and easy visualization to the region, for retrieval and repositioning of the medially displaced and dislocated proximal fracture fragment. The retromandibular approach is more suited for the lower level condylar neck fractures, providing a direct visual field and a wide, straight line access for implant fixation at this region.