Abstract
Sub-condylar fractures of the temporomandibular joint can be treated by an extraoral or intraoral approach. Trans-masseteric antero-parotid approach (TMAP) is an extraoral approach utilising a retromandibular incision. The authors evaluated patients' status and any complications of using TMAP from the years 2013-2017. There were 39 patients (44 fractures). When using TMAP, in 43 fractures the fragments were favourably positioned, in one case the position was compromised. Of the complications, postoperative palsy of the facial nerve was reported 6.8% - in all cases this was only temporary. Late occlusion had an equal number of complications (in 2 cases this was as a result of an infectious complication of the wound, and in 2 cases due to resorption of the proximal fragment). Muscular pain and dysfunction of the temporomandibular joint following trauma were observed consistently in 6.8% of patients. Sialocoele, a non-conforming scar, and infectious complications were observed in 4.5% of patients. TMAP allows rapid surgical performance, with a good view for perfect repositioning and fixation of fragments of sub-condylar fractures of the temporomandibular joint. The complications associated with this approach are, for the most part, temporary, the aesthetic handicap of a scar is considered by patients to be acceptable. Overall, it is possible to evaluate retromandibular TMAP as safe, and the authors recommended it for treatment of sub-condylar fractures of the mandible.
Highlights
Temporomandibular joint fractures belong to the most common fractures of the facial skeleton, forming 25 to 35% of all fractures of the lower jaw
The principle of surgical treatment consists of open reduction of the fragments into their anatomical position and stable fixation by osteosynthesis (ORIF)
Material and Methods The group consisted of patients with sub-condylar fractures of their joints, treated by open reduction and internal fixation between January 2013 and May 2017, all by a retromandibular trans-masseteric antero-parotid approach (TMAP)
Summary
Temporomandibular joint fractures belong to the most common fractures of the facial skeleton, forming 25 to 35% of all fractures of the lower jaw. They can be classified as fractures of the articular head (intra-articular), the articular neck, and sub-condylar fractures. Treatment of joint fractures can be conservative (nonsurgical) or surgical. Conservative treatment comprises of a soft diet, temporary intermaxillary fixation and rehabilitation of mouth opening. The principle of surgical treatment consists of open reduction of the fragments into their anatomical position and stable fixation by osteosynthesis (ORIF). Access for open reduction and internal fixation may include, pre-auricular, end-aural, posterior-auricular, retromandibular, subangular, submandibular and intraoral approaches (Eckelt and Loukota, 2010; Leiser et al, 2013; Spinzia et al, 2014)
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