Is the high submandibular transmasseteric approach to the mandibular condyle safe for the inferior buccal branch?

Abstract

There are basically 3 main approaches for extra-articular mandibular condyle fractures: low cervical, retromandibular and preauricular. These include a risk of facial palsy affecting the marginal mandibular branch. We use a high submandibular transmasseteric approach featuring masseter section10-20mm above the mandibular basilar edge. Our null hypothesis was that both the marginal mandibular and the inferior buccal branches are not more at risk than in other surgical approaches. This study was based on 20 parotidomasseteric dissections from 10 embalmed cadaveric heads. We used as reference the vertical line, passing through the mandibular angle, parallel to the preauricular line. We performed measurements of the marginal mandibular and inferior buccal branches' heights. The inferior buccal branch had an average height of 16.8mm and the highest standard deviation (7.2). Extremes were, respectively, 32 and 7mm. The marginal mandibular branch had an average height of 3.2mm with standard deviation equal to 3.0. Extremes were, respectively, 9 and -3mm. The high submandibular transmasseteric approach provides great exposure of facial nerve branches lying on the masseter muscle, if even encountered. Through masseteric incision performed between 10 and 20mm above the basilar edge of the mandible, the marginal mandibular branch is safe from wound with an added safety margin of 4mm. The surgeon using this approach is most likely to encounter the inferior buccal branch. It can then be avoided under visual control. This makes it a swift and safe approach to the mandibular condyle.