Modified Risdon approach using periangular incision in surgical treatment of subcondylar mandibular fractures

Abstract

No consensus has been reached yet on the surgical approach for treatment of condylar fractures. The aim of this study was to present modified Risdon approach (without facial nerve identification) in the treatment of subcondylar mandibular fractures. This is a retrospective study of a period 2005–2012. During this seven-year period, 25 condylar mandibular fractures in 22 men and three women (19–68 years old) were treated by modified Risdon approach without identifying the facial nerve. The main inclusion criterion was subcondylar fracture according to Lindahl classification. No additional morbidity related to postoperative complications, such as infection or salivary fistula, was observed in this series. Only two (8%) patients developed temporary weakness of the marginal branch of the facial nerve, which resolved six weeks postoperatively. Each patient achieved good mouth opening postoperatively. Scar was camouflaged in the first cervical wrinkle. Two patients developed temporomandibular joint dysfunction. No patient had postoperative occlusal disturbance. In all of the patients good aesthetic result was achieved in a two-year follow-up. In comparison with techniques described in the literature, the main advantages of the modified Risdon approach are the following: no need for facial vessels identification; direct, fast, and safe approach to mandibular angle and subcondylar region; relatively simple surgical technique and good cosmetic result – due to aesthetically placed incision. This approach could be recommended for subcondylar fracture as a simplified and safe procedure.