P-61069874-222 - Antero-Parotid trans-massetric approach for reduction of mandibular subcondylar fractures; clinical tricks.

Abstract

Sub-condylar fractures of mandible are a common occurrence in the trauma of the maxillofacial region both in children and adults. These fractures are treated by open reduction and internal fixation or by closed reduction according to the patient's age, his general condition and the facilities available in a particular healthcare setting. Use of the antero-parotid trans-massetric approach for treating mandibular subcondylar fractures has the least postoperative complications among other approaches for treating mandibular subcondylar fractures. Data was collected over seven years with a total of 245 fractures operated on 205 patients. Only minor complications were noticed during the 10 day post operative period, with mild temporary weakness of the buccal branches of facial nerve in 3.4% of cases while post operative unusual edema and trismus in 8.7% which resolved during the first ten days. No parotid leak/sialocele was found in any of these cases. Our aim is to give some clinical tricks after seven years experience in using this approach to treat subcondylar fractures and to achieve the best results with the least complications. The tricks include: the type of fractures which can be treated with this approach, to identify the access site, to deal with facial nerve branches in surgical site, the needfor perfect retraction and how to aid in reduction of fractures. We recommend this approach as it is rapid,easy, safe and effective for treating low subcondylar fractures.We suggest consideration of those clinical tricks to achieve the least complications and minimize surgical time.