Abstract
Mandibular condyle fractures constitute 17.5% to 52% of mandibular fractures. Open reduction with internal fixation and closed reduction are described for their treatment. Fonseca describes the absolute indications for open treatment when there is displacement of the mandibular condyle to the middle cranial fossa, foreign body invasion, extra capsular displacement of the condyle, and/or malocclusion not susceptible to closed reduction. It includes indications with vast evidence for open treatment of bicondyle fractures, condylar displacement greater than 45 degrees, reduction in the height of the mandibular ramus greater than or equal to 2mm, fractures associated with fractures of the middle third and when there is unstable occlusion. The above establishes sufficient evidence to perform open treatment in various situations of condylar fractures. Regarding the approach of the mandibular condyle region there are different surgical techniques, such as, the preauricular, retroauricular, submandibular, retromandibular, and rhytidectomy approaches.
Highlights
The approach to the mandibular condyle region is complex due to the existence of the branches of the facial nerve which is why the management of condylar fractures comes into discussion as to when to perform an open or closed treatment
In the Maxillofacial Surgery Service of the 1o de Octubre Regional Hospital, we have chosen to perform a transparotid retromandibular approach, which we describe below including the author’s suggestions: Using general anesthesia with nasotracheal intubation, the surgical area is delimited keeping the corner of the mouth and the ear lobe visible on the side of the fracture
We suggest the use of a McKesson gag, which is placed in the most posterior region of the fractured side to descend the mandibular ramus producing the reposition of the mandibular condyle within the glenoid cavity when the ideal position of the condyle is achieved; we proceed to perform the fixation with the use of condyle plates
Summary
The approach to the mandibular condyle region is complex due to the existence of the branches of the facial nerve which is why the management of condylar fractures comes into discussion as to when to perform an open or closed treatment. Different approaches have been proposed; the retromandibular approach described by Hinds in 1967 suggests that a subcondylar mandibular vertical osteotomy in the correction of prognathism is performed. This technique describes the incision below the ear lobe with an incision extension no greater than 2.5cm [3]. Anesthetic is infiltrated superficially along with 1 cc of vasoconstrictor for hemostatic purposes
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