Retroparotid Transmasseteric Approach to Condylar Fracture Through Mini-Retromandibular Access

Abstract

Statement of the Problem: The incidence of condylar fractures amongst mandibular fractures is between 17.5% and 52%. Almost 50% of condylar fractures have other associated fractures and 80% of them are unilateral fractures. Most are not caused by direct trauma but from indirect forces transmitted to condyle from elsewhere. Broadly there are 2 types of fractures, intracapsular and extracapsular, but for diagnostic and practical reasons it has been divided into 3 categories: condylar head (intracapsular), the condylar neck (extracapsular) and the subcondylar fractures. They are classified as: undisplaced, deviated, displaced (with medial or lateral overlap) and dislocated. The management of mandibular condylar fractures remains controversial. A wide spectrum of management is seen from plain analgesic, to physiotherapy, intermaxillary fixation and open reduction with internal fixation. Over the past decade better understanding of biological considerations of condylar fractures, improved surgical facilities and skills have tilted the balance in favor of open reduction. Open reduction is usually carried out by extra-oral approach such as preauricular, submandibular and retromandibular. Various modifications have been proposed for retromandibular approach like transparotid, transmasseter, high cervical transmasseteric anteroparotid, and mini retromandibular. This talk will present our experience with the retro-parotid transmasseteric approach to condylar fractures through mini-retromandibular access. This approach minimizes nerve injury and provides good access.