The Preauricular Transmasseteric Approach: A Novel Option for the Exposure of Mandibular Condyle Fracture

Abstract

Background: Mandibular Condyle fractures are common and the traditional method for the exposure is the retromandibular approach, however it presents some limitations and considerations among facial nerve palsy and parotid gland fistulae. This technical note present a novel approach to the subcondylar fractures, using preauricular incision with an innovative transmasseteric dissection. Study Design: Technical note. Objective: Present a novel approach to the subcondylar fractures, using preauricular incision with an innovative transmasseteric dissection. Methods: Patients diagnosed for mandibular condyle fractures in a Level 1 Trauma Center in Brazil. All the procedures were performed in the shortest possible time since the trauma. Traditional preauricular incision with gentle lower dissection through the superficial musculoaponeurotic system, the facial nerve branches are exposed and retracted. The parotid gland capsule plane is outlined and the parotid gland is retracted posteriorly. The masseteric fascia is exposed and the masseteric muscle is incised and the blunt dissection continues toward the periosteum and the mandibular condyle. Results: Eight patients were surgically managed in the acute trauma with a mean of 2.57 days to the operation. Transient parotid gland fistulae was observed in only 12.5% of the patients. Facial nerve palsy was observed in 37.5% of the patients in the first 7 days of postoperative time, with no records of persistent facial nerve paralysis. Conclusions: The preauricular transmasseteric approach is a reliable and versatile option for the exposure of the mandibular condyle, being a safe and aesthetic incision on the management of the subcondylar area. The surgical team use it as a novel tool in the approach for condyle fractures.