Retromandibular Transparotid Approach Research Articles

Risk factors for postoperative facial nerve injury in retromandibular-approach surgery: A retrospective study including CT measurements of maxillofacial bone structure

The purpose of this retrospective study was to identify risks of postoperative facial nerve injury (FNI) in mandibular condylar fractures. A total of 59 consecutive cases of condyle fracture or plate removal with a retromandibular transparotid approach (RMTA) were divided into FNI and non-FNI groups that were evaluated for associations with age, sex, laterality, fracture type, height, weight, body mass index (BMI), and maxillofacial bone height and width diameters on computed tomography (CT).FNI occurred in 11 of 59 patients (18.64%), all of them female (p = 0.0011). Other statistically significant factors on univariate analysis for FNI included a short height (156.95 ± 8.16 cm vs. 164.29 ± 9.89 cm, p = 0.04), low weight (46.08 ± 8.03 kg vs. 58.94 ± 11.79 kg, p = 0.003), low BMI (18.64 ± 2.63 kg/m2 21.68 ± 3.02 kg/m2, p = 0.007), short condylion–anterior fracture distance (19.34 ± 3.15 mm vs. 22.26 ± 3.96 mm, p = 0.04) and short condylion–posterior fracture distance (20.12 ± 3.98 mm vs. 25.45 ± 5.02 mm, p = 0.009).Our retrospective study suggested that FNI with RMTA surgery occurs particularly in female patients and may occur more frequently in patients who are short, lean or have high condyle fractures.

A Temporary Intraoperative Fixation Method for the Absorbable Plates Fixation of Condylar Fracture by Retromandibular Transparotid Approach.

The authors describe a temporary intraoperative fixation method for the absorbable plates' fixation of subcondylar fracture by retromandibular transparotid approach. First, the fracture was temporarily fixed with a 4-hole titanium microplate across the fracture line in the center of the lateral surface of the condyle to maintain the reduction of the fracture. Then, two 4-hole absorbable mini-plates were fixed on the posterior and anterior border of the condylar neck. Finally, the 4-hole titanium microplate and screws were removed before the wound closure. In the absorbable plates' fixation of subcondylar fracture by transparotid approach, the method of temporary intraoperative fixation using a 4-hole titanium microplate offsets the limited exposure of the operative field, smooths the operation, and offers the reliability and validity of the absorbable plates' fixation.

Inferio-parotid Transmasssetric Approach for Mandibular Subcondylar Fracture: A Novel Approach

Apropos to the article by Ramaj, Patil et al. [1] entitled "Variations in the retromandibular transparotid approach to the condyle-transparotid versus anteroparotid transmassetric- a prospective clinical comparative study," a few clarifications are in order. According to the author, the mandibular condylar processes are one of the most common sites of fracture in mandibular fractures

Comparative study between preauricular retromandibular anteroparotid approach and retromandibular transparotid approach in open reduction and internal fixation of subcondylar fracture on facial nerve injury and parotid fistula

Background: Condyle fractures account for 17.5 percent to 50 percent of all mandibular fractures, although there are still many debates on whether to treat them close or open. There are several techniques of managing the mandibular condyle, each with its own set of benefits and drawbacks. Aim: compare the innovative preauricular transmasseteric anteroparotid approach (P-TMAP) to the usual retromandibular transparotid technique. Patients and methods: 20 cases, patients with an odd number (1,3,5,7,9,11,13,15,17,19) received a preauricular transmasseteric anteroparotid approach (study group), while patients with a double number (2,4,6,8,10,12,14,16,18,20) had a retromandibular transparotid approach (control group) (control group). Patients were closely monitored for six months. Results: Fractures were caused by a road traffic accident (RTA) in 6(60%) of the cases, interpersonal violence in 3(30%) of the cases and falling in 1(10%) of the cases in both groups. Immediate postoperative facial nerve affection was higher in the transparotid approach group (30%) than in the anteroparotid approach group (10%), but both groups exhibited no statistically significant difference three months after surgery. There were no parotid injuries in any of the cases in either group.

The Study Intends to Compare the Efficiency of the Modified Tragus Edge Approach and the Retromandibular Transparotid Approach in Patients Who Underwent Open Reduction and Internal Fixation of Low-Level Condylar Fractures

The Study Intends to Compare the Efficiency of the Modified Tragus Edge Approach and the Retromandibular Transparotid Approach in Patients Who Underwent Open Reduction and Internal Fixation of Low-Level Condylar Fractures

Facial Nerve Weakness Following Retromandibular Transparotid Approach for Subcondylar Fractures of Mandible- A Series of Five Cases

Mandibular condyle fractures are the most commonly reported mandible fractures. The incidence of condylar fractures is 25-30% among all mandibular fractures and there are ongoing controversies about their management. The retromandibular transparotid technique is the most frequently employed technique to manage fracture of mandibular condyle. The benefits of this method have been reported to include a shorter working distance between the incision and the fracture site, less morbidity to the facial nerve as it can be identified and retracted under direct vision, cosmetically pleasing outcomes and ease of reduction/fixation of fractures. Nevertheless, surgical treatment of mandibular condyle fractures, can pose danger to facial nerve branches. With respect to condylar fracture surgical treatment, the prevalence of Facial Nerve (FN) injury has been reported to be around 12-48%. This case series reports the surgical and postoperative journey of five patients with subcondylar fracture. The retromandibular transparotid technique was applied in all patients for Open Reduction Internal Fixation (ORIF). Using the House-Brackman facial grading system, FN weakness was assessed. Postoperatively, FN weakness was evident after 24 hours of surgery in two patients. With a mean recovery period of two months, all patients maintained FN function at three months. None presented with persistent paralysis of the facial nerve. Parotid fistulation was not observed in any patient. Inconspicuous scar after six months was observed in four patients. The retromandibular transparotid approach is a safe and effective technique that gives less morbidity to the facial nerve, excellent access, good cosmetic results and patient satisfaction.

Open Reduction Internal Fixation of Mandibular Condylar Fractures: Factors Influencing Radiographic Anatomical Reduction

Mandible fractures occur frequently, accounting for approximately 70% of all facial fractures. Of those, fractures of the mandibular condyle account for 25-35%.1,2 Over several decades, there has been much controversy over the standard treatment method for condylar fractures, with increasing support for open reduction internal fixation (ORIF). The aim of this study is to determine negative and positive factors that may influence radiographic reduction outcomes after ORIF of mandibular condylar fractures.This retrospective study assessed the influence of several clinical factors on the quality of reduction. Records from patients treated with ORIF for condylar fractures between 2013 and 2021 at a single institution were reviewed. The predictor variables were condylar fracture level, type of fracture, amount and direction of displacement, vertical segment overlap, height of fracture, amount of soft-tissue envelope thickness, surgical approach, time to surgery, type of plate utilized, and surgeon experience. The primary outcome variable was the radiographic postoperative outcome of reduction and fixation as rated by 2 blinded observers in a 1-5 ordinal scale, with a score of 5 indicating adequate anatomical alignment of the posterior border of the mandibular-condylar border without displacement or deviation of the condylar process after ORIF.The data were analyzed statistically using ANOVA and Pearson's Correlation Coefficient tests using IBM SPSS Statistics to determine the significance between factors that may affect anatomical reduction and fixation of the mandibular condyle.The sample was composed of 21 subjects with 22 subcondylar fractures; 1 subject with bilateral subcondylar fractures was treated with ORIF with the majority being left subcondylar fractures (68%) with a concurrent fracture (86%). The study composed of nondisplaced (7), displaced (11), and dislocated (4) subcondylar fractures. The majority of subcondylar fractures treated with ORIF utilized 2 single miniplates (55%) via the retromandibular transparotid approach (90%). The mean adequacy of ORIF of subcondylar fracture score was 4.16 with the interclass correlation coefficient being 0.75, indicating good agreement between the 2 blinded observers. The plate utilized (P = .042), surgeon experience (P = .000), time to surgery (P =.000), and a concurrent mandible fracture (P = .000) were all shown to be significant in the adequacy of open reduction internal fixation of subcondylar fractures. A single plate along with a concurrent mandible fracture were shown to be negative factors influencing the ORIF of subcondylar fractures, whereas increased duration from the time of injury to ORIF was shown to be a positive factor.The management of condylar fractures is a subject of much debate and controversy within the field of oral and maxillofacial surgery. This study assessed multiple factors that may influence the objective radiographic outcome of ORIF of subcondylar fractures. Perhaps this study will further provide the oral and maxillofacial surgeon with an objective assessment based on radiographic interpretation for achieving anatomical reduction of the fractured condylar segment prior to taking the patient to the operative room.

Retromandibular Transparotid Approach for the Treatment of Benign Nontraumatic Conditions of the Mandible. A Retrospective Consecutive Case-Series Study.

The retromandibular transparotid approach enables the most direct access to the central and posterior part of the mandibular ramus including the condylar region. So far it has not been widely used for the management of benign pathology of the mandible. The purpose of this study was to evaluate the utilization rate of this approach in the nontrauma setting including the determination of suitable indications for this access. In total, 105 patients with 107 retromandibular transparotid approaches performed in the 6.5 years (from May 2014 to November 2020) were evaluated. Patients suffering from nontrauma pathology accounted for 4.7% of all cases. The recurrences of different types of odontogenic cysts and secondary chronic osteomyelitis were surgically managed via this approach with aesthetically acceptable resultant scar achievement and no identified postoperative complications. All lesions resolved and no recurrences occurred during the follow-up 32.0 ± 20.7 months (range 6 to 59 months, median = 26 months). The retromandibular transparotid approach may be considered for the enucleation of benign bone lesions in selected patients. Another type of surgery for the management of benign nontraumatic conditions in an accessible area without requirements for continuity resection and jaw reconstruction may be also suitable for using this approach.

The retromandibular transparotid approach vs. retromandibular retroparotid approach for the mandibular condyle

Aim: The mandible is regarded as a frequently fractured bone in patients who present with maxillofacial trauma accounting for almost 15.5% to 59% of all facial fractures. Managing condylar trauma has remained to be a point of contention amongst experts, regardless of the advances in surgical modalities and methodologies, and the treatment plan is often determined by the preference and the experience of the surgeon. There exist various approaches in the literature, each with its own specific benefits and drawbacks. With this study, we aimed to evaluate the prevalence of post-operative complications in patients who experienced ORIF by means of the retromandibular approach, by comparing the outcomes of one group having undergone transparotid surgery, with another that underwent retroparotid surgery. Methods: An experimental trial was undertaken. Convenience sampling was done from among the cases of condylar neck and base fracture visiting the department of OMFS, Dow University of Health Sciences from January 2017 to December 2019. An overall 26 patients were divided into 2 groups of 13 members each; one was managed using Open Reduction Internal Fixation (ORIF) by means of a retromandibular transparotid approach while the other group was treated with ORIF by means of a retromandibular retroparotid approach. A 6 month follow-up was done to assess range of active motion, occlusion, and complications such as deviation/deflection, neural injury, infections, sialocele, salivary fistulae and Frey’s syndrome in both groups. Results: There was no statistically significant difference between the two groups in terms of inter-incisal opening, right and left lateral movements, or protrusion. One patient in the retroparotid group had deviation on mouth opening (7.69%), while one in the transparotid group reported with infection (7.69%), and 2 developed post operative seromas (15.38%). None had persisting facial nerve palsy at 6 months. Conclusion: We find no significant disparity between the 2 approaches at a follow-up of 6 months; therefore, the primary determining factor for selection of either technique is surgeon preference and appropriate case selection.

Management of mandibular condylar fractures by the retromandibular approach – An evaluation of its complications

Background: Mandibular condyle fractures are commonly encountered in the practice of maxillofacial surgeon. Even though being a commonly seen fracture, the fracture condyle of the mandible demands meticulous diagnosis and a tailor made treatment plan for each and every patient. The treatment plan largely depends on the age of the patient and the displacement of the fractured fragment. This retrospective study provides an insight in to the management of fracture mandibular condyle by retromandibular approach.
 Aims and Objectives: The aim of this study was to evaluate the complications of the retromandibular transparotid approach in surgically operated patients with mandibular condylar fractures.
 Materials and Methods: A retrospective study was performed by analyzing the treatment records of patients who underwent open reduction and internal fixation (ORIF) by the retromandibular transparotid approach for seven years. Thirty-five patients who fulfilled the criteria were included in the study. Clinical parameters such as marginal mandibular nerve weakness, sialocele, occlusal derangement and decreased mouth opening were recorded during the first, fourth and twelfth weeks postoperatively. The retrieved data were analyzed for complications of the retromandibular approach in the management of mandibular condylar fractures.
 Results: In patients (N= 35) who underwent ORIF by the retromandibular transparotid approach, findings recorded at the end of the first week included 5 patients with sialocele, 2 patients with derangement of occlusion, 6 patients with restricted mouth opening and 1 patient with marginal mandibular nerve weakness. However, postoperatively, at the end of 4 weeks, the only complication observed was sialocele in 3 patients. Furthermore, at the end of 12 weeks, sialocele had completely resolved in all 3 patients, and they were free of complications.
 Conclusion: The retromandibular transparotid approach is a reliable and straightforward technique with manageable complications.

Analysis of facial nerve function after open reduction of mandibular condylar fracture via a retromandibular approach

Mandibular condylar fractures account for a sizeable segment amongst facial fractures. Previously most of these fractures were managed conservatively with periods of Intermaxillary fixation(IMF). Shortcomings of such an approach such as prolonged pain, Tmj dysfunction and delayed return to function has shifted the discourse to open reduction and internal fixation of the fractured mandibular condyle.ORIF is the universally accepted and mainstay of intervention. Numerous extra oral approaches have been employed with various modifications. The retromandibular transparotid approach is a relatively simple and direct approach to the posterior mandible, enabling the surgeon to deal with sub condylar and condylar neck fractures with relative ease. This approach is a safe approach and does not result in permanent palsy of any of the branches of the facial nerve. To analyse facial nerve function after ORIF of mandibular sub condylar fractures through the retromandibular transparotid approach. 25 patients reporting with unilateral condylar fractures, sub condylar (16) and neck fracture (9) (Ellis classification)consenting for the study were taken up. All patients were followed up for 8 months. Post-operative nerve function was evaluated at 24 hours after surgery, 1,4,12 weeks and at the end of 8 months. 4(16%) patients presented with weakness of the facial nerve. Buccal branch (3) and zygomatic branch (1). In all cases the weakness was temporary and no permanent deficit was noted.

Retromandibular transparotid approach for subcondylar mandibular fracture: A retrospective study.

The retromandibular transparotid approach provides the shortest and the most direct access to mandibular sub-condylar fractures. However, this approach is less preferred due to the fear of facial nerve injury. The aim of this study was to evaluate the safety and morbidity of the retromandibular transparotid approach for open reduction and internal fixation of sub-condylar mandibular fractures. A retrospective cohort study of 29 patients with 35 sub-condylar mandibular fractures who underwent open reduction and internal fixation through the retromandibular transparotid approach was conducted. The primary study variable was facial nerve palsy, whereas the secondary variables were infection, sialocele, salivary fistula, stability of the fractured segments, post-operative malocclusion, Frey's syndrome, and unesthetic scar. All patients were followed up for 6months. Predictor variables included age, gender, side, location, displacement, etiology, concomitant maxillofacial fractures, and healing status. Fisher's exact test was calculated to find the association between primary variables and predictor variables. Out of 35 sub-condylar fractures (29 patients; 23 male, 6 female), four (11.42%) developed transient facial nerve palsy. Fractures at the condylar neck level (P=.045) and with displacement (P=.026) were significantly associated with the development of facial nerve palsy. Four patients (13.8%) developed slight malocclusion, two had surgical site infections, two developed sialoceles, and one had a salivary fistula. The retromandibular transparotid approach is safe and effective with rare major complications in the management of sub-condylar fractures of the mandible. Condylar neck fractures and displaced fractured segments are associated with an increased risk of development of facial nerve palsy.

An Anatomical Landmark for Retromandibular Transparotid Approach to Treat Subcondylar Fractures.

Although the retromandibular transparotid approach (RTA) has been widely used to treat mandibular subcondyle fractures, the transient facial nerve injury (FNI) caused by this approach is not uncommon. The purpose of this paper was to present an anatomical landmark for RTA to treat subcondylar fractures, aiming to minimize FNI caused by the surgery. A total of 25 patients with subcondylar fractures but no FNI underwent RTA surgery. Intraoperatively, the plane of angulus oris was utilized as a reference to open the parotid and masseter tissues for exposing the fracture site. Postoperatively, FNI and other surgical complications were counted. The results showed that except for 2 cases of hematoma, no FNI or other complications occur. As a conclusion, utilization of plane of angulus oris as a reference for RTA to treat subcondylar fractures might make the surgery safer and less invasive.

Does the Retromandibular Transparotid Approach Provide Quicker Access to Fracture of Mandibular Subcondyle Compared With the Retromandibular Transmasseteric Anterior Parotid Approach?

Limited studies are available in the literature comparing various surgical approaches for the management of condylar fractures, and those comparing different types of retromandibular approaches are even fewer in number. This study aimed to compare the efficacy of 2 variants of the retromandibular approach-retromandibular transmasseteric anterior parotid (RMTMAP) and retromandibular transparotid (RMTP) in terms of exposure time, blood loss, facial nerve palsy, sialoceles or parotid fistula formation, infection, and esthetics of scar tissue. A randomized controlled trial was designed in patients with mandibular subcondylar fractures requiring operative intervention. Patients were randomized into 2 groups based on a computer-generated randomization table. Group A included 37 cases, treated with the RMTMAP approach, and group B included 38 cases treated with the RMTP approach. The primary outcome variable was exposure time. Secondary outcome variables were blood loss during exposure, complications like facial nerve palsy, sialocele formation, surgical site infection, and scar esthetics. All patients were followed for 3months. Collected data were analyzed using the χ2 and analysis of variance tests. The mean exposure time for fractures treated with the RMTMAP approach and RMTP approach was 21.08±9.18 and 13.57±6.09, respectively (P<.05). The mean blood loss for RMTMAP and RMTP approach was 11.75±5.11 and 9.9±3.77mL, respectively (P=.078). No facial nerve injury was seen in patients treated with the RMTMAP approach, whereas 3 (7.8%) patients in the RMTP group had transient facial nerve injury (P=.08). This study concludes that the RMTP approach provides quicker access to the condyle as compared with the RMTMAP approach. However, the incidence of transient facial nerve injury was more in the RMTP approach. Except for reduced blood loss in the RMTP approach, all other parameters were comparable in both the approaches.

Comparative Evaluation of Clinical and Radiological Outcomes of Retromandibular Transparotid and Transoral Endoscopic-Assisted Approach for Surgical Management of Mandibular Subcondylar Fractures.

A prospective randomized comparative study was conducted to evaluate the clinical and radiological outcomes of the retromandibular transparotid (RMT) approach with endoscopic-assisted transoral (ENDO) approach used for open reduction and internal fixation (ORIF) of adult mandibular subcondylar fractures. To evaluate and compare the primary functional outcome using the Helkimo's dysfunction index, the surgical ease, the incidence of facial nerve weakness, the cosmetic outcomes and the number of complications following ORIF of mandibular subcodylar fractures using the RMT and ENDO approaches. In this prospective study, 20 patients with unilateral/bilateral subcondylay fractures requiring ORIF were recruited between 2017 and 2018. Patients were randomly divided into RMT and ENDO group, 10 patients in each. Clinical and radiological assessment was done preoperatively and in postoperative period it was done at different intervals over the period of 6 months. The intraoperative parameter time taken during surgery was correlated for association with the time elasped since day of trauma and with the fracture severity. Similarly, the presence of multiple fractures of the mandible and postoperative occlusion were evaluated for the association. Comparable functional results were noted in both groups without any statistical significance. ORIF in ENDO group proved to be more time-consuming. For the RMT group, visible scars were rated best or close to best at the end of 6 months but a greater number of facial nerve injuries were reported in the RMT group. Superiority of one approach over others cannot be established since the outcomes were not statistically different. However, the ENDO approach appears to be safer. Therefore, there is a need for the development of innovative armamentarium which would improve the dexterity and ease of the surgeon and hence the total time taken for this minimally invasive approach for the management of subcondylar fracture.

Effectiveness of ‘Preauricular-Retroparotid' and ‘Retromandibular-Transparotid' approaches in the management of displaced and dislocated condylar head and neck fractures.

Introduction: Management of fractures of the condylar head, neck and base regions can be quite tricky, owing to differences in the morphology and location of the fracture, degree & direction of displacement, extent of comminution, and position of condylar head in relation to glenoid fossa. Hence, choosing an ideal surgical approach for each individual case, is both difficult as well as important. Aim: To assess the effectiveness of two major surgical approaches, the ‘Preauricular-Retroparotid’ and ‘Retromandibular-Transparotid’ approaches in the management of different types of displaced and dislocated condylar head and neck fractures. Patients and Methods: This retrospective study includes 56 patients operated over a period of four years from Jan 2016 to Dec 2019, of whom 14 had bilateral and 42 had unilateral displaced condylar head or neck fractures. 22 surgeries were for condylar head or high condylar neck fractures, treated using the Preauricular-Retroparotid approach. 48 surgeries were for low condylar neck fractures, managed using the Retromandibular-Transparotid approach. Intraoperative and postoperative complications, and detailed objective, subjective and functional treatment outcome assessments, were recorded over a postoperative follow up period ranging from one to three years. Results & Conclusion: Both surgical approaches were found effective in achieving good esthetic and functional results with no major complications, other than occasional transient neurological deficits and few instances of salivary fistulas and sialocoeles. Depending upon the level of the condylar fractures, a preauricular approach is ideal for the condylar head and high condylar neck fractures, providing direct and easy visualization to the region, for retrieval and repositioning of the medially displaced and dislocated proximal fracture fragment. The retromandibular approach is more suited for the lower level condylar neck fractures, providing a direct visual field and a wide, straight line access for implant fixation at this region.

The Retromandibular Transparotid Approach for Reduction and Internal Fixation of Mandibular Condylar Fractures.

Introduction:The retromandibular transparotid approach is most useful for condylar and subcondylar fractures and provides the best access to the joint and ascending ramus. The study aims at evaluating the ease of access and outcomes encountered on using the retromandibular transparotid approach to access the fracture site for the open reduction and internal fixation (ORIF) of condylar and sub-condylar fractures.Materials and Methods:An observational clinical study was carried out among 10 patients with unilateral and bilateral condylar fracture requiring ORIF. Maximal interincisal mouth opening, facial swelling, occlusal discrepancy, facial nerve injury, scar formation, and acceptability and complications including wound dehiscence, infection, and sialocele/salivary fistula were assessed and measured preoperatively and postoperatively.Results:There was a notable improvement in mouth opening and facial nerve weakness. Postoperative intermaxillary fixation was done with selective patients who had a discrepancy in their occlusion. Preoperatively, swelling was present in four patients (40%) out of 10 patients studied. There was no incidence of sialocele/salivary fistula in any of the cases studied.Conclusion:Retromandibular transparotid incision is technique sensitive and thorough knowledge about the retromandibular area is must for good results and minimal morbidity. The cosmetic results are good in this approach, as well as the facial nerve injury were less in this without any permanent damages.

Biportal transparotid dissection in the retromandibular approach for condylar fracture osteosynthesis: Efficacy of a novel technique

Facial nerve injury is a primary complication of open surgical management of condylar fractures. A new modification of the retromandibular transparotid approach, the "biportal transparotid dissection" (BTD), was developed to reduce these injuries in accidental nerve exposure. Prospective cohort study. Tertiary referral center. Patients managed by retromandibular transparotid approach for condylar fractures at Department of Otolaryngology - Head and Neck Surgery, Mansoura University were included between November 2015 and August 2019 with exclusion of cases managed endoscopically or by a closed approach. Three groups were identified: Group A included patients undergoing the BTD technique, which entails transparotid dissection above and below exposed nerve branches and minimal nerve retraction; Group B included patients undergoing traditional dissection and nerve retraction away from the surgical field; and Group C included patients with unidentified facial nerve branches. The function of facial nerve branches was documented postoperatively. Fifty-seven fractures were included in the study. Facial nerve branches' injury occurred in 13 cases (22.8%): two (of ten) in Group A (20%), seven (of ten) in Group B (70%) and four (of 37) in Group C (10.81%). Compared to patients with non-exposed branches, Groups A and B were found to have 2.06 (p = 0.447) and 19.25 (p = 0.001) greater odds of nerve injury, respectively. The results showed significant faster nerve recovery in the BTD group compared to traditional dissection (mean 5 versus 9 weeks) (p = 0.015). Although avoiding facial nerve exposure minimizes injury the most, BTD approach reduces exposed nerve injury compared to the traditional method.

Retromandibular transparotid approach compared with transmasseteric anterior parotid approach for the management of fractures of the mandibular condylar process: a prospective randomised study

Fractures of the mandibular condyle lead to displacement of the condyle and loss of the height of the ramus. A retromandibular approach is the most commonly used for open reduction and internal fixation (ORIF) of such fractures. We aimed to compare the complications associated with a retromandibular transparotid approach with a retromandibular transmasseteric anterior parotid (TMAP) approach for their management. Thirty patients were randomly selected into two groups (15 in each): Group A comprised the retromandibular transparotid approach and Group B the retromandibular TMAP. The variables evaluated were: operating time, facial nerve injury, occurrence of Frey syndrome, and sialocoele at one week, four weeks, three months, and six months. The mean (SD) age in group A and B was 33.93 (17.97) years and 33.53 (16.15) years, respectively, and there were 28 men and two women. Mean (SD) exposure time in the transparotid approach was 26.93 (5.19) minutes and 25.4 (8.35) minutes in the TMAP approach. The incidence of facial nerve injury was 2/15 patients in the transparotid group and 3/15 in the TMAP group, all of which resolved within six months. The incidence of sialocoele was 2/15 in the transparotid group. The results did not show any significant difference in complications between the two approaches, but the retromandibular transparotid approach provided straight-line access in fractures of the condylar neck, with fewer incidences of nerve injury. The anterior parotid approach, on the other hand, provided easier access for fractures that were medially dislocated or of the condylar base but had an increased incidence of facial nerve injuries.

Variations in the retromandibular approach to the condyle-transparotid versus anteroparotid transmasseteric – a prospective clinical comparative study

BackgroundThe management of mandibular condylar fracture remains controversial many surgeons still favour the open reduction and internal fixation (ORIF) which provides good result and immediate functioning as compared to closed reduction. With proven consensus for ORIF, dilemma remains in choosing the surgical approach to condyle due to proximity of complex and important anatomic structure. Various extra-oral surgical approaches are available for ORIF including preauricular, submandibular, retromandibular, transmasseteric anteroparotid etc. Variations in retromandibular approach such as transparotid, retro-parotid and anteroparotid are reported in literature. In our study we compared the retromandibular transparotid and retromandibular anteroparotid transmasseteric variations. MethodologyThirty condylar fracture in 26 patients, 15 in each group (group A – Retromandibular transparotid approach & group B – Retromandibular anteroparotid approach) were treated under general anaesthesia with naos-tracheal intubation and by the same surgeon having 20 years of experience in maxillofacial surgeries. We evaluated time taken for the procedure, amount of bone exposure, intra-operative haemorrhage. Postoperative presence of infection, sinus and fistula formation at the incision site, parotid fistula formation, facial nerve functioning using House-Brackman scale in immediate postoperative period, 3rd month postoperatively and 6 month postoperatively. ResultThe mean average time taken for group A was 78.2minutes and mean average time taken for group B was 64.8minutes. None of the patient had haemorrhage intra-operatively in both the groups. Exposure was sufficient in both the groups with same length of the incision. None of the patient suffered from postoperative infection in both the groups. Parotid fistula formation was present in 2 patients in group A while none of the patient had parotid fistula in group B. Three patients out of 15 had the transient facial nerve weakness in group A which got resolved in 6 month while none of the patient had facial nerve weakness in group B. All patients had adequate mouth opening with no occlusal discrepancies. ConclusionRetromandibular anteroparotid approach as described in this study has proven to be an extremely useful approach provides good access, and associated with minimal complications and morbidity compare to retromandibular transparotid approach. It is hence safe to say that this approach is relatively useful for an inexperienced and novice surgeon as well.