Transmasseter approach to condylar fractures by mini-retromandibular access.
OBJECTIVE
The published data are full of evidence that surgical treatment of condylar fractures, performed through an intraoral or extraoral approach, leads to better results than nonoperative treatment. Intraoral surgery can be technically demanding, and an extraoral approach presents risks of facial nerve injuries and visible scarring. The mini-retromandibular approach we have described allows the treatment of condylar fractures at any level in a simplified and rapid manner while reducing the risk of complications common to the other techniques.


METHODS
A total of 33 patients with 38 condylar fractures were treated with a 20-mm mini-retromandibular approach. The mean operative time was 33 minutes (range 17 to 56). One patient in the present study was only 14 years old at surgery, which was performed 25 days after the associated trauma.


RESULTS
Correct anatomic reduction and occlusion were achieved in all cases. Additionally, all patients showed normal articular function. Infection of the surgical site occurred in the first 2 surgical cases. In another patient, an additional operation was necessary to fix an erroneously reduced fracture, which had occurred because of insufficient surgical access (15 mm). No facial nerve injury was observed, and all surgical scars were barely visible.


CONCLUSIONS
We suggest that the mini-retromandibular approach outlined in the present study should be the technique of choice for condylar fracture management, because it allows for easy, fast reduction and synthesis while minimizing the risk of facial nerve injury and visible scars.
Biglioli
Federico
F
Department of Maxillofacial Surgery, San Paolo Hospital, University of Milan, Milan, Italy.
Colletti
Giacomo
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D008335:Mandibular Condyle / Q000293:injuries / Q000601:surgery*; D008337:Mandibular Fractures / Q000601:surgery*; D008406:Masseter Muscle / Q000601:surgery; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D019647:Oral Surgical Procedures / Q000295:instrumentation / Q000379:methods; D019637:Orthopedic Procedures / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult