Is the high submandibular transmasseteric approach to the mandibular condyle safe for the inferior buccal branch?
OBJECTIVE
There are basically 3 main approaches for extra-articular mandibular condyle fractures: low cervical, retromandibular and preauricular. These include a risk of facial palsy affecting the marginal mandibular branch. We use a high submandibular transmasseteric approach featuring masseter section 10-20 mm above the mandibular basilar edge. Our null hypothesis was that both the marginal mandibular and the inferior buccal branches are not more at risk than in other surgical approaches.


METHODS
This study was based on 20 parotidomasseteric dissections from 10 embalmed cadaveric heads. We used as reference the vertical line, passing through the mandibular angle, parallel to the preauricular line. We performed measurements of the marginal mandibular and inferior buccal branches' heights.


RESULTS
The inferior buccal branch had an average height of 16.8 mm and the highest standard deviation (7.2). Extremes were, respectively, 32 and 7 mm. The marginal mandibular branch had an average height of 3.2 mm with standard deviation equal to 3.0. Extremes were, respectively, 9 and -3 mm.


CONCLUSIONS
The high submandibular transmasseteric approach provides great exposure of facial nerve branches lying on the masseter muscle, if even encountered. Through masseteric incision performed between 10 and 20 mm above the basilar edge of the mandible, the marginal mandibular branch is safe from wound with an added safety margin of 4 mm. The surgeon using this approach is most likely to encounter the inferior buccal branch. It can then be avoided under visual control. This makes it a swift and safe approach to the mandibular condyle.
Lutz
Jean-Christophe
JC
Anatomy Department, Strasbourg University of Medicine, 4, rue Kirschleger, 67085, Strasbourg Cedex, France. jean-christophe.lutz@chru-strasbourg.fr
Clavert
P
P
Wolfram-Gabel
R
R
Wilk
A
A
Kahn
J-L
JL
D000328:Adult; D005154:Facial Nerve / Q000033:anatomy & histology*; D005158:Facial Paralysis / Q000209:etiology / Q000517:prevention & control; D005260:Female; D005592:Fracture Fixation / Q000009:adverse effects; D006801:Humans; D008297:Male; D008335:Mandibular Condyle / Q000033:anatomy & histology / Q000601:surgery*; D008337:Mandibular Fractures / Q000601:surgery*; D008406:Masseter Muscle / Q000601:surgery
Int J Oral Maxillofac Surg. 2003 Jun;32(3):253-6
12767870
Surg Radiol Anat. 1997;19(2):69-72
9210238
Surg Radiol Anat. 2006 May;28(2):170-5
16636775
Rev Stomatol Chir Maxillofac. 2006 Dec;107(6):449-54
17194998
Surg Radiol Anat. 2004 Dec;26(6):494-500
15368081
J Oral Maxillofac Surg. 2008 Jan;66(1):201-4
18083441
Clin Anat. 2005 Apr;18(3):171-8
15768421
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999 Sep;88(3):292-6
10503856
J Craniomaxillofac Surg. 2008 Jul;36(5):260-8
18328720
J Oral Maxillofac Surg. 2000 Sep;58(9):950-8
10981974
Surg Radiol Anat. 2006 Oct;28(5):462-7
16838086
Br J Oral Maxillofac Surg. 2005 Feb;43(1):57-60
15620776
Rev Stomatol Chir Maxillofac. 2004 Jun;105(3):149-52
15211212