Preauricular transmasseteric anteroparotid approach for extracorporeal fixation of mandibular condyle fractures.
BACKGROUND
Free grafting or extracorporeal fixation of traumatically displaced mandibular condyles is sometimes required in patients with severe anteromedial displacement of condylar head. Majority of the published studies report the use of a submandibular, retromandibular or preauricular incisions for the access which have demerits of limited visibility, access and potential to cause damage to facial nerve and other parotid gland related complications.


OBJECTIVE
This retrospective clinical case record study was done to evaluate the preauricular transmasseteric anteroparotid (P-TMAP) approach for open reduction and extracorporeal fixation of displaced and dislocated high condylar fractures of the mandible.


METHODS
This retrospective study involved search of clinical case records of seven patients with displaced and dislocated high condylar fractures treated by open reduction and extracorporeal fixation over a 3-year period. The parameters assessed were as follows: a) the ease of access for retrieval, reimplantation and fixation of the proximal segment; b) the postoperative approach related complications; c) the adequacy of anatomical reduction and stability of fixation; d) the occlusal changes; and the e) TMJ function and radiological changes.


RESULTS
Accessibility and visibility were good. Accurate anatomical reduction and fixation were achieved in all the patients. The recorded complications were minimal and transient. Facial nerve (buccal branch) palsy was noted in one patient with spontaneous resolution within 3 months. No cases of sialocele or Frey's syndrome were seen.


CONCLUSIONS
The P-TMAP approach provides good access for open reduction and extracorporeal fixation of severely displaced condylar fractures. It facilitates retrieval, transplantation, repositioning, fixing the condyle and also reduces the chances of requirement of a vertical ramus osteotomy. It gives straight-line access to condylar head and ramus thereby permitting perpendicular placement of screws with minimal risk of damage to the facial nerve.
Department of Oral and Maxillofacial Surgery, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India.
Rajasekhar
R
Gali
Department of Oral and Maxillofacial Surgery, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India.
Sathya Kumar
SK
Devireddy
Department of Oral and Maxillofacial Surgery, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India.
Kishore Kumar Rayadurgam
KK
Venkata
Department of Oral and Maxillofacial Surgery, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India.
Sridhar Reddy
SR
Kanubaddy
Department of Oral and Maxillofacial Surgery, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India.
Chaithanyaa
C
Nemaly
Department of Oral and Maxillofacial Surgery, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India.
Mallikarjuna
M
Dasari
Access; approach; condylar fracture; extracorporeal fixation