Evaluation of Open Reduction and Internal Fixation of Mandibular Subcondylar Fractures through Transmasseteric-anteroparotid approach- an Original Study

Background: Management of mandibular subcondylar fractures has always been a matter of debate and controversy in spite of being 1/3rd of all mandibular fractures. Literature increasingly suggests that surgical management of these fractures is superior to conservative management. Undiagnosed or indirectly treated condylar fractures can lead to severe functional impairment including poor occlusion, reduced opening associated deviation and limited mandibular lateral movements. However it is of outmost importance that the surgical procedure must guarantee maximum safety for the facial nerve and must provide a good cosmetic outcome. Objective: In this paper we advocate a rapid and comfortable technique which fulfils these conditions and is unlikely to damage the facial nerve. Methodology: A series of 30 patients with mandibular subcondylar fractures who were treated by ORIF via the retro mandibular transmasseteric-anteroparotid approach over a period of 4 years from 2011 through 2015. These patients were evaluated on various parameters such as 1. Postoperative occlusal stability 2. facial nerve integrity on the House Brackmann Facial Nerve Grading System 3. Range of mandibular movements and 4. Scar visibility on the visual analogue scale The patients were divided into groups A (those with isolated subcondylar fractures) and B with concomitant facial fractures. Results: In all cases good anatomical reduction and stable post-operative fixation was achieved with mandibular movements within normal range. Conclusion: In our opinion the anteroparotidtransmassetric approach is appropriate for surgical management of mandibularsubcondylar fractures as it provides adequate access, ensures safety of the facial nerve and is relatively easy to master.