Retromandibular approach for open reduction and internal fixation of condylar process fractures

Abstract

Indications for open reduction of condylar process fractures in adults are controversial. In patients without displacement of the condylar process, consensus has been reached that the method of choice is closed treatment. However, open reduction followed by rigid fixation is indicated in condylar process fractures with substantial displacement, dislocation, or both. Once open reduction has been chosen, it is necessary to select the incision and fixation methods. The conventional incision for open reduction of condylar process fractures is made via the submandibular or the preauricular approach. However, these incisions are associated with difficulty in manipulating fragments in a small area and have the risk of damaging the facial nerve. We used a retromandibular approach to circumvent these problems, as described by Ellis et al., in a series of patients prospectively studied between 1995 and 1997. The aim of this study was to evaluate clinical results in 11 patients who were followed up for longer than 1 year.
The retromandibular surgical approach was successful in all but one patient (miniplate fracture). All patients had satisfactory mouth opening and occlusion. Permanent facial nerve palsy did not occur. Our results indicate that open reduction via the retromandibular approach is a safe and useful technique in patients with displaced or dislocated condylar process fractures (or both).