Direct transparotid approach via a modified mini-preauricular incision for open reduction and internal fixation of subcondylar fractures

Abstract

A transparotid approach, with a retromandibular or preauricular incision, is an alternative surgical approach for treating a subcondylar fracture and reducing the potential for complications such as injury to the facial nerves. However, retromandibular and preauricular incisions are both created far away from the parotid gland-dissection area. Thus, it is necessary to undermine the skin and retract it anteriorly to access the surgical field. Here, we introduce a modified approach wherein the incision allows for direct access to the fracture site. This approach may be adopted to shorten the incision length, reduce the retraction trauma at the surgical site, and help prevent injury to the facial nerve.

Keywords: Facial nerve injury; Mandibular fracture; Parotid gland.

Fig. 1

A. Landmark line for the skin incision. A line was drawn, 2 cm long, at 1 cm anterior to and parallel to the placement of a conventional preauricular incision. It was located immediately below the earlobe, parallel to the Frankfort horizontal plane. B. Skin incision. The incision is less than 2 cm long, made inferior to the earlobe in the direction of the superficial musculoaponeurotic system. The parotid capsule incised horizontally (purple dotted line), and the parotid tissues were bluntly dissected open with vessel forceps.

Fig. 2

The masseter muscles. As the dissection continued, the masseter muscles were encountered. They were dissected obliquely (green dotted line), parallel to the masseter muscle fibers anteriorly and posteriorly.

Fig. 3

The periosteum dissection. The periosteum was dissected superiorly and inferiorly, and the fracture site was exposed for a short distance, with retraction.

Fig. 4

A. Reduction and fixation of the fracture. A four-hole mini-plate was fixed under retraction with a posterior, sigmoidal area and inferior direction. B. Fractured mandibular subcondyle repair. The fractured area was fixed with two four-hole metal mini-plates and 6-mm screws, after confirming that the dental occlusion was favorable.

Fig. 5

A. Panoramic radiograph taken preoperatively of the 22-year-old patient. B. Coronal view of a computed tomography scan taken preoperatively of the 22-year-old patient.

Fig. 6

Panoramic radiograph taken immediately postoperatively in the 22-year-old patient. The image shows good reduction of the subcondyle fracture.

Fig. 7

Seven-month outcome of surgery for a subcondyle fracture in the 22-year-old patient. No significant postsurgical scar was visible at the skin incision site after seven months.

Fig. 8

A. Panoramic radiograph taken preoperatively of the 37-year-old patient. B. Coronal view of a computed tomography scan taken preoperatively of the 37-year-old patient.

Fig. 9

Panoramic radiograph taken immediately postoperatively in the 37-year-old patient. The image shows good reduction at the fractured sites in the mandible.

Fig. 10

Seven-month surgical outcome of the subcondyle fracture in the 37-year-old patient. No postsurgical scar was visible at the skin incision site after seven months.