16Mar 2020

MANAGEMENT OF SUB CONDYLAR FRACTURES BY RETRO-MANDIBULAR APPROACH AND ASSESSMENT OF POST-OPERATIVE COMPLICATIONS: A PROSPECTIVE STUDY

  • Specialist Oral and Maxillofacial Surgeon, Department of Dentistry, King Salman bin Abdul Aziz Hospital, Ministry of Health, Kingdom of Saudi Arabia.
  • Associate Professor of Oral Pathology, Princess Nourah Bint Abdur Rehman University, Riyadh, Saudi Arabia.
  • Specialist oral and Maxillofacial Surgeon, Department of Dentistry, Salman bin Abdul Aziz Hospital, Ministry of Health, Kingdom of Saudi Arabia.
  • King Saud University, Riyadh Kingdom of Saudi Arabia.
Crossref Cited-by Linking logo
  • Abstract
  • Keywords
  • References
  • Cite This Article as
  • Corresponding Author

Maxillofacial injuries are common during trauma and sub-condylar fractures are considered one of the most challenging fractures to manage due to esthetic and functional concern. Purpose: Assessment of facial nerve damage and stability of occlusion by retro-mandibular approach. This was a Prospective cross-sectional study at a secondary care hospital, Ministry of Health, Riyadh, Saudi Arabia during from August 2017 to July 2019. Patients and Methods: Fourteen patients with sub condylar fracture were operated with open reduction and internal fixation through retro mandibular approach. Inclusion criteria were patients above fifteen years old with disturbed occlusion and displaced fractured sub-condyle. Results: Efficacy was assessed based on occlusion stability and status of the facial nerve postoperatively All Patients with sub condylar fractures (n=14) were operated with retro-mandibular approach. Fourteen patients aged sixteen years and above including 12(85.7%) males and 2(14.3%) females, with left side 7 (42.9%), right side 7 (42.9%) and bilateral 2 (14.3%) involvement. The significant etiological factor was road traffic accident 8 (57.1%) followed by history of fall 2(14.3%). Immediate postoperative findings showed facial nerve weakness in 2(14.3%) patients [buccal branch 1(7.1%); marginal mandibular branch 1(7.1%)] and both fully recovered after three months. Postoperative occlusion was normal in 12 (85.7%) patients while it was temporarily disturbed in 2(14.3%) patients and it significantly improved by the final follow-up visit. Conclusion: On the basis of our clinical findings, we recommend the retro mandibular approach as it provides good visibility with less facial nerve damage risk.


  1. Mumtaz M, Warraich RA, Bhatti MUD, Ali S. Comparative Study of Evaluation of Results of Orbital Floor Reconstruction with Calvarial Bone Graft Vs Sialastic Implant. Annals of King Edward Medical University. 2010;16(4):270-5.
  2. Khan I, Singh S, Faisal M, Ahmad SA, Cybil D. The retromandibular approach for treating sub-condylar fractures of mandible. International Journal of Oral and Maxillofacial Surgery. 2013;42(10):1205-6.
  3. Rashid A, Mumtaz M, Asif J, Azeem M. Mandibular condyle fracture- effect of treatment on occlusal relationship. Pakistan Oral & Dental Journal. 2014;34(1):30-3.
  4. Kang DH. Surgical management of a mandible subcondylar fracture. . Archives of Plastic Surgery. 2012;39(4):284-90.
  5. Shiju M, Rastogi S, Gupta P, Kukreja S, Thomas R, Bhugra AK, et al. Fractures of the mandibular condyle - Open versus closed - A treatment dilemma. . Journal of Cranio-Maxillo-Facial Surgery. 2015;43(4):448-51.
  6. Biglioli F, Colletti G. Transmasseter Approach to Condylar Fractures by Mini-Retromandibular Access. Journal of Oral and Maxillofacial Surgery. 2009;67(11):2418-24.
  7. Salgarelli AC, Anesi A, Bellini P, Pollastri G, Tanza D, Barberini S, et al. How to improve retromandibular transmasseteric anteroparotid approach for mandibular condylar fractures: Our clinical experience. International Journal of Oral and Maxillofacial Surgery. 2013;42(4):464-9.
  8. Bhutia O, Kumar L, Jose A, Roychoudhury A, Trikha A. Evaluation of facial nerve following open reduction and internal fixation of subcondylar fracture through retromandibular transparotid approach. British Journal of Oral and Maxillofacial Surgery. 2014;52(3):236-40.
  9. Mohan AP, Kumar KAJ, Venkatesh V, Kumar BP, Patil K. Comparison of preauricular approach versus retromandibular approach in management of condylar fractures. Journal of Maxillofacial and Oral Surgery. 2012;11(4):435-41.
  10. Filho TSC, Rodrigues DC, Lauria A, Moreira RWF, Consani S. Development plates for stable internal fixation: Study of mechanical resistance in simulated fractures of the mandibular condyle. Journal of Cranio-Maxillo-Facial Surgery : Official Publication of the European Association for Cranio-Maxillo-Facial Surgery. 2015;43(1):158-61.
  11. Valiati R, Ibrahim D, Abreu MER, Heitz C, Oliveira RBd, Pagnoncelli RM, et al. The treatment of condylar fractures: To open or not to open? A critical review of this controversy. International Journal of Medical Sciences. 2008;5(6):313-8.
  12. Assael LA. A devotion to trauma. Journal of Oral and Maxillofacial surgery. 2003;61(4):415-6.
  13. Zhou J-H, Ren C-Q. A preauricular long-corniform approach for open reduction and internal fixation of mandibular condylar fractures. Journal of Cranio-Maxillo-Facial Surgery. 2013;41(5):359-66.
  14. Yang L, Patil PM. The retromandibular transparotid approach to mandibular subcondylar fractures. International Journal of Oral and Maxillofacial Surgery. 2012;41(4):494-9.
  15. N, Tetsu T, Kensuke Y, Ikuya M, Takeshi K, Noriaki Y, et al. Clinical comparison between the retromandibular approach for reduction and fixation and endoscope-assisted open reduction and internal fixation for mandibular condyle fractures. The Journal of Craniofacial Surgery. 2012;23(6):1815-8.
  16. Spinzia A, Patrone R, Belli E, Orabona GDA, Ungari C, Filiaci F, et al. Open reduction and internal fixation of extracapsular mandibular condyle fractures: a long-term clinical and radiological follow-up of 25 patients. BMC Surgery. 2014;14(1):68-78.
  17. Klatt J, Pohlenz P, Blessmann M, Blake F, Eichhorn W, Schmelzle R, et al. Clinical follow up examination of surgically treated fracture of the condylar process using transparotid approach. Journal of Oral Maxillofac Surgery. 2010;68(3):611-17.

[Muhammad Mumtaz, Farhat Kazmi, Nasir Muneer Otaibi and Noaf Fawaz Alfawaz (2020); MANAGEMENT OF SUB CONDYLAR FRACTURES BY RETRO-MANDIBULAR APPROACH AND ASSESSMENT OF POST-OPERATIVE COMPLICATIONS: A PROSPECTIVE STUDY Int. J. of Adv. Res. 8 (3). 179-187] (ISSN 2320-5407). www.journalijar.com


Dr. Muhammad Mumtaz
Head department of Oral and Maxillofacial Surgery, Department of dentistry, King Salman bin Abdul Aziz Hospital, Ministry of Health, Riyadh Kingdom of Saudi Arabia.

DOI:


Article DOI: 10.21474/IJAR01/10614       DOI URL: http://dx.doi.org/10.21474/IJAR01/10614


Share this article