Open Reduction and Internal Fixation of Subcondylar Fractures via Transmasseteric Anteroparotid Approach – Surgical Guidelines for a Safe Procedure

Objectives: The objective of the present study was to evaluate success and complications encountered upon utilization of open reduction and internal fixation (ORIF) of subcondylar fractures via the high cervical transmasseteric anteroparotid approach in adults and children.

Methods: A prospective clinical and radiological evaluation of patients presenting with displaced subcondylar fractures during a 45 month period was undertaken. All fractures were treated using high cervical transmasseteric anteroparotid approach. The parameters evaluated were: mouth opening, the occurrence of salivary fistula, infection, injuries to the seventh facial nerve, plate fracture and occlusal disturbances. Clinical and radiologic examinations were performed at 1 week and 1, 3, and 6 months and there after every 6 months.

Results: A total of 24 patients were operated with a mean follow-up of 12 months. All of the fractures were classified as types II and IV (17/7) according to Spiessel and Schroll classification. Mean age at time of operation- 24.5. two of our patients were children, ages 5 and 6- close follow up for growth disturbances and facial asymmetry – 36 months after surgery, no growth disturbances or facial asymmetry were noted. Mouth opening regained full range in 96% (2 patients required prolonged intensive physiotherapy). 1 month postoperatively 92% presented preserved occlusion. At 3 months postoperatively, no malocclusion was observed. No facial palsy occurred, including no transient facial palsy. Complications consisted of 1 salivary fistula and 2 plate fractures.

Conclusions: ORIF of subcondylar fractures via the transmasseteric anteroparotid approach in adults and children is a safe procedure with minimal complications. This procedure is the preferred method of subcondylar fracture ORIF performed in our department.