Page 100 - Open versus closed Mandibular condyle fractures

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Chapter 3.2 Open
A sialocele was seen in 2.3% and a salivary fistula in about 4.3% of patients. In the studies included in this review, sialoceles and salivary fistulae were only seen in patients in whom a transparotid approach was used. One exception was a patient with a salivary fistula in the study reported by Hou et al.36 after an anterior parotid approach.
It is believed that this complication can be avoided in most cases by careful closure of the parotid capsule with running sutures.18,29,30 If sialoceles or fistulae did occur, these were managed in most studies by aspiration and collection, and placement of a compression dressing.28,37,45,86
To further reduce the risk of developing Frey syndrome, sialoceles, and salivary fistulae, approaches were elaborated by locating the dissection plane through the masseter muscle instead of the parotid gland.42,49 In the study by Narayanan et al.42, in which the transmasseteric anterior parotid approach was used, none of these complications was observed. A possible disadvantage of this approach is that a longer incision is needed than those used in other approaches.
Surgery is always associated with a certain number of wound infections. Based on the systematic review, on average, 2.7% of patients had a wound infection. The infection rate was quite variable among the studies (range, 0 - 13.3%), most presumably due to differences in surgical and antibiotic protocols.29,30 Unfortunately, in the majority of the studies, the use of antibiotics was not described. Therefore, it is impossible to determine whether antibiotics were helpful in decreasing the rate of this complication.
Currently, surgeons are using more minimally invasive surgery (MIS).36 The suggested advantages of small incisions include: less surgical trauma, less bleeding, fewer and smaller scars, reduction in infection risk, and shorter hospital stays.36 Some use the mini retromandibular approach, limited to 20 mm, for fractures at every level, from high-neck to low-subcondylar fractures.3,4,18 Colletti et al.18 stated that this broad application is possible because the view is limited by the deeper part of the access, not by the skin incision.