Page 102 - Open versus closed Mandibular condyle fractures

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Chapter 3.2 Open
Concerning the skin incision, no real preference exists, although the submandibular and peri-angular skin incision showed the best results. Subcutaneously, a transparotid approach is recommended, because, it is straightforward, with direct visibility of the fracture and the shortest distance between the skin and the mandibular condyle and therefore results in less traction on the facial nerve.
Most important for the surgeon is a sufficient view of the fracture site. With regard to the skin incision, one could argue for using the pre-auricular, retro-auricular or perilobular approach for high condylar fractures,13 the retromandibular or pre- auricular approach for middle-height fractures,13-16 and the retromandibular, high submandibular, peri-angular approach, or rhytidectomy modifications for low condylar fractures.13-17 After the open reduction and fixation, the parotid capsule is sutured with care.
When there is a high level of experience, MIS could be used. On the other hand, especially for surgeons with limited experience, it is prudent to discourage approaching the fracture with a small incision and forcible opening of the dissected tissues.52 Furthermore, the use of a neurostimulator during surgery is advised.