J Korean Assoc Oral Maxillofac Surg.  2022 Oct;48(5):267-276. 10.5125/jkaoms.2022.48.5.267.

Modified high-submandibular appraoch for open reduction and internal fixation of condylar fracture: case series report

• Lee SJ
• Chun YJ
• Lee SJ
• Jun SH
• Song IS

• KMID: 2534806
• DOI: http://doi.org/10.5125/jkaoms.2022.48.5.267

Abstract

Objectives
Recently a modified high-submandibular approach (HSMA) has been introduced for treatment of condylar fracture. This approach involves an incision line close to the mandibular angle and transmasseteric transection, leading to a low incidence of facial palsy and allowing good visualization of the condyle area, especially the condylar neck and subcondyle positions. This study reports several cases managed with this modified HSMA technique for treating condylar fractures.
Materials and Methods
Six cases of condylar fractures treated with modified HSMA technique were reviewed.
Results
Three unilateral subcondylar fracture, 1 bilateral subcondylar fracture, 1 unilateral condylar neck fracture, 1 unlateral simultaneous condylar neck and subcondylar fracture cases were reviewed. All the cases were successfully treated without any major complication.
Conclusion
Reduction, fixation, and osteosynthesis of condylar fractures via the modified HSMA technique enabled effective and stable treatment outcomes. Therefore, the described approach can be used especially for subcondylar and condylar neck fractures with minimal complications.

Keyword

Mandibular condyle; Mandibular fracture; Open fracture reduction; Fracture fixation

Figure

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  Fig. 1 Typical percutaneous approaches and HSMA (high-submandibular approach) techniques for mandibular condylar fractures. 1: preauricular approach, 2: endaural approach, 3: retromandibular approach, 4: submandibular (risdon) approach, and 5: high-submandibular approach. (P: parotid gland, MMB: marginal mandibular branch)

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  Fig. 2 Schematic expression of the surgical path of the modified HSMA (high-submandibular approach) technique in the coronal view. (P: parotid gland, MPm: medial pterygoid muscle, Mm: masseter muscle)

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  Fig. 3 A, B. Right mandibular subcondylar and parasymphysis fractures are seen. C. The view immediately after ORIF (open reduction and internal fixation).

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  Fig. 4 A. The postoperative scar was significant at six weeks after the surgery. B. A subcutaneous, intralesional injection of triamcinolone (40 mg) was performed. C. A second injection was performed at eight weeks after the surgery. D. A third injection was performed at 10 weeks after the surgery. E. A photograph taken one year after surgery reveals a significant improvement of aesthetics. The patient was satisfied with the outcome.

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  Fig. 5 A-C. Panfacial bone fractures, with bilateral subcondylar fractures accompanied by a LeFort III fracture, blowout fracture, and zygomatic arch and mandibular symphysis fractures in the oral and maxillofacial area. D-F. Immediately after ORIF (open reduction and internal fixation). G. A panoramic view recorded at six months after the surgery.

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  Fig. 6 A. A left mandibular condylar neck fracture. B. Immediately after ORIF (open reduction and internal fixation). C, D. One month after the first surgery, occlusion change and anterior open bite attributed to screw loosening were observed. E. Immediately after reoperation.

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  Fig. 7 A, B. Right mandibular condylar neck and subcondylar fractures are seen. C. Immediately after ORIF (open reduction and internal fixation) was done.

Reference

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