To compare the submandibular, preauricular and the transparotid approaches to the condylar fracture

Abstract

Aims: The purpose of this study was to compare the submandibular, preauricular and the transparotid approaches to the condyle with respect to these parameters and correlated them with the specific features of condylar fractures.

Material and methods:A Retrospective study was conducted in the Department of Maxillofacial surgery, Narayan Medical College and Hospital ,Sasaram,Bihar,India for 1 year. 150 Patients with condylar fracture that required open reduction and internal fixation were include in this study. All patients were classified based on Spiessl and Schroll classification of condylar fractures, using radiological examination, into three groups- preauricular group (type VI), submandibular group (type II and type IV), and the transparotid group (type IIIb, type IIIc, and type V). Parameters like post-op IMF, palsy of facial nerve, scar, wound infection, malocclusion and plate retrieval were noted.Results:Out of 150 30(20%) of them were women where as120 (80%) were men with a p value of 0.33. RTA was the major etiology of injury(80%) in all the three groups followed by self- fall and assault. P-value was found to be significant (p-0.01). 8% of case in the submandibular group was bilateral, which was managed by closed reduction on one side. 60% of the cases in pre-auricular and trans-parotid and 56% of cases in the submandibular group were on the right side. (p-value 0.88). 90% of fractures in the pre-auricular group, 80% of fractures in the sub-mandibular group and 50% of the fractures in the trans-parotid group were associated with other fractures of the facial skeleton. A p-value of 0.018 was obtained which was found to be significant. Post-op IMF was present in 14% of preauricular group when compared 0% in the other two groups with a p-value of 0.10facial nerve palsy was seen in 8% of preauricular cases, 24% of submandibular group and 18% of trans-parotid group with a p-value of 0.41.

Conclusion: The inferior neck fractures seem to benefit from ORIF via submandibular approach, high neck fractures via the transparotid fractures and the condylar head fractures via the pre auricular approach with a low rate of complications.

Keywords: Condylar fractures, Open reduction,Pre-auricular, Sub-mandibular ,Transparotid.