Transmasseteric Approach for Open Reduction and Internal Fixation of Mandible Subcondylar Fracture.

Kim, Hak Soo; Kim, Seong Eun

Original Article

Journal of the Korean Society of Plastic and Reconstructive Surgeons 2010;37(2):161-168.
Published online March 1, 2010.

Transmasseteric Approach for Open Reduction and Internal Fixation of Mandible Subcondylar Fracture.

Hak Soo Kim, Seong Eun Kim

Pohang Semyeong Christianity Hospital, Department of Plastic and Reconstructive Surgery, Gyeongbuk-do, Korea. pskimhs@hanmail.net

Abstract

PURPOSE
Surgical approaches to the condylar neck and subcondyle area can cause some morbidity such as, facial nerve injury, time-consuming nature and external scar etc. So many surgeons hesitate using open reduction and internal fixation for the treatment of subcondylar fractures. We report open reduction and internal fixation of subcondylar fractures in 13 adult patients via transmasseteric approach. METHODS: From 2007 to 2009, 13 adults with subcondylar fracture of mandible were treated with open reduction and internal fixation via transmasseteric approach. A preauricular incision was extended downwards in a curvilinear fashion in the cervicomastoid skin crease. Skin flap was elevated above the SMAS layer. Masseter muscle was splitted at the anteroinferior edge of the parotid gland. After the fracture was reduced, fixed with appropriate plates and screws. All operation were performed under general anesthesia.
RESULTS
Mean follow-up period was 13.3 months. There were no signs and symptoms of facial nerve injury, difficulty in mouth opening, or malocclusion. Dissection time was roughly within 30 minutes.
CONCLUSION
Transmasseteric open reduction and internal fixation of mandible subcondylar fracture can be performed with excellent visualization, and inconspicuous scar. It also offers swift access to the subcondylar area while substatially reducing the risk to the facial nerve and eliminating the complications associated with transparotid approaches.

Keywords: Subcondylar fracture; Transmasseteric approach