Evaluation of Complications Following a Trans-masseteric Antero-parotid Approach for Patients with Sub-condylar Fractures of Their Temporomandibular Joint. A Retrospective Study

Abstract

Sub-condylar fractures of the temporomandibular joint can be treated by an extraoral or intraoral approach. Trans-masseteric antero-parotid approach (TMAP) is an extraoral approach utilising a retromandibular incision. The authors evaluated patients’ status and any complications of using TMAP from the years 2013–2017. There were 39 patients (44 fractures). When using TMAP, in 43 fractures the fragments were favourably positioned, in one case the position was compromised. Of the complications, postoperative palsy of the facial nerve was reported 6.8% – in all cases this was only temporary. Late occlusion had an equal number of complications (in 2 cases this was as a result of an infectious complication of the wound, and in 2 cases due to resorption of the proximal fragment). Muscular pain and dysfunction of the temporomandibular joint following trauma were observed consistently in 6.8% of patients. Sialocoele, a non-conforming scar, and infectious complications were observed in 4.5% of patients. TMAP allows rapid surgical performance, with a good view for perfect repositioning and fixation of fragments of sub-condylar fractures of the temporomandibular joint. The complications associated with this approach are, for the most part, temporary, the aesthetic handicap of a scar is considered by patients to be acceptable. Overall, it is possible to evaluate retromandibular TMAP as safe, and the authors recommended it for treatment of sub-condylar fractures of the mandible.

Is the facial nerve at risk following surgical correction of mandibular condylar fracture: A systematic review and meta-analysis

“…Studies by Vesnaver et al .,[ 17 ] 2005; Bindra et al ., 2010;[ 18 ] Bhutia et al ., 2013;[ 10 ] Shi et al ., 2015;[ 9 ] Ghezta et al ., 2016;[ 11 ] Kanno et al ., 2016;[ 19 ] Bruneau et al .,[ 12 ] 2016 and Parihar et al ., 2019[ 20 ] showed both displacement and dislocation of condylar fractures. All other studies[ 5 16 21 22 23 ] showed only displacement of the condyle, whereas Imai et al ., 2019;[ 7 ] Imai et al ., 2020[ 26 ] showed isolated condyle dislocation [ Graph 4 and Table 2 ].…”

Retromandibular Transparotid Approach for the Treatment of Benign Nontraumatic Conditions of the Mandible. A Retrospective Consecutive Case-Series Study

“…6,7 The retromandibular anteroparotid approach based on the skin incision modification of Wilson transmasseteric anteroparotid approach was first described independently by Parihar et al and Machon et al in 2019. 3,8,9 The retromandibular transparotid approach (RTA) was first introduced by Ellis and Dean in 1993 and the subparotid variant in 2021 by Bruneau et al and Scolozzi and Foletti in the years 2018 and 2020, respectively [10][11][12] Retromandibular transparotid approach traverses the parotid gland and enables exposure of the entire ramus and condylar neck from behind the posterior border. The primary advantage is the most direct proximity of skin incision to the area of interest compared to other transfacial approaches, of course with the number of possible complications described.…”

“…The retromandibular retroparotid approach was first reported by Chossegros et al in 1996, but the retroparotid access from the lazy “S“ incision has been already known since 1978 6,7 . The retromandibular anteroparotid approach based on the skin incision modification of Wilson transmasseteric anteroparotid approach was first described independently by Parihar et al and Machon et al in 2019 3,8,9 . The retromandibular transparotid approach (RTA) was first introduced by Ellis and Dean in 1993 and the subparotid variant in 2021 by Bruneau et al and Scolozzi and Foletti in the years 2018 and 2020, respectively 10–12 …”