Retromandibular transparotid approach and absorbable bone fixation for treatment of condylar base fractures

  Background  Condylar base fracture is one of the most difficult fracture patterns to repair in maxillofacial surgery. For condylar base fractures, an arc-shaped incision around the angle of the mandible or an additional anterior tragus incision will be used commonly. Since the incision is far from the fracture line and the operation is difficult, drilling screws perpendicular to the bone surface cannot be performed, thus absorbable osteosynthesis plate nail also cannot be applied for internal fixation.

  Objective  To treat condylar base fractures by retrognathic incision through parotid approach combined with absorbable osteosynthesis plate, compare it with the traditional closed mandibular angle incision combined with titanium plate nail fixation, and evaluate its outcomes.

  Methods  Clinical data about 20 patients aged 18-66 years, including 13 males and 7 females, with condylar base fractures treated in the First Medical Center of Chinese PLA General Hospital from September 2015 to September 2019 were retrospectively reviewed. In the observation group, 10 patients were fixed by retrognathic incision through parotid approach combined with absorbable osteosynthesis plate nail, while 10 patients in the control group were fixed by arc incision around the mandibular angle and titanium osteosynthesis plate. Incision length, operating time, blood loss, recovery time of mouth opening and the number of cases with temporary postoperative facial paralysis were compared, and occlusion, wound healing and radiographs were compared to evaluate the surgical outcomes.

  Results  The observation group was significantly better than the control group in terms of incision length (cm)(4.3 ± 1.1 vs 7.5 ± 2.6, P＜0.001), operating time (min) (45.3 ± 18.7 vs 57.2 ± 7.3, P=0.016), blood loss (mL) (20.3 ± 6.8 vs 38.3 ± 7.1, P=0.032), postoperative complications (10% vs 100%, P＜0.001) and recovery time of mouth opening (d) (28 ± 7 vs 43 ± 5, P＜0.001), the incision was rated as grade A healing in all patients without sialorrhea fistula, and the surgical results were good.

  Conclusion  The rigid internal fixation by the retromandibular transparotid approach with the absorbable bone fixation is an effective surgical method to treat condylar base fracture.