Biportal Transparotid Dissection in the Retromandibular Approach for Condylar Fracture Osteosynthesis: Efficacy of a Novel Technique

Biportal Transparotid Dissection in the Retromandibular Approach for Condylar Fracture Osteosynthesis: Efficacy of a Novel Technique: : Facial nerve injury is a primary complication of open surgical management of condylar fractures. A new modification of the retromandibular transparotid approach, the “biportal transparotid dissection” (BTD), was developed to reduce these injuries in accidental nerve exposure.

Abstract

Objective

: Facial nerve injury is a primary complication of open surgical management of condylar fractures. A new modification of the retromandibular transparotid approach, the “biportal transparotid dissection” (BTD), was developed to reduce these injuries in accidental nerve exposure.

Design

: Prospective cohort study

Setting

: Tertiary referral center

Methods

: Patients managed by retromandibular transparotid approach for condylar fractures at Department of Otolaryngology – Head and Neck Surgery, Mansoura University were included between November 2015 and August 2019 with exclusion of cases managed endoscopically or by a closed approach. Three groups were identified; Group A included patients undergoing the BTD technique, which entails transparotid dissection above and below exposed nerve branches and minimal nerve retraction; Group B included patients undergoing traditional dissection and nerve retraction away from the surgical field; Group C included patients with unidentified facial nerve branches. The function of facial nerve branches was documented postoperatively.

Results

: Fifty-seven fractures were included in the study. Facial nerve branches’ injury occurred in thirteen cases (22.8%): two (of ten) in Group A (20%), seven (of ten) in Group B (70%) and four (of 37) in Group C (10.81%). Compared to patients with non-exposed branches, Group A and B were found to have 2.06 (p=0.447) and 19.25 (p=0.001) greater odds of nerve injury, respectively. Results showed significant faster nerve recovery in the BTD group compared to traditional dissection (mean 5 versus 9 weeks) (p=0.015).

Conclusion and relevance

: Although avoiding facial nerve exposure minimizes injury the most, BTD approach reduces exposed nerve injury compared to the traditional method.

Keywords:

Condylar fracture, Retromandibular, Biportal, Transparotid, Facial nerve