Facial Nerve Weakness Following Retromandibular Transparotid Approach for Subcondylar Fractures of Mandible- A Series of Five Cases

Abstract

Mandibular condyle fractures are the most commonly reported mandible fractures. The incidence of condylar fractures is 25-30% among all mandibular fractures and there are ongoing controversies about their management. The retromandibular transparotid technique is the most frequently employed technique to manage fracture of mandibular condyle. The benefits of this method have been reported to include a shorter working distance between the incision and the fracture site, less morbidity to the facial nerve as it can be identified and retracted under direct vision, cosmetically pleasing outcomes and ease of reduction/fixation of fractures. Nevertheless, surgical treatment of mandibular condyle fractures, can pose danger to facial nerve branches. With respect to condylar fracture surgical treatment, the prevalence of Facial Nerve (FN) injury has been reported to be around 12-48%. This case series reports the surgical and postoperative journey of five patients with subcondylar fracture. The retromandibular transparotid technique was applied in all patients for Open Reduction Internal Fixation (ORIF). Using the House-Brackman facial grading system, FN weakness was assessed. Postoperatively, FN weakness was evident after 24 hours of surgery in two patients. With a mean recovery period of two months, all patients maintained FN function at three months. None presented with persistent paralysis of the facial nerve. Parotid fistulation was not observed in any patient. Inconspicuous scar after six months was observed in four patients. The retromandibular transparotid approach is a safe and effective technique that gives less morbidity to the facial nerve, excellent access, good cosmetic results and patient satisfaction.