Clinical Analysis Of Modified S-shape Parotid Approach For Mandibular Condylar Fracture

Objective To analysis the advantages and disadvantages of different surgical approaches for condylar process fractures, and discuss outstanding advantages of a modified S-shape parotid approach to open reduction and rigid internal fixation, in order to offer a better choose of surgical approach for condylar fracture treatment.Material and Methods Patients with condyloid process fractures treated at Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Kunming Medical University from September,2007to November,2011were investigated. We gathered information from medical record and by telephone following-up, and performed statistical analysis on the corresponding data in the form of statistical graphs. Data regarding age, gender, pattern of fracture, fracture characteristic, surgical approach, internal fixation, treatment effectiveness and its complications were reviewed.Results There were78patients, a total of84cases with condylar process fracture retrieved patients, including23joint capsule fracture cases,46neck condyle fracture cases,15subcondylar fracture cases. The84cases of condyle fracture were performed surgical operation including20modified S-shape parotid approach cases,42preauricular approach cases,22retromandibular approach cases. For post-operative healing process,25patients have had facial nerve injury, including7patients with lateral frontal lines disappeared,11patients with incomplete eyelid closure,2patients with shallow lateral nasal labial sulcus, and5patients with commissure distortion, all of whom returned to normal by the end of follow-up period. On the facial nerve injury rates, the patients treated by modified S-shape parotid approach showed significant differences with other approaches by the lowest rate of10%. There is1postoperative salivary leakage case. During post-operation following-up, all patients recovered themselves including occlusion, temporomandibular joint function, scar healing, and month open limit94.9%of the patients were satisfied with the operations.Conclusions The modified S-shape parotid approach open reduction on condyle fracture was appropriate for many types of surgical treatment of fractures including capsule fracture, neck fracture and subcondylar fracture. The incision goes through the front of parotid organization and part of masseter, direct "windowing" into fracture lines, has the advantage of conceal incision simple operation, and avoids large-area anatomy of the facial nerve, and other complications. Mini-plate rigid fixation combined with modified S-shape parotid approach to treat condylar fractures is proved to be effective to treat mandibular condyle fractures. It is an ideal approach to treat condylar fracture.