Comparison between Retromandibular Anteroparotid Approach, Retromandibular Transparotid Approach and High Subangulomandibular Approach for Mandibular Subcondylar Fracture Fixation: A Prospective Randomised Study

Abstract

Background: Condylar fractures remain a subject of ongoing debate in the field of oral and maxillofacial surgery. The choice of surgical approach depends on various functional and aesthetic considerations. This original research article compares three surgical approaches—retromandibular anteroparotid approach, retromandibular transparotid approach and high subangulomandibular approach—by evaluating facial nerve injury, scar aesthetics, and sialocele formation. Materials and Methods: A prospective study was conducted at the Sanjay Gandhi Institute of Trauma and Orthopedics, Bangalore, involving 33 patients who were divided into three groups of 11 patients each. The outcomes assessed included facial nerve injury, scar aesthetics, and sialocele formation, with follow-up for 3 months. Data analysis was performed using the Chi-square test. Results: The comparison of facial nerve injury incidence between different time intervals in each group, analyzed using Cochran's Q test, revealed that 9.1% of patients in Group A (retromandibular anteroparotid approach), 36.4% in Group B (retromandibular transparotid approach), and 18.2% in Group C (high subangulomandibular approach) experienced facial nerve injury on Day 1. Group B showed a statistically significant result with a p-value of 0.02. Sialocele formation on Day 1 occurred in 27.3% of Group A, 45.5% of Group B, and none in Group C, with a statistically significant p-value of 0.04. The comparison of mean scar aesthetic scores showed 1.45 ± 0.52 for Group A, 2.36 ± 0.51 for Group B, and 2.45 ± 0.52 for Group C, with a statistically significant result (p = 0.001). Significant differences were found between Group A and Group B (p = 0.002) and Group A and Group C (p = 0.001). Conclusion: This study indicates that the retromandibular anteroparotid approach (Group A) had the least incidence of facial nerve injury and better scar aesthetics. The high subangulomandibular approach (Group C) showed the least incidence of sialocele formation, though it posed challenges in accessing the fracture site. Therefore, the high subangulomandibular approach is recommended for low subcondylar fractures rather than high subcondylar fractures.