A novel surgical approach to subcondylar fractures of mandible

Submandibular and intraoral approaches are the 2 most commonly used methods to access mandibular fractures. Although they provide excellent access to repair fractures of body and ramus, we have found it difficult to manage subcondylar fractures using either of these approaches. An extended preauricular approach is also described for condylar and subcondylar fractures of the mandible, but it results in inappropriately extensive dissection and a larger scar, especially for an isolated subcondylar fracture. We describe a novel approach for subcondylar fractures that provides direct access to the fracture site. The incision line is located just above the lower border of the mandible and lies accurately and safely between the marginal mandibular and the buccal branches of the facial nerve. We also performed cadaver head dissection to follow and locate facial nerve branches in relation to the proposed incision. To date, we have operated on 38 patients and have found excellent functional results and acceptable aesthetic outcome.