Retromandibular Transmasseteric Anteroparotid Approach versus Retromandibular Transparotid Approach for Open Reduction and Internal Fixation of Mandibular Condylar Fractures: A Comparative Clinical Study

Abstract

Background: Mandibular condylar fractures are among the most common mandibular fractures and present significant functional and surgical management challenges. Open reduction and internal fixation (ORIF) has become the preferred treatment for displaced mandibular condylar fractures over closed reduction, owing to superior anatomical restoration and earlier functional rehabilitation. Among the various surgical corridors described, the retromandibular approach remains popular; however, concerns regarding facial nerve injury and parotid gland morbidity have led to the development of modified access routes such as the transmasseteric anteroparotid (TMAP) technique. Aim: To compare the efficacy of the retromandibular transmasseteric anteroparotid (TMAP) approach and the retromandibular transparotid approach for ORIF of mandibular condylar fractures.

Materials and Methods: Twenty patients with sub-condylar fractures, with or without associated mandibular fractures, were randomly allocated into two equal groups of ten. Group A underwent ORIF via the TMAP approach, and Group B via the transparotid approach, both using a 2 mm delta plate and 2×8 mm screws. Exposure time, occlusal derangement, maximal interincisal opening, protrusive and lateral excursive movements, facial nerve function (House–Brackmann grading), and parotid fistula formation were assessed preoperatively and postoperatively at 1 day, 1 week, 4 weeks, and 3 months.

Results: The mean exposure time was significantly shorter in Group A (18.7 ± 3.1 minutes) than Group B (21.9 ± 2.1 minutes; p = 0.008). Both groups showed comparable, statistically significant improvement in maximal interincisal opening, protrusive movement, and lateral excursion over time (p < 0.001), with no significant intergroup differences at any interval. All patients in both groups achieved normal occlusion and Grade I (House–Brackmann) facial nerve function by 3 months. One patient (10%) in Group B developed a parotid fistula, which resolved conservatively; none occurred in Group A.

Conclusion: Both the TMAP and transparotid approaches are safe and effective for ORIF of mandibular condylar fractures, providing comparable functional and occlusal outcomes with complete facial nerve preservation. The TMAP approach offers the additional advantages of significantly reduced exposure time and freedom from parotid fistula complications, making it a favorable alternative to the conventional transparotid technique.