The commonest fracture of the mandible is reported in the region of the condyle. Untreated this can lead to shortening of the ramus, facial asymmetry, arthrosis of the temporomandibular joint, impaired mastication and speech. The standard treatment is open reduction and non compressive miniplates fixation, and there are a number of surgical approaches described to access the fracture. The retromandibular transparotid is one that is widely used. The main drawback, however, is transient or permanent damage to the facial nerve. This is usually secondary to traction, manipulation of the fractures and the plating. Despite the large number of these fracture treatments there is a paucity of data regarding intraoperative nerve injury. This is a retrospective study of 90 patients with 102 fractures fixed over seven years. It was designed to look at incidence of injury, identify risk factors and optimise treatment approaches. Eighteen fractures (18%) postoperatively had some damage to the facial nerve, they were all transient. The authors describe their technique and analyse the possible cause for the damage. They conclude neck fractures, fracture dislocations (as expected) and operator inexperience (operators with less than three years of experience) all lead to increased risk of damage. This is a large study with a standardised collection of data. The paper is well written with colour photographs and gives a good overview of the subject, it is well worth a read.
Facial nerve injuries in fixing mandibular condylar fractures
Reviewed by Sunil K Bhatia
Facial nerve injuries associated with the retromandibular transparotid approach for reduction and fixation of the mandibular condyle fractures.
