Which is the fastest and safest approach? A comparison of time and complications of transparotid and anteroparotid retromandibular approach in management of mandibular subcondylar fractures: A prospective randomized controlled trial.

Introduction: Mandibular condylar fractures are among the most common facial fractures and its incidence has been rising since the past few decades. Although various approaches for management of mandibular condylar fractures have been described in literature there is a gap in the published literature when it comes to comparison of these approaches. There have only been a handful of studies which have compared use of Retromandibular Transparotid against Retromandibular anteroparotid approach in management of mandibular condylar fractures with conflicting results. The aim of this study was to aid in decision making regarding the choice of approach between the Retromandibular Transparotid and Anteroparotid Transmasseteric approach based on the ease of surgical access and incidence of complications.

Materials And Methods: A total of 24 patients were registered in the study under two treatment groups, Transparotid (Group A) and Anteroparotid (Group B). Data collection was done by a single blinded observer for measurement of exposure time, facial nerve weakness, facial oedema, presence of a sialocele, presence of a parotid fistula (and presence of various complications).

Results: The average time required for exposure of fracture site in group A was 11 min ± 2.73 min and in group B was 9 min ±1.91 min. Facial nerve injury (Grade III House Brackmann scale) was noted in one patient in group A. There was no significant difference in quality of reduction, occlusion and mandibular mobility.

Conclusion: The results of this study indicate that the rate of complications and time required to access the fracture site was comparable in both the approaches. It can be said that both the anteroparotid and transparotid approaches are reasonably safe and convenient in management of mandibular condylar fractures.