Small incision through the tragus for the treatment of sagittal condylar fracture

The purpose of this study was to a new operative approach for sagittal condylar fractures via a preauricular small incision-based technique and to examine the effectiveness of this approach.

Fifteen patients (19 sides) with sagittal condylar fractures were included in the study. The incision length was approximately 4 cm through the tragus, exposing the superficial temporal vessels, which was then pulled forward. Next, the deep temporal superficial fascia was cut, and the surface of the zygomatic arch and the articular capsule of the temporomandibular joint were exposed. Joint capsule incision was performed, with mandibular condylar fracture fixation under direct vision. We followed up with the patients postoperatively for 6 months with clinical and radiographic examinations.

All patients had 1 week postoperation before being discharged, during which 2 cases of mild facial paralysis (with lateral temporal level Ⅱ facial paralysis, with lateral temporal branch level Ⅲ facial paralysis and level Ⅱ zygomatic branch of facial nerve paralysis after treatment) were observed, after given nerve nutrition agents, 2 cases returned to normal within 3 months. No patient exhibited a postoperative delayed fistula infection or other serious complications. Intraoperative occlusion relationships recovered well, and postoperative CTs suggested that the fracture ends and condyles were in good condition. The occlusion relationship was normal for 3 months after surgery, with a degree of opening greater than 30 mm, no play in the joints and no oblique openings being observed, and reexamination 6 months after the surgery revealed no obvious scars.

This surgical method involves a small incision and clear anatomic structures and avoids damage to the facial nerve. This method provides better surgical vision for treatment of sagittal condylar fractures, is safe and convenient, and deserves clinical recommendation.