A retrospective analysis of clinical outcomes: a retroauricular transmeatal approach for condylar fractures

To evaluate the safety and efficacy of the retroauricular transmeatal approach in the treatment of condylar head and neck fractures, and to provide a reference for clinical practice.

This study has been reviewed and approved by the institutional medical ethics committee and has obtained informed consent from the patients. A retrospective analysis was conducted on the clinical data of patients with condylar head and neck fractures treated via the retroauricular transmeatal approach between March and October 2024. Postoperative follow-up was performed for at least 3 months, including clinical and radiographical evaluations. The assessed parameters included facial nerve function, temporal region numbness, hematoma, infection, salivary fistula, mouth opening, malocclusion, mandibular movement function, temporomandibular joint (TMJ) pain and clicking, external auditory canal (EAC) stenosis, hearing function impairment, surgical scar concealment, postoperative reduction and fixation outcomes.

A total of 16 patients with condylar fractures were treated via the retroauricular transmeatal approach, including 10 unilateral and 6 bilateral cases. Specifically, 18 sides were condylar head fractures, and 4 sides were condylar neck fractures. All patients achieved a House-Brackmann Grade I, indicating normal facial nerve function postoperatively. On postoperative day 1, 3 sides experienced temporal numbness in the temporal region on the surgical side, with spontaneous resolution in all cases. All patients recovered after surgery without hematoma, infection, or salivary fistula. Limited mouth opening was improved (14 cases with restricted mouth opening preoperatively vs. 3 cases postoperatively). No malocclusion occurred in any patient. All patients achieved satisfactory recovery of postoperative mandibular movement function, manifested as restored range of motion without pain. No TMJ clicking was observed within 3 months after surgery. One keloid-prone patient developed progressive EAC stenosis (2 mm lumen constriction) accompanied by conductive hearing impairment, which recovered after dilation therapy. All patients were satisfied with the aesthetic outcomes. Radiographically parametric assessment demonstrated satisfactory fracture reduction and fixation; with no loosening of titanium plates or screws.

The retroauricular transmeatal approach effectively reduces the risk of facial nerve injury and salivary fistulas formation with providing concealed scarring and high patient satisfaction. However, caution should be exercised regarding EAC stenosis, especially for keloid-prone patients.