Comparative Analysis Of Minimal Access Retromandibular Transparotid Versus Transmasseteric Approaches For Open Reduction And Internal Fixation Of Mandibular Subcondylar Fractures: A Retrospective Study From A Tertiary Care Centre

Background: Surgical management of mandibular subcondylar fractures remains a subject of clinical debate, particularly in selecting the optimal surgical approach that balances access, nerve preservation, and cosmetic outcomes. This study compares the minimal access retromandibular transparotid approach and the transmasseteric approach in terms of operative, functional, and aesthetic outcomes.

Methods: A retrospective analysis was performed on 30 patients with 38 subcondylar fractures treated at a tertiary care center between January 2018 and March 2024. Twenty-six fractures in 20 patients were treated using the transparotid approach, while 12 fractures in 10 patients underwent the transmasseteric approach. Parameters assessed included operative time, scar length, mouth opening, occlusal stability, facial nerve function, scar acceptability, and postoperative complications. Multivariate regression was used to identify independent predictors of facial nerve paresis and scar satisfaction.

Results: The mean operative time was significantly shorter in the transparotid group (56.3 ± 8.5 min) compared to the transmasseteric group (72.4 ± 9.6 min, p < 0.001). Scar length was also significantly lower in the transparotid group (1.6 ± 0.3 cm vs. 2.8 ± 0.4 cm, p < 0.001). Both groups achieved comparable mouth opening (>40 mm at 6 months) and 100% occlusal stability. However, facial nerve paresis occurred in 20% of transmasseteric cases and 0% of transparotid cases (p = 0.035). Scar acceptability was significantly higher in the transparotid group (85% vs. 60%, p = 0.048). There were no major complications in either group. On multivariate analysis, the transparotid approach was independently associated with a reduced risk of facial nerve paresis (OR 6.82, 95% CI: 1.01–46.0) and higher scar acceptability (OR 4.63, 95% CI: 1.01–21.1).

Conclusion: The minimal access retromandibular transparotid approach offers distinct advantages over the transmasseteric approach, including shorter operative time, lower facial nerve morbidity, and superior scar acceptability, without compromising functional outcomes. These findings support its use as a safe, efficient, and cosmetically favourable option for the surgical management of subcondylar fractures.