Retro-Auricular Approach to the Fractures of the Mandibular Condyle: A Systematic Review

This systematic review was conducted to evaluate the retro-auricular trans-meatal approach (RA) to mandibular head fractures. Fractures of the mandibular head (8%) are a specific type of mandibular condyle fractures (34%). Despite numerous complications of conservative treatment, e.g., limited mobility and even ankylosis of the temporomandibular joint, as well as shortening of the mandibular ramus resulting in malocclusion, surgical intervention in this type of fracture is still problematic. The main problems with the dominant pre-auricular approach are the high risk of paralysis of the facial nerve and persistence of a visible scar. An attractive alternative is RA, which, despite its long history, has been described in English very few times, i.e., in only two clinical trials described in three articles in the last 21 years. According to these studies, RA gives a minimum of 90% of ideal positions of bone fragments and an always fully preserved function of the facial nerve in the course of long-term observation. RA allows the application of long screws for fixation, which provide good stabilization. In addition, new types of headless screws leave a smooth, non-irritating bone surface, and the immediate future may be dominated by their resorbable varieties. RA can, therefore, be treated as a very favorable access to fractures of the mandibular head, especially due to the protection of the facial nerve and the possibility of providing a stable and predictable fixation.