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Incision Selection in Mandibular Angle ORIF: Postoperative Complications and Neurosensory Outcomes by Approach.

Timothy C Olsen, Keith Sweitzer¹, Raquel Arias-Camison¹

¹Division of Plastic and Reconstructive Surgery, University of Rochester Medical Center, Rochester, NY.

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|March 16, 2026

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The trocar-assisted transbuccal approach for open reduction internal fixation (ORIF) of mandibular angle fractures is linked to increased postoperative complications, including nerve injury. Other surgical approaches appear safer for ORIF of mandibular angle fractures.

Area of Science:

Oral and Maxillofacial Surgery
Surgical Outcomes Research
Fracture Management

Background:

Mandibular angle fractures often lead to significant postoperative complications.
The choice of surgical incision for open reduction internal fixation (ORIF) remains a critical, yet debated, aspect of treatment.

Purpose of the Study:

To determine if the surgical incision type, specifically trocar-assisted transbuccal access, independently correlates with postoperative complications after ORIF for mandibular angle fractures.
To investigate the association between surgical approach and outcomes such as paresthesia, infection, and return to the operating room.

Main Methods:

A retrospective cohort study analyzed 116 patients undergoing ORIF for mandibular angle fractures.
Incisional approaches included intraoral, transparotid, retroparotid/submandibular, and trocar-assisted transbuccal.

Keywords:

Champy technique ORIF craniomaxillofacial trauma delayed union dental caries facial trauma hardware exposure incision selection inferior alveolar nerve internal fixation intraoral approach malocclusion mandibular angle mandibular angle fracture mandibular fracture maxillofacial trauma miniplate osteosynthesis multivariable logistic regression neuropraxia neurosensory outcomes nonunion open reduction and internal fixation paresthesia postoperative complications reoperation retromandibular approach retrospective cohort study return to operating room risk factors submandibular approach surgical approach selection surgical site infection teeth in the line of fracture third molar third molar extraction transbuccal approach transbuccal trocar transoral approach transparotid approach trocar-assisted fixation

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Multivariable logistic regression adjusted for patient and fracture characteristics to assess complication rates.

Main Results:

The trocar-assisted transbuccal approach showed a significantly higher odds of any postoperative complication (OR, 6.22) compared to the intraoral approach.
Intraoral and transparotid approaches were found to be protective against complications when compared to the trocar-assisted transbuccal method.
Trocar use and intraoperative third molar extraction were associated with increased odds of neuropraxia.

Conclusions:

The findings advocate for a risk-stratified approach to selecting surgical incisions for mandibular angle fracture ORIF.
Selective use of the trocar-assisted transbuccal approach may be considered for complex or anatomically challenging cases.
Standardized documentation of nerve dysfunction is crucial for improving clinical decision-making and benchmarking outcomes.