17 Osteosynthesis of Condylar Head Fractures by Retroauricular Approach

The Retroauricular Approach

The skin incision runs 2–3 mm behind the dorsal conchal fold, reaching from the cranial dorsal fold of the concha until slightly above the earlobe (Fig. 17.1). Crani-ally, identification of the deep layer of the temporal fascia avoids lesions to the frontal branch of the facial nerve. This layer is bluntly dissected toward the zygomatic arch and articular fossa. Caudally, starting from the mastoid fascia level, a blunt epiperichondral dissection in a strictly horizontal plane follows the chondral portions of the auditory canal, which is then transsected using, for example, a blade 20 scalpel. Cutting near the bony external acoustic meatus should be strictly avoided, to prevent postoperative cicatricial stenoses (Fig. 17.2).

The dissection can now proceed toward the articular fossa and articular eminence, following the deep layer of the temporal fascia; medial temporal vessels that cross the dissection path should be closed by ligatures. The zygomatic periosteum, however, should be left intact. Instead, a blunt dissection of the periarticular soft tissue strictly follows the lateral ligament plane using a pair of periostium elevators. As a rule, it is not necessary to expose the articular eminence in condylar head traumatology. As the joint space itself is entered directly over the fracture gap via a vertical incision into the posterior recess, the attachments of both lateral ligament and capsule can be left intact. The fracture gap can then be visualized by exposure of the upper parts of the condylar process, especially regarding the medio-caudal aspects (Fig. 17.3).

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