Assessment of Facial Nerve Dysfunction in the Retromandibular Approach for Mandibular Condylar Fracture Management

Background:Condylar fractures account for a significant proportion of mandibular fractures. Surgical management of these fractures often involves navigating around the facial nerve, which controls the motor function of the muscles of facial expression along with other specialized functions. Preserving the integrity of this nerve during surgical intervention is crucial to prevent functional impairment. Objective:To evaluate the incidence of facial nerve dysfunction following the retromandibular approach for the management of mandibular condylar fractures. Materials & Methods: It was a ‘Descriptive Case Series’ completed within six months from October 20, 2020 to April 20, 2021 in the department of oral and maxillofacial surgery, Mayo Hospital, Lahore. A total of 60 patients meeting the inclusion criteria were enrolled in the study. All patients underwent surgical reduction and fixation of condylar fractures via the retromandibular approach under general anesthesia. Facial nerve dysfunction involving any of its peripheral branches was assessed three months postoperatively using the House-Brackmann Facial Nerve Grading System (HBFNGS). Nerve involvement was documented if dysfunction was observed in any of the branches, including the zygomatic, temporal, buccal, marginal mandibular, or cervical branches. Results:The mean age of the patients was 30.50 ± 11.88 years. The study population comprised 55 (91.67%) males and five (8.33%) females. At the three-month follow-up, buccal nerve involvement was noted in two patients (66.67%), while zygomatic nerve involvement was observed in one patient (33.3%). Overall, facial nerve dysfunction was identified in three patients (5%). Conclusion:This study found that the incidence of facial nerve dysfunction following the retromandibular approach for mandibular condylar fractures was 5%. While the approach remains a viable surgical technique, careful attention must be given to minimizing the risk of nerve injury.