Non-shortening fracture of the mandibular head resulting in severe mouth opening disorder operated on via the retroauricular approach – a case report

Maciej Sikora, Maciej Chęciński, Dariusz Chlubek


This report describes a case of a non-shortening fracture of the mandibular head resulting in severe mouth opening disorder operated on via a retroauricular approach (RA). We published this report because there is a very limited number of English--language articles on the RA. The second reason that prompted us to publish this report was the uniqueness of the case, i.e., there was an almost complete limitation of mandibular abduction in the fracture which did not shorten the vertical dimension of the mandible branch. The case described by us is an example of the effective use of the RA for the open treatment of a fracture of the mandibular head. Papers on the RA, including this report, indicate the satisfactory results of this method – a strong alternative to pre- and transauricular approaches. A non-shortening fracture of the mandibular head in the form of a significant persistent limitation of mandibular abduction is atypical and may be treated as another indication for open treatment.


retroauricular approach; mandibular condyle fracture; mandibular head fracture; retro-auricular transmeatal approach

Full Text:



Boffano P, Roccia F, Zavattero E, Dediol E, Uglešić V, Kovačič Ž, et al. European Maxillofacial Trauma (EURMAT) project: a multicentre and prospective study. J Craniomaxillofac Surg 2015;43(1):62-70.

Chrcanovic BR. Open versus closed reduction: diacapitular fractures of the mandibular condyle. Oral Maxillofac Surg 2012;16(3):257-65.

Sikora M, Chęciński M, Chlubek D. Retro-auricular approach to the fractures of the mandibular condyle: a systematic review. J Clin Med 2021;10(2):230.

Kolk A, Neff A. Long-term results of ORIF of condylar head fractures of the mandible: a prospective 5-year follow-up study of small-fragment positional-screw osteosynthesis (SFPSO). J Craniomaxillofac Surg 2015;43(4):452-61.

Chen M, Yang C, He D, Zhang S, Jiang B. Soft tissue reduction during open treatment of intracapsular condylar fracture of the temporomandibular joint: our institution’s experience. J Oral Maxillofac Surg 2010;68(9):2189-95.

Spiessl B, Schroll K. Gelenkfortsatz-und Kieferköpfchenfrakturen. Spezielle Frakturen-und Luxationslehre. Band l/1: Gesichtsschädel ed. Stuttgart: Georg Thieme Verlag; 1972. p. 136-52.

Neff A, Cornelius CP, Rasse M, Torre DD, Audigé L. The comprehensive AOCMF classification system: condylar process fractures – level 3 tutorial. Craniomaxillofac Trauma Reconstr 2014;7(Suppl 1):S044-58.

Kozakiewicz M. Classification proposal for fractures of the processus condylaris mandibulae. Clin Oral Investig 2019;23(1):485-91.

Neff A, Kolk A, Meschke F, Horch HH. Neue Aspekte zur Prävalenz sogenannter “Trümmerfrakturen” des Gelenkkopfs – klinisch-anato mische Befunde und therapeutische Konsequenzen. Dtsch Zahnärztl Z 2004;59(6):343-

Kaczmarzyk T, Babiuch K, Bołtacz-Rzepkowska E, Dominiak M, Konopka T, Lipski M, et al. Polish Dental Association And National Programme To Protect Antibiotics Working Group recommendations for administration of antibiotics in dentistry. J Stoma 2018;71(6):457-65.

Neff A. Retroauricular approach. Internal fixation of the condylar head. In: Meyer C, Kleinheinz J, editors. Fractures of the mandibular condyle: basic considerations and treatment. London: IBRA/Quintessence Publishing; 2009. 231-46.

Kozakiewicz M. Fractures of the Mandibular Condylar Process. Warszawa: PZWL; 2019.

Skroch L, Fischer I, Meisgeier A, Kozolka F, Apitzsch J, Neff A. Condylar remodeling after osteosynthesis of fractures of the condylar head or close to the temporomandibular joint. J Craniomaxillofac Surg 2020;48(4):413-20.

Shakya S, Zhang X, Liu L. Key points in surgical management of mandibular condylar fractures. Chin J Traumatol 2020;23(2):63-70.

Sikora M, Olszowski T, Chlubek D. Current views on the treatment of condylar fractures. Pomeranian J Life Sci 2018;64(4):14-23. doi: 10.21164/pomjlifesci.482.

Kolk A, Scheunemann LM, Grill F, Stimmer H, Wolff KD, Neff A. Prognostic factors for long-term results after condylar head fractures: a comparative study of non-surgical treatment versus open reduction and osteosynthesis. J Craniomaxillofac Surg 2020;48(12):1138-45.

Ren R, Dai J, Zhi Y, Xie F, Shi J. Comparison of temporomandibular joint function and morphology after surgical and non-surgical treatment in adult condylar head fractures. J Craniomaxillofac Surg 2020;48(3):323-30.

Kumaran A, Soh HL. Management of nonunion and malunion ater primary mandibular condylar fracture treatment: a review and recommendations. J Oral Maxillofac Surg 2020;78(12):2267-72.

Shiju M, Rastogi S, Gupta P, Kukreja S, Thomas R, Bhugra AK, et al. Fractures of the mandibular condyle – open versus closed – a treatment dilemma. J Craniomaxillofac Surg 2015;43(4):448-51.

Hirjak D, Machon V, Beno M, Galis B, Kupcova I. Surgical treatment of condylar head fractures, the way to minimize the postraumatic TMJ ankylosis. Bratisl Lek Listy 2017;118(1):17-22.

Boffano P, Corre P, Righi S. The role of intra-articular surgery in the management of mandibular condylar head fractures. Atlas Oral Maxillofac Surg Clin North Am 2017;25(1):25-34.

He D, Yang C, Chen M, Bin J, Zhang X, Qiu Y. Modified preauricular approach and rigid internal fixation for intracapsular condyle fracture of the mandible. J Oral Maxillofac Surg 2010;68(7):1578-84.

He D, Yang C, Chen M, Jiang B, Wang B. Intracapsular condylar fracture of the mandible: our classification and open treatment experience. J Oral Maxillofac Surg 2009;67(8):1672-9.

Jeyaraj P. Chronic recurrent temporomandibular joint dislocation: a comparison of various surgical treatment options, and demonstration of the versatility and efficacy of the Dautrey’s procedure. J Maxillofac Oral Surg 2018;17(1):95-106.

Sikora M, Chęciński M, Nowak Z, Chlubek D. Variants and Modifications of the Retroauricular Approach Using in Temporomandibular Joint Surgery: A Systematic Review. J Clin Med 2021;10(10):2049.

McLeod NMH, Saeed NR. Treatment of fractures of the mandibular condylar head with ultrasound-activated resorbable pins: early clinical experience. Br J Oral Maxillofac Surg 2016;54(8):872-7.

Benech A, Arcuri F, Baragiotta N, Nicolotti M, Brucoli M. Retroauricular transmeatal approach to manage mandibular condylar head fractures. J Craniofac Surg 2011;22(2):641-7.

Arcuri F, Brucoli M, Benech A. Analysis of the retroauricular transmeatal approach: a novel transfacial access to the mandibular skeleton. Br J Oral Maxillofac Surg 2012;50(2):e22-6.

Bockenheimer P. Eine neue Methode zur Freilegung der Kiefergelenke ohne sichtbare Narben und ohne Verletzung des Nervus facialis. Zentralbl Chir 1920;47:1560-79.

Smolka W, Cornelius CP, Lechler C. Resorption behaviour of the articular surface dome and functional outcome after open reduction and internal fixation of mandibular condylar head fractures using small-fragment positional screws. J Craniomaxillofac Surg 2018;46(11):1953-9.

Neff A, Kolk A, Meschke F, Deppe H, Horch HH. Kleinfragmentschrauben vs. Plattenosteosynthese bei Gelenkwalzenfrakturen. Vergleich funktioneller Ergebnisse mit MRT und Achsiographie. Mund Kiefer Gesichtschir 2005;9(2):80-8.

Kozakiewicz M. Comparison of compression screws used for mandible head fracture treatment – experimental study. Clin Oral Investig 2019;23(11):4059-66.

Sukegawa S, Yamamoto N, Nakano K, Takabatake K, Kawai H, Kanno T, et al. Biomechanical loading comparison between titanium and bioactive resorbable screw systems for fixation of intracapsular condylar head fractures. Materials (Basel) 2020;13(14):3153.

Kozakiewicz M, Świniarski J. Treatment of high fracture of the neck of the mandibular condylar process by rigid fixation performed by lag screws: Finite element analysis. Dent Med Probl 2017;54(3):223-8.

Kozakiewicz M. Small-diameter compression screws completely embedded in bone for rigid internal fixation of the condylar head of the mandible. Br J Oral Maxillofac Surg 2018;56(1):74-6.

Neff A, Mühlberger G, Karoglan M, Kolk A, Mittelmeier W, Scheruhn D, et al. Stabilität der Osteosynthese bei Gelenkwalzenfrakturen in Klinik und biomechanischer Simulation. Mund Kiefer Gesichtschir 2004;8(2):63-74.

Bielecki-Kowalski B, Kozakiewicz M. Clinico-anatomical classification of the processus condylaris mandibulae for traumatological purposes. Ann Anat 2021;234:151616.

Pavlychuk T, Chernogorskyi D, Chepurnyi Y, Neff A, Kopchak A. Biomechanical evaluation of type p condylar head osteosynthesis using conventional small-fragment screws reinforced by a patient specific two-component plate. Head Face Med 2020;16(1):25.

Neff A, Kolk A, Neff F, Horch HH. Operative vs. konservative Therapie diakapitulärer und hoher Kollumluxationsfrakturen. Vergleich mit MRT und Achsiographie. Mund Kiefer Gesichtschir 2002;6(2):66-73.

Kozakiewicz M. Are magnesium screws proper for mandibular condyle head osteosynthesis? Materials (Basel) 2020;13(11):2641.

Kozakiewicz M. Change in pull-out force during resorption of magnesium compression screws for osteosynthesis of mandibular condylar fractures. Materials (Basel) 2021;14(2):237.


Copyright (c) 2021 Maciej Sikora, Maciej Chęciński, Dariusz Chlubek

License URL: