Analysis of the retroauricular transmeatal approach: a novel transfacial access to the mandibular skeleton.

In 2005 experimental work was published about the successful surgical management of fractures of the condylar head through a retroauricular approach. There were two reports in German, and later publications have not mentioned this route to open reduction and internal fixation of such fractures. The approach was studied in Germany but was poorly described and illustrated; later reports in English do not mention this route to the mandible. The aim of this study was to illustrate the retroauricular transmeatal approach, and briefly to review current surgical approaches to the mandibular skeleton and their technical variants. We exposed the mandibular skeleton by a retroauricular transmeatal route with transection of the external ear, dissection of the parotid gland, isolation of the retromandibular vein, and protection of the frontal branch of the facial nerve and the auriculotemporal nerve within the substance of the anteriorly retracted flap. Although we cannot draw any significant conclusions, the retroauricular transmeatal approach ensures extremely low risk of injury to the facial nerve, and leaves an invisible scar. The morbidity is low in terms of facial nerve lesions, vascular injuries, aesthetic deformity, auditory stenosis, salivary fistulas, sialocele and Frey syndrome. We think that further prospective clinical trials are needed better to assess and eventually develop this approach.