{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T04:39:51Z","timestamp":1791088791793,"version":"4.1.0"},"reference-count":43,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2021,1,11]],"date-time":"2021-01-11T00:00:00Z","timestamp":1610323200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>This systematic review was conducted to evaluate the retro-auricular trans-meatal approach (RA) to mandibular head fractures. Fractures of the mandibular head (8%) are a specific type of mandibular condyle fractures (34%). Despite numerous complications of conservative treatment, e.g., limited mobility and even ankylosis of the temporomandibular joint, as well as shortening of the mandibular ramus resulting in malocclusion, surgical intervention in this type of fracture is still problematic. The main problems with the dominant pre-auricular approach are the high risk of paralysis of the facial nerve and persistence of a visible scar. An attractive alternative is RA, which, despite its long history, has been described in English very few times, i.e., in only two clinical trials described in three articles in the last 21 years. According to these studies, RA gives a minimum of 90% of ideal positions of bone fragments and an always fully preserved function of the facial nerve in the course of long-term observation. RA allows the application of long screws for fixation, which provide good stabilization. In addition, new types of headless screws leave a smooth, non-irritating bone surface, and the immediate future may be dominated by their resorbable varieties. RA can, therefore, be treated as a very favorable access to fractures of the mandibular head, especially due to the protection of the facial nerve and the possibility of providing a stable and predictable fixation.<\/jats:p>","DOI":"10.3390\/jcm10020230","type":"journal-article","created":{"date-parts":[[2021,1,11]],"date-time":"2021-01-11T11:36:11Z","timestamp":1610364971000},"page":"230","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Retro-Auricular Approach to the Fractures of the Mandibular Condyle: A Systematic Review"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3348-1950","authenticated-orcid":false,"given":"Maciej","family":"Sikora","sequence":"first","affiliation":[{"name":"Department of Maxillofacial Surgery, Hospital of the Ministry of Interior, Wojska Polskiego 51, 25-375 Kielce, Poland"},{"name":"Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Powsta\u0144c\u00f3w Wielkopolskich 72, 70-111 Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6199-4753","authenticated-orcid":false,"given":"Maciej","family":"Ch\u0119ci\u0144ski","sequence":"additional","affiliation":[{"name":"STOMADENT Non-Public Healthcare Institution, Dental Clinic, Ko\u015bciuszki 32, 46-320 Praszka, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4497-4395","authenticated-orcid":false,"given":"Dariusz","family":"Chlubek","sequence":"additional","affiliation":[{"name":"Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Powsta\u0144c\u00f3w Wielkopolskich 72, 70-111 Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,1,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"521","DOI":"10.4103\/0970-9290.118365","article-title":"Facial nerve injury following surgery for temporomandibular joint ankylosis: A prospective clinical study","volume":"24","author":"Gokkulakrishnan","year":"2013","journal-title":"Indian J. Dent. Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"51","DOI":"10.4103\/ams.ams_200_17","article-title":"Facial nerve injury in temporomandibular joint approaches","volume":"8","author":"Moin","year":"2018","journal-title":"Ann. Maxillofac. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.cjtee.2019.08.006","article-title":"Key points in surgical management of mandibular condylar fractures","volume":"23","author":"Shakya","year":"2020","journal-title":"Chin. J. Traumatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"291","DOI":"10.5999\/aps.2012.39.4.291","article-title":"Current concepts in the mandibular condyle fracture management part I: Overview of condylar fracture","volume":"39","author":"Choi","year":"2012","journal-title":"Arch. Plast. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"313","DOI":"10.7150\/ijms.5.313","article-title":"The treatment of condylar fractures: To open or not to open? A critical review of this controversy","volume":"5","author":"Valiati","year":"2008","journal-title":"Int. J. Med. Sci."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1016\/j.jcms.2015.01.012","article-title":"Fractures of the mandibular condyle\u2014Open versus closed\u2014A treatment dilemma","volume":"43","author":"Shiju","year":"2015","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1054\/bjom.1998.0014","article-title":"Mandibular condyle fractures: A consensus","volume":"37","author":"Bos","year":"1999","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.cxom.2016.10.001","article-title":"The role of intra-articular surgery in the management of mandibular condylar head fractures","volume":"25","author":"Boffano","year":"2017","journal-title":"Atlas Oral Maxillofac. Surg. Clin. N. Am."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1016\/j.jcms.2006.03.003","article-title":"Open versus closed treatment of fractures of the mandibular condylar process-a prospective randomized multi-centre study","volume":"34","author":"Eckelt","year":"2006","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1007\/s10006-012-0337-6","article-title":"Open versus closed reduction: Diacapitular fractures of the mandibular condyle","volume":"16","author":"Chrcanovic","year":"2012","journal-title":"Oral Maxillofac. Surg."},{"key":"ref_11","first-page":"17","article-title":"Surgical treatment of condylar head fractures, the way to minimize the postraumatic TMJ. ankylosis","volume":"118","author":"Hirjak","year":"2017","journal-title":"Bratisl. Lek. Listy"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"872","DOI":"10.1016\/j.bjoms.2016.05.027","article-title":"Treatment of fractures of the mandibular condylar head with ultrasound-activated resorbable pins: Early clinical experience","volume":"54","author":"McLeod","year":"2016","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1953","DOI":"10.1016\/j.jcms.2018.09.008","article-title":"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","volume":"46","author":"Smolka","year":"2018","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_14","first-page":"14","article-title":"Current views on the treatment of condylar fractures","volume":"64","author":"Sikora","year":"2018","journal-title":"Pomeranian J. Life Sci."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/0278-2391(83)90214-8","article-title":"Indications for open reduction of mandibular condyle fractures","volume":"41","author":"Zide","year":"1983","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_16","unstructured":"(2020, November 30). American Association of Oral and Maxillofacial Surgeons [Internet] Rosemont: American Association of Oral and Maxillofacial Surgeons. Available online: http:\/\/www.aaoms.org\/."},{"key":"ref_17","first-page":"1560","article-title":"Eine neue methode zur freilegung der kiefergelenke ohne sichtbare narben unde ohne verletzung des nervus facialis","volume":"47","author":"Bockenheimer","year":"1920","journal-title":"Zentralbl. Chir."},{"key":"ref_18","unstructured":"Meyer, C., and Kleinheinz, J. (2009). Fractures of the Mandibular Condyle: Basic Considerations and Treatment, IBRA\/Quintessence."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1097\/SCS.0b013e318207f495","article-title":"Retroauricular transmeatal approach to manage mandibular condylar head fractures","volume":"22","author":"Benech","year":"2011","journal-title":"J. Craniofac. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1016\/j.jcms.2015.02.004","article-title":"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)","volume":"43","author":"Kolk","year":"2015","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/2046-4053-4-1","article-title":"Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement","volume":"4","author":"Moher","year":"2015","journal-title":"Syst. Rev."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1177\/1524839919893361","article-title":"A Review of the PubMed PICO Tool: Using Evidence-Based Practice in Health Education","volume":"21","author":"Brown","year":"2020","journal-title":"Health Promot. Pract."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e22","DOI":"10.1016\/j.bjoms.2011.08.006","article-title":"Analysis of the retroauricular transmeatal approach: A novel transfacial access to the mandibular skeleton","volume":"50","author":"Arcuri","year":"2012","journal-title":"Br. J. Oral Max. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/j.jcms.2014.10.011","article-title":"European Maxillofacial Trauma (EURMAT) project: A multicentre and prospective study","volume":"43","author":"Boffano","year":"2015","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1501","DOI":"10.1097\/SCS.0000000000004858","article-title":"Condyle fractures: Impact of surgical and conservative approaches on oral health","volume":"29","author":"Andrade","year":"2018","journal-title":"J. Craniofac. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e7352","DOI":"10.5867\/medwave.2018.07.7351","article-title":"Surgical or conservative treatment for mandibular condyle fractures","volume":"18","author":"Santana","year":"2018","journal-title":"Medwave"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1007\/s10006-001-0345-4","article-title":"Surgical vs. conservative therapy of diacapitular and high condylar fractures with dislocation. A comparison between MRI and axiography","volume":"6","author":"Neff","year":"2002","journal-title":"Mund Kiefer Gesichtschir."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1227","DOI":"10.1016\/j.ijom.2019.02.003","article-title":"Surgical approaches for condylar fractures related to facial nerve injury: Deep versus superficial dissection","volume":"48","author":"Imai","year":"2019","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"715126","DOI":"10.1155\/2015\/715126","article-title":"The relationship of the facial nerve to the condylar process: A cadaveric study with implications for open reduction internal fixation","volume":"2015","author":"Barham","year":"2015","journal-title":"Int. J. Otolaryngol."},{"key":"ref_30","first-page":"713","article-title":"Die operative freilegung des kiefergelenks","volume":"3","author":"Axhausen","year":"1931","journal-title":"Chirurg"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1097\/00006534-197010000-00005","article-title":"Operative treatment of fractures of the mandibular condyle in children. Using the post-auricular approach","volume":"46","author":"Hoopes","year":"1970","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1097\/00006534-197010000-00013","article-title":"Post-auricular approach to mandibular condyle","volume":"46","author":"Ivy","year":"1970","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1007\/s10006-004-0529-9","article-title":"Stability of osteosyntheses for condylar head fractures in the clinic and biomechanical simulation","volume":"8","author":"Neff","year":"2004","journal-title":"Mund Kiefer Gesichtschir."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1007\/s10006-005-0600-1","article-title":"Small fragment screws vs. plate osteosynthesis in condylar head fractures. A comparison of functional results based on MRI and axiography","volume":"9","author":"Neff","year":"2005","journal-title":"Mund Kiefer Gesichtschir."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1046\/j.1365-2842.2000.00501.x","article-title":"Investigation of a possible relationship between kinematic points and condylar attachments of the lateral ligaments","volume":"27","author":"Morneburg","year":"2000","journal-title":"J. Oral Rehabil."},{"key":"ref_36","unstructured":"Reymond, J. (2012). Osteonecrosis of the Mandibular Head as a Complication of Injuries of the Lower Level of the Facial Part of the Skull-Analysis of Morphological Conditions, Warsaw Medical University."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"7","DOI":"10.2535\/ofaj1936.78.1_7","article-title":"Nutrient arteries of the temporomandibular joint: An anatomical and a pathological study","volume":"78","author":"Funakoshi","year":"2001","journal-title":"Okajimas Folia Anat Jpn."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/j.jcms.2011.03.017","article-title":"Vascularization of the mandibular condylar head with respect to intracapsular fractures of mandible","volume":"40","author":"Wysocki","year":"2012","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_39","first-page":"155","article-title":"Delayed bleeding from the superficial temporal artery after local flap reconstruction","volume":"35","author":"Vila","year":"2009","journal-title":"Dermatol. Surg."},{"key":"ref_40","first-page":"S044","article-title":"The Comprehensive AOCMF Classification System: Condylar Process Fractures\u2014Level 3 Tutorial","volume":"7","author":"Neff","year":"2014","journal-title":"Cranio-Maxillofac. Trauma Reconstr."},{"key":"ref_41","unstructured":"Kozakiewicz, M. (2019). Fractures of the Mandibular Condylar Process, PZWL."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.bjoms.2017.04.013","article-title":"Small-diameter compression screws completely embedded in bone for rigid internal fixation of the condylar head of the mandible","volume":"56","author":"Kozakiewicz","year":"2018","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"4059","DOI":"10.1007\/s00784-019-02842-y","article-title":"Comparison of compression screws used for mandible head fracture treatment-experimental study","volume":"23","author":"Kozakiewicz","year":"2019","journal-title":"Clin. Oral Investig."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/2\/230\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:09:33Z","timestamp":1760159373000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/2\/230"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,11]]},"references-count":43,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2021,1]]}},"alternative-id":["jcm10020230"],"URL":"https:\/\/doi.org\/10.3390\/jcm10020230","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1,11]]}}}