{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T04:18:29Z","timestamp":1791001109567,"version":"4.1.0"},"reference-count":23,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T00:00:00Z","timestamp":1768953600000},"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>Background\/Objectives: Subcondylar mandibular fractures represent a challenging subset of maxillofacial trauma due to their proximity to the temporomandibular joint and the facial nerve. The retromandibular approach can be performed through either an anteroparotid or a transparotid route, but comparative clinical data remain limited. This study aimed to evaluate clinical outcomes, complication profiles, and operative parameters associated with the retromandibular anteroparotid versus transparotid approach for open reduction and internal fixation (ORIF) of subcondylar fractures. Methods: A retrospective analysis was conducted on 80 consecutive patients treated for subcondylar mandibular fractures at the Department of Maxillofacial Surgery, Umberto I General Hospital, Sapienza University of Rome, between 2018 and 2025. All patients underwent ORIF via a retromandibular approach (anteroparotid or transparotid) with a minimum follow-up of 6 months. Demographic data, trauma etiology, fracture morphology (classified as simple or complex), associated fractures, surgical approach, fixation details, operative time, hospital stay, and postoperative complications were collected. Facial nerve function was clinically assessed and graded using the House\u2013Brackmann scale. Associations between fracture type, surgical approach, number of plates, and complications were evaluated using Chi-square or Fisher\u2019s exact tests, while operative time was compared using one-way ANOVA and Kruskal\u2013Wallis tests (p &lt; 0.05). Results: The cohort had a mean age of 41.9 years and was predominantly male (67.5%). The anteroparotid route was used in 54 patients (67.5%) and the transparotid route in 26 (32.5%). Overall, 10 patients (12.5%) developed postoperative complications, including transient facial nerve weakness, malocclusion, visible scarring, and sialocele. All cases of sialocele occurred in the transparotid subgroup, whereas no salivary complications were observed after the anteroparotid approach. No permanent facial nerve deficits, temporomandibular joint ankylosis, or long-term facial asymmetry were recorded at 6 months. No significant association was found between surgical approach and overall complication rate, but complex fracture patterns were significantly associated with increased operative time. Conclusions: The retromandibular approach is a safe and effective option for ORIF of subcondylar mandibular fractures. Both anteroparotid and transparotid routes provided reliable exposure and stable fixation with low complication rates. The anteroparotid route appears to minimize parotid-related complications, such as sialocele, while maintaining comparable functional outcomes. These findings support the retromandibular anteroparotid approach as a valuable alternative in the surgical management of subcondylar fractures.<\/jats:p>","DOI":"10.3390\/jcm15020887","type":"journal-article","created":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T09:21:40Z","timestamp":1769505700000},"page":"887","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Retromandibular Anteroparotid Versus Transparotid Approach for Subcondylar Mandibular Fractures: A Retrospective Comparative Study of 80 Cases"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4604-0716","authenticated-orcid":false,"given":"Andrea","family":"Battisti","sequence":"first","affiliation":[{"name":"Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy"},{"name":"Unit of Maxillofacial Surgery, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5756-219X","authenticated-orcid":false,"given":"Danilo","family":"Di Giorgio","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy"},{"name":"Unit of Maxillofacial Surgery, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica Orsina","family":"Ferri","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy"},{"name":"Unit of Maxillofacial Surgery, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6235-9754","authenticated-orcid":false,"given":"Marco","family":"Della Monaca","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy"},{"name":"Unit of Maxillofacial Surgery, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedetta","family":"Capasso","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy"},{"name":"Unit of Maxillofacial Surgery, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Priore","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy"},{"name":"Unit of Maxillofacial Surgery, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Terenzi","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, Tor Vergata University, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentino","family":"Valentini","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy"},{"name":"Unit of Maxillofacial Surgery, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"E346","DOI":"10.1097\/SCS.0000000000007118","article-title":"Mandibular Fractures Epidemiology and Treatment Plans in the Center of Italy: A Retrospective Study","volume":"32","author":"Gualtieri","year":"2021","journal-title":"J. Craniofac. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e400","DOI":"10.1097\/SCS.0b013e31825bd004","article-title":"Mini-retromandibular access to the condyle in panfacial fractures","volume":"23","author":"Colletti","year":"2012","journal-title":"J. Craniofac. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2418","DOI":"10.1016\/j.joms.2009.04.066","article-title":"Transmasseter Approach to Condylar Fractures by Mini-Retromandibular Access","volume":"67","author":"Biglioli","year":"2009","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1016\/j.jcms.2008.05.001","article-title":"Mini-retromandibular approach to condylar fractures","volume":"36","author":"Biglioli","year":"2008","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1238","DOI":"10.1016\/j.joms.2009.09.042","article-title":"Open Versus Closed Treatment of Unilateral Subcondylar and Condylar Neck Fractures: A Prospective, Randomized Clinical Study","volume":"68","author":"Danda","year":"2010","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/0030-4220(93)90285-C","article-title":"Rigid fixation of mandibular condyle fractures","volume":"76","author":"Ellis","year":"1993","journal-title":"Oral Surg. Oral Med. Oral Pathol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1016\/j.fsc.2025.03.005","article-title":"Comprehensive Review on the Management of Subcondylar and Condylar Mandibular Fractures","volume":"33","author":"Parikh","year":"2025","journal-title":"Facial Plast. Surg. Clin. N. Am."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1007\/s10006-025-01338-2","article-title":"Primary surgery of subcondylar mandibular fracture using patient-specific implant: The Helsinki protocol","volume":"29","author":"Saloniemi","year":"2025","journal-title":"Oral Maxillofac. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1368","DOI":"10.1016\/j.bjoms.2022.09.003","article-title":"Orbital bone fractures: 10 years\u2019 experience at the Rome trauma centre: Retrospective analysis of 543 patients","volume":"60","author":"Priore","year":"2022","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e753","DOI":"10.1097\/SCS.0000000000009629","article-title":"Long-Term Aesthetic Cicatrization Analysis of Lower Eyelid Incision for Orbital Floor Fracture Approach","volume":"34","author":"Beneduce","year":"2023","journal-title":"J. Craniofac. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1182","DOI":"10.1097\/SCS.0000000000008468","article-title":"Impact of COVID19 on Maxillofacial Fractures in the Province of L\u2019Aquila, Abruzzo, Italy. Review of 296 Patients Treated with Statistical Comparison of the Two-Year Pre-COVID19 and COVID19","volume":"33","author":"Giovannetti","year":"2022","journal-title":"J. Craniofac. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1016\/j.bjoms.2024.06.002","article-title":"European Quality Markers in Oral and Maxillofacial Surgery Specialty Training: Defining Standards","volume":"62","author":"Puladi","year":"2024","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1002\/ohn.185","article-title":"Current Management of Subcondylar Fractures: A Systematic Review","volume":"168","author":"Shikara","year":"2023","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"398E","DOI":"10.1097\/PRS.0000000000008294","article-title":"Mandibular Subcondylar Fracture: Improved Functional Outcomes in Selected Patients with Open Treatment","volume":"148","author":"Gibstein","year":"2021","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1111\/edt.12626","article-title":"Retromandibular transparotid approach for subcondylar mandibular fracture: A retrospective study","volume":"37","author":"Koirala","year":"2021","journal-title":"Dent. Traumatol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"102441","DOI":"10.1016\/j.jormas.2025.102441","article-title":"Intraoperative repositioning accuracy in transoral endoscopically-assisted mandibular subcondylar fracture repair: A 3-dimensional analysis","volume":"126","author":"Sakkas","year":"2025","journal-title":"J. Stomatol. Oral Maxillofac. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1016\/j.bjoms.2023.01.005","article-title":"Quality of life related to both general and oral health two years after treatment for subcondylar fracture","volume":"61","year":"2023","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Louvrier, A., Bertin, E., Boulahdour, Z., and Meyer, C. (2022). Wound of the Parotid Duct Following a Subcondylar Fracture. J. Oral Maxillofac. Surg., 80.","DOI":"10.1016\/j.joms.2021.08.269"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1737","DOI":"10.1097\/SCS.0000000000009238","article-title":"Biomechanical Comparison of Titanium and Poly- L -Lactic Acid Trapezoidal Plates Applied in a Subcondylar Fracture Model","volume":"34","year":"2023","journal-title":"J. Craniofac. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2581","DOI":"10.1007\/s11517-023-02854-7","article-title":"Biomechanical influence of plate configurations on mandible subcondylar fracture fixation: A finite element study","volume":"61","author":"Gupta","year":"2023","journal-title":"Med. Biol. Eng. Comput."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Huang, C.M., Chan, M.Y., Hsu, J.T., and Su, K.C. (2021). Biomechanical analysis of subcondylar fracture fixation using miniplates at different positions and of different lengths. BMC Oral Health, 21.","DOI":"10.1186\/s12903-021-01905-5"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1007\/s10006-021-00938-y","article-title":"Two miniplates versus 3-dimensional plate in the management of mandibular subcondylar fractures: A retrospective analysis","volume":"25","author":"Rai","year":"2021","journal-title":"Oral Maxillofac. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"E754","DOI":"10.1097\/SCS.0000000000008734","article-title":"Endoscopic-Assisted Intraoral Approach for Osteosynthesis of Mandibular Subcondylar Fractures","volume":"33","author":"Lam","year":"2022","journal-title":"J. Craniofac. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/2\/887\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T09:29:41Z","timestamp":1769506181000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/2\/887"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,21]]},"references-count":23,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["jcm15020887"],"URL":"https:\/\/doi.org\/10.3390\/jcm15020887","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,21]]}}}