Submandibular Approach Through the Submandibular Gland Fascia for Treating Mandibular Fractures Without Identifying the Facial Nerve

Background: The submandibular, or Risdon, approach is the classic, reliable extraoral approach for treating mandibular fractures. Although the intraoral approach has been used recently for open reduction and internal fixation, in some cases, such as comminuted fractures or fractures in an atrophic mandible, the submandibular approach is still prerequisite. Damage to the marginal mandibular branch of the facial nerve is the only concern other than skin scarring. Methods: To minimize the risk of neuropraxia, we prospectively assessed an approach for treating mandibular fractures at 24 surgical sites in 22 patients (17 men, 5 women; mean age, 54.3 years) using direct submandibular gland capsule fascial layer elevation that did not require identifying the facial nerve. Results: As complications, one patient (4.2%) had temporary facial weakness in the mandibular branch, but this resolved completely within 3 months. The postoperative clinical course was uneventful in the other patients with one minor fistula and minimal scarring. Conclusions: In conclusion, submandibular gland capsular layer elevation without facial nerve identification is a safe and less time-consuming technique applying the submandibular approach for the treatment of mandibular fractures.