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British Journal of Oral and Maxillofacial Surgery 49 (2011) 664–665

Case report
Classification of surgical approaches to the mandibular
condyle
G.J. Knepil a , A.N. Kanatas b,∗ , R.J. Loukota b
a Oral and Maxillofacial Surgery, Gloucestershire Hospitals NHS Foundation Trust, Gloucester Royal Infirmary, Great Western Road, Gloucester,
Gloucestershire, GL1 3NN, United Kingdom
b Department of Oral and Maxillofacial Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom

Accepted 8 February 2011

Available online 31 March 2011

Abstract

Published articles on surgical approaches to the mandibular condyle seem to be confusing.

We present a classification system that describes and differentiates between surgical approaches to the mandibular condyle and is based on
the relation to the facial nerve, height of the approach, and choice of skin incision.
© 2011 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Keywords: Mandibular condyle; Open reduction and internal fixation

Introduction

There is uncertainty arising from the numerous terms used

to describe surgical approaches to the mandibular condyle.
Similar procedures have been described by different names,
and differing procedures by the same name.1–5 The principal
consideration when planning surgical access is the poten-
tial for iatrogenic injury to the seventh cranial nerve. This
has resulted in the development of a variety of surgical
approaches based on the relation to the facial nerve and the
height of the part of the condyle being approached (head,
neck, or base).

Classification system

The absence of a classification system has resulted in sim-

ilar terms being used to describe approaches that differ

Fig. 1. Relation of the surgical approach to the facial nerve.

∗
Corresponding author. Tel.: +44 7956603118.
E-mail addresses: greg.knepil@glos.nhs.uk (G.J. Knepil),
a.kanatas@doctors.org.uk (A.N. Kanatas),
Richard.Loukota@leedsth.nhs.uk (R.J. Loukota).

0266-4356/$ – see front matter © 2011 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.bjoms.2011.02.009
 G.J. Knepil et al. / British Journal of Oral and Maxillofacial Surgery 49 (2011) 664–665 665

Table 1
Classification of surgical approaches to the mandibular condyle.
Relation of the intended level of dissection Intended height of approach Incision (examples currently in
to the plane of the facial nerve use)1–6
Deep Supra-auricular Temporal
Auricular Postauricular
Auricular
Preauricular
Subauricular Retromandibular
Oral Buccal sulcus
Traversing High – between zygomatic and Preauricular
buccal branches Perilobular
Middle – between buccal and Retromandibular
mandibular branches Periangular
Low – between mandibular and Submandibular
cervical branches Rhytidectomy

in their relation to the facial nerve, and in multiple terms References

being used to describe approaches that follow the same
relation to the nerve. This has rendered meaningful com-
parison of procedures difficult and potentially inaccurate,
particularly with reference to retromandibular approaches.3,5
We recommend a classification system that is based on
the relation of the approach to the facial nerve. The first
descriptor indicates whether the intended plane of dissec-
tion passes deep to the nerve or traverses through the plane
of the nerve (Fig. 1), and the second refers to the height
of the approach. Finally the choice of skin incision is
described (Table 1).
This simple system can be used to differentiate
and to describe all the approaches to the mandibu-
lar condyle, allowing accurate comparisons to be made
between them. Only then can we accurately compare our
outcomes.
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