“Trans-zygomatic approach” for reduction & internal fixation of a malunited, medially dislocated condyle fracture in a geriatric patient with cervical spine injury

The open reduction and internal fixation of medially displaced/dislocated condyle fracture is challenging due to inadequate visibility and access to the dislocated condyle. The common approach to reduction of such condyles is by inferior distraction of the mandible which facilitates visualization as well as instrumentation. However, this maneuver may be difficult, or contraindicated in patients with concomitant cervical spine injury where excessive manipulation of the mandible may predispose the spine to further trauma. Ramus osteotomies which are used when conventional reduction methods fail, facilitate reduction but are associated with additional incision, complications and surgical time. This case report presents an alternative method, the "trans-zygomatic approach" which was used effectively to reduce a dislocated and malunited condyle fracture in a geriatric patient with co-existent cervical spine injury. The approach facilitated precise reduction of condyle fracture with minimal impact on the cervical spine.