A 21-year-old male patient presented with a bilateral condylar and a symphysis fracture. In this case, a combined approach was employed to reduce and fix the fractured condyle. The right medially displaced condylar fracture was addressed. A preauricular approach was advocated to retrieve the medially displaced fractured condyle []. To facilitate proper reduction and fixation of the fractured segments, a retromandibular approach was also used. We used Hegar's uterine dilators in sequence to create an accessible working space for reduction and fixation, passing it through the retromandibular incision, and exiting through the preauricular incision []. During plating, the superior screws were placed through the preauricular incision and the inferior screws were placed through the retromandibular incision. Finally, the symphysis fracture was reduced and fixed through an intraoral vestibular incision. Postoperative radiograph was taken to assess the surgical outcome [].
An 8-month-old male child presented with salivary discharge from the right cheek since birth. On inspection, there was a 1 mm external fistulous opening, 2 cm from the angle of the mouth with ipsilateral preauricular appendage. Intraoral examination was normal. On sinogram, no obvious tract could be identified. Under general anesthesia, cannulation of external fistulous opening was extremely difficult due to its very narrow caliber. A 24G plastic cannula could be passed for only 5 mm through which methylene blue dye was injected. Similar dissection was done as in the previous case with the tract being dissected externally and transposed intraorally. Diffuse intraoral discoloration by the dye was noted and insufficient length of cannula within the duct made identification of further intraoral tract difficult and the procedure had to be abandoned. The preauricular skin tag was excised. Postoperatively, there was local edema and a small dry ulcer over the cheek []. It eventually healed with secondary intention. At 1-year follow-up, there is no external salivary discharge with good cosmetic outcome.