The submandibular approach by Dr. Ashish is indicated for challenging mandibular body and angle fractures unsuitable for intraoral treatment. The technique involves specific skin incisions, careful dissection to protect vital structures, and layered wound closure to ensure anatomical realignment. Proper exposure and fixation of fracture segments are critical for successful outcomes in these complex cases.

1. SUBMANDIBULAR
APPROACH
Presented by – Dr. Ashish ( R1 )

2. INDICATIONS
• This approach is selected for fractures of the
mandibular body and angle regions unsuitable
for intraoral treatment.
• This applies to more difficult fracture patterns
such as comminuted, atrophic, and defect
fractures to allow optimal manipulation of the
fragments, good control of the lingual cortex
and inferior border

3. Exposure offered by the
submandibular approach.

4. LAYERS IN SUBMANDIBULAR REGION
SKIN
SUCUTANEOUS TISSUE
PLATYSMA
SUPERFICIAL LAYER OF
DEEP CERVICAL FASCIA
PTERYGOMASSETRIC
SLING
PERIOSTEUM

5. VITAL STRUCTURES

6. SKIN INCISION
• The incision can either
be parallel to the
inferior border of the
mandible (A) or
• be placed in an
existing skin crease (B)
for maximum cosmetic
benefit (RSTL)

7. • If using skin creases
for the incision the
orientation of the
scalpel blade is
parallel to the
relaxed skin tension
lines (RSTL).

8. SKIN INCISION
• Skin incision is
placed 2-3 cm below
the inferior border
of the mandible.
• Incision of skin and
subcutaneous
tissues exposes the
underlying platysma
muscle.

12. BLUNT DISSECTION OF PLATYSMA
• In order to protect the
marginal mandibular
branch of the facial nerve,
the platysma is
undermined bluntly with
scissors prior to dividing it
with a scalpel.
• The platysma muscle is
divided sharply,
preferably 2-3 cm below
the mandibular border, not
necessarily at the same
level of the skin incision

13. EXPOSURE AND SPLITTING OF
PTERYGOMASSETRIC SLING
• Superior subplatysmal
dissection would
expose the underlying
marginal mandibular
branch of the facial
nerve (CN VII)
• Divide the
pterygomasseteric sling
and incise the
periosteum at the
inferior border to
expose the ramus.

14. FIXATION OF FRACTURE SEGMENTS

15. WOUND CLOSURE
• During wound
closure, the
pterygomasseteric
sling is repaired.
• The wound is then
closed in layers to
realign the anatomic
structures and
eliminate dead
space. The platysma
muscle is repaired

16. • The wound is then
closed in layers to
realign the anatomic
structures and
eliminate dead
space. The platysma
muscle is repaired

17. THANK YOU