The management of condylar fractures has always generated controversy in maxillofacial surgery. Historically, conservative treatment with or without maxillo-mandibular fixation (MMF) has been the preferred choice of management (Delaire et al., 1975). Advances in medical technology and progression in surgical techniques have shifted the treatment choice in favor of surgical options with open reduction and internal fixation (ORIF), as confirmed by multiple studies (Eckelt et al., 2006; Al Moraissi et al., 2015; Ellis and Throckmorton, 2020). Despite the fact that in children and adolescents closed treatment shows good clinical outcomes (Du et al., 2021), in older patients with condylar base and neck fractures displaced and dislocated, ORIF is currently considered the gold standard of care (Neff et al., 2014a; Bansal et al., 2021, Mohamed et al., 2021).

In this field, several approaches have been described (Ellis et al., 1993); however, there is still a lack of consensus on the surgical approach to be used. Choices among these techniques are in most cases dictated by surgical habits and experience, rather than by objective advantages, indications and pitfalls. As well known, the most frequent fractures involving the condylar process are the neck and base fractures, and finding a well-standardized and safe procedure to repair these is highly desirable (Marker et al., 2000; Zachariades et al., 2006).

A recent meta-analysis (Al Moraissi et al., 2018a) well details all of the different surgical approaches related to the rate of facial nerve injuries. However, indications in relation to the fracture type, suitability, disadvantages and achieved results (functionally and aesthetically) among surgical approaches remains to be clarified.

In the past authors’ clinical practice, high condylar neck fractures were treated with a preauricular approach, the one regularly used for temporo-mandibular joint (TMJ) surgery; lower fractures were usually treated by classic retromandibular transparotid approach, switched in the last years to mini-retromandibular incision associated with transmasseteric anteroparotid (TMAP) dissection (Biglioli and Colletti, 2008).

This technique well increases the facial nerve safety but remains, like the classic retromandibular transparotid, technically demanding in neck fracture treatment. Furthermore, despite the skin incision being very short, it is not well hidden and remains visible.

The “high submandibular approach” (Meyer et al., 2006), a great improvement of a classic Risdon technique, presents the same disadvantages, being difficult to use in high neck fractures and leaving an even more visible scar.

The intraoral approach appears to be useful for the condylar base fractures, but not for the neck fracture (Kitagawa et al., 2004; Kanno et al., 2011).

In an effort to reduce these drawbacks, in 2020 a novel surgical technique was introduced by the authors, adopting a skin incision usually used in face lift surgery, closely limiting its extension to the portion corresponding to the auricle's caudal two-thirds. This makes the scar almost invisible.

The TMAP dissection was associated with the present approach because it seems to be the safest way to reach the condylar process. Moreover, this favorable incision location, together with the wide skin undermining, greatly improves the surgical field in high condylar neck area, facilitating condylar neck fracture management.

The aim of the present study was to present the novel technique as the unique way to fix any type of extracapsular condylar fractures.