The retromandibular approach to the mandible varies with surgeons in the position of the skin incision - which also dictates the underlying dissection. Some surgeons advocate placing an incision approximately 2 cm posterior to the ramus. The parotid gland is approached from behind and sharply dissected from the sternocleidomastoid muscle, allowing retraction of the gland superiorly and anteriorly to gain access to the ramus. The theoretic advantage to this approach is that it avoids the branching facial nerve, which is contained within the parotid gland. Unfortunately, the primary advantage of the retromandibular approach, the direct proximity of the skin incision to the mandible, is then lost. An alternate approach, presented here, was described by Hinds (2). The incision is placed at the posterior ramus, just below the earlobe. Dissection to the posterior border of the mandible is direct, traversing the parotid gland and exposing some branches of the facial nerve.
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