• Inferior border of mandible is marked, along with site of fracture and anticipated location of incision

• Incision begins through skin and subcutaneous tissue to the level of the platysma

• Platysma is incised in a single layer

• Once the platysma is incised, skin hooks are used to provide retraction and expose the underside of the platysma muscle

• Dissection then proceeds toward the mandible in the plane just below the platysma muscle

• The flap should include skin, subcutaneous tissue, and platysma

• Once the platysma has been elevated to the level of the mandible, the submandibular gland can be exposed and facial vessels can be identified as in a standard Risdon approach
• These steps, along with fracture reduction and hardware fixation, are made much easier due to increased access afforded by subplatysmal flap elevation

• Hemostasis should be ensured prior to closure
• Can apply a hemostatic agent as pictured

• Platysma is reapproximated with resorbable sutures

• Skin closure

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