Endoscopic-assisted Open Treatment for Subcondylar Fracture

Objectives: This clinical trial is to evaluate the feasibility of the endoscopy assisted transoral approach for open reduction of condylar mandible fractures with limited incisions in order to reduce the risk of facial nerve damage and extensive visible scars.Methods: From April of 2003 to May of 2005, the minimally invasive transoral approach for endoscopically assisted reduction and osteosynthesis of 10 displaced condylar mandible fractures (with/ without mandibular symphasis fracture ) was performed in 10 consecutive patients. By means of limited transoral incision, the endoscopically assisted reduction and fixation of condylar fractures was performed using 30- degree angled endoscopes. All the ten fractures were subcondylar. The condylar neck of the proximal fragment was displaced medially in 4 fractures and laterally in 6 fractures. Using angled endoscopes, good visibility of the fracture site was obtained, which allowed for precise anatomical reduction in 8 out of 10 patients. A transbuccal drill and screwdriver facilitated miniplate fixation by a 3mm incision. Results:Postoperatively, all patients showed limited swelling, quick recovery to pre-injury occlusion and short in-hospital time. No facial nerve injury and visible scars were detected. Normal temporomandibular joint function was noted 6 months after surgery in all patients. Conclusions: The transoral endoscopically assisted treatment using an transbuccal drill and screwdriver is the method of choice for surgical management of displaced condylar fractures. Facial nerve injury and visible scars can be avoided by using the transoral approach.