Intraoral Endoscopic Approach for Treatment of Condylar Fractures of the Mandible

Oral and Maxillofacial Surgery for the Clinician ◽

10.1007/978-981-15-1346-6_54 ◽

2021 ◽

pp. 1115-1124

Author(s):

Frank Wilde

Keyword(s):

Facial Nerve ◽

Internal Fixation ◽

Nerve Injury ◽

Open Reduction ◽

Endoscopic Approach ◽

Facial Nerve Injury ◽

Great Auricular Nerve ◽

Intraoral Approach ◽

Condylar Fractures

AbstractThe literature is replete with techniques regarding the open reduction and fixation of the condylar fractures of the mandible. The extraoral approach is preferred by the majority of surgeons in comparison to the intraoral approach. Nevertheless, open reduction and internal fixation by an extraoral approach has the evident risk to cause transient or even permanent facial nerve injury [1–4], leads inevitably to a facial scar [1, 5], and can course salivary fistulas, sialoceles [1, 6], Frey syndrome, or disturbance of the great auricular nerve [1]. In contrast, an intraoral approach is minimizing these abovementioned risks and facial scars can be avoided in general [7, 8].

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Condylar Neck and Sub-Condylar Fractures: Surgical Consideration and Evolution of the Technique with Short Follow-Up on Five Cases

Dentistry Journal ◽

10.3390/dj8040125 ◽

2020 ◽

Vol 8 (4) ◽

pp. 125

Author(s):

Antonio Cortese ◽

Antonio Borri ◽

Marco Bergaminelli ◽

Fabrizio Bergaminelli ◽

Pier Paolo Claudio

Keyword(s):

Facial Nerve ◽

Nerve Injury ◽

Maxillofacial Surgery ◽

Complete Healing ◽

Oblique View ◽

Facial Nerve Injury ◽

Intraoral Approach ◽

Soft Tissue Dissection ◽

Condylar Fractures ◽

Condylar Neck

Condylar neck and sub-condylar fractures of the mandible are a frequent occurrence in maxillofacial surgery. The indication for surgical treatment of these fractures has changed over time, and several techniques have been developed with different results in the attempt to avoid the most worrisome adverse event, i.e., facial nerve injury. In this study, we present a new technique that combines an intraoral and a cutaneous pre-auricular access, which allows for easy and safe access to the surgical site, preventing facial nerve injury and avoiding surgical scars in high-impact aesthetic areas of the neck. Five consecutive patients affected by condylar neck or sub-condylar fractures were treated at a single institution using a combined intraoral and pre-auricular access. Results were evaluated after three months from surgery in terms of mandibular mobility, occurrence of complications, and patient’s satisfaction. All five patients had good outcome, with complete healing of the fracture and no occurrence of complications, including no facial nerve palsy. A key point of the technique is the safe reduction of the two mandibular fragments realized by a combined intraoral and a cutaneous pre-auricular surgical access. The periosteal plan of the ramus can be widely and safely elevated with the intraoral approach and connected to the condylar bone plane by the pre-auricular cutaneous approach without any need for soft tissue dissection at the fracture rim, thereby avoiding facial nerve injuries. Wide ramus periosteum elevation creates an “optical space”, allowing fragment reduction and fixation under direct oblique view without any endoscopic need. Our results strongly suggest that with our technique it is possible to treat sub-condylar and condylar neck fractures safely, avoiding facial nerve injury, which is an unacceptable complication due to its heavy impact on a patient’s life.

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Endoscopic-Assisted Intraoral Open Reduction Internal Fixation of Mandibular Subcondylar Fractures: Initial Experiences from a Tertiary-Care Maxillofacial Center in India

Craniomaxillofacial Trauma & Reconstruction ◽

10.1055/s-0037-1603457 ◽

2018 ◽

Vol 11 (3) ◽

pp. 183-191 ◽

Cited By ~ 2

Author(s):

Venkatesh Anehosur ◽

Abhijit Joshi ◽

Saravanan Rajendiran

Keyword(s):

Facial Nerve ◽

Learning Curve ◽

Internal Fixation ◽

Open Reduction ◽

Tertiary Care ◽

Mouth Opening ◽

Open Reduction Internal Fixation ◽

Steep Learning Curve ◽

Intraoral Approach ◽

Condylar Fractures

Management of condylar fractures is a highly controversial and debatable area. Open reduction and internal fixation (ORIF) using an extraoral approach has certain benefits over the nonsurgical treatment. Risk of damage to the facial nerve and an extraoral scar remains constant deterrents. An endoscopic-assisted ORIF offers an intraoral approach, thus eliminating consequences such as scarring. Though this technique offers unparalleled advantages, it is associated with a steep learning curve. Surgical results improve only with patience and experience. Patients with condylar fractures reported to SDM Craniofacial Unit, Dharwad, India, from 2013 to 2015 are included. Patients were treated with endoscopic-assisted ORIF and were evaluated for functional outcomes that included occlusion, maximal interincisal opening, and deviation of mouth and complications such as facial nerve pareses, postsurgical infection, and morbidity. Fifteen patients included in the study: 4 left sided and 11 right sided fractures. Nine patients had associated other mandibular fracture. Mean age of the patients was 28.2 years. Mean mouth opening at the end of 1 week, 6 weeks, and 6 months was 32.6, 37.8, and 40.5 mm, respectively. Transient facial nerve pareses were noted in one patient, and an extraoral draining sinus was noted in another. Endoscopic-assisted ORIF has a definite scope in management of condylar fractures. Results are more predictable with appropriate case selection due to a steep learning curve and intraoperative technical challenges. An initial experience in ORIF using extraoral approaches would greatly benefit a surgeon in utilizing this novel and alternate tool.

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