Endoscopically assisted repair of subcondylar fractures of the mandible: an evolving technique.

OBJECTIVE

To review one surgeon's experience with the endoscopic approach to assist with reduction and rigid fixation of subcondylar fractures of the mandible.

DESIGN

Chart review of all cases in which endoscopic techniques were used to assist with the reduction and, when possible, repair of these fractures. The numbers of fractures approached, successfully repaired with the use of plates and screws, and not successfully plated with this approach were documented.

SETTING

All surgeries were performed in the operating room at a university hospital.

PATIENTS

All patients who underwent endoscopic exploration of a single or bilateral subcondylar fractures of the mandible were included. Seventeen explorations were carried out in 12 patients (age range, 16-39 years). Associated mandibular and other facial fractures were noted.

INTERVENTIONS

Endoscopic exploration via a transoral approach. A secondary port in the submandibular region was made in 13 of 17 fracture explorations, and this second port was used primarily for the application of downward traction on the angle of the mandible. Plates were introduced transorally, while screws were placed through a transbuccal trochar.

MAIN OUTCOME MEASURE

Success was judged by the successful reduction of the fracture and application of a rigid fixation plate by means of the limited, endoscopically assisted approach, a measure of the ability to accomplish the procedure, not an evaluation of functional results. (With these criteria, 9 of 10 successes had normal function at last follow-up, as did the 10th after revision.)

RESULTS

Rigid plate fixation was completed endoscopically for 10 fractures, and 2 were plated after conversion to a full open approach. Four were reduced but could not be plated, and in 1 exploration, a bent plate was removed, but a new plate was not applied. Nine of the 10 fractures plated endoscopically resulted in normal occlusion and function. In the 10th case, a persistent malocclusion necessitated reexploration and refixation, resulting in a successful functional outcome with normal occlusion.

CONCLUSION

The endoscopically assisted approach for the repair of subcondylar fractures of the mandible is a feasible but challenging technique.