Operative Controversies: Thoughts on an Intraoral Endoscopic Assisted Method of Condylar Fracture Repair

ABSTRACT

Fractures of the mandibular condyle are common injuries. Operative management remains controversial. Closed treatment rarely results in anatomic realignment of the displaced bone fragments. Open surgical repair can yield anatomic restoration of the mandible. Studies have shown many benefits to anatomic surgical repair; however, transcutaneous incisional surgical access to the condyle is associated with facial scarring and a significant risk of facial nerve injury. Recently, an intraoral endoscopic assisted method of reduction and internal fixation of mandibular condylar fractures has been described. This method can be applied to anatomically repair most displaced fractures of the adult condylar process with minimization of the risks and disadvantages customarily associated with traditional transcutaneous incisional techniques of surgical repair. Our diagnostic workup to define the anatomic displacement and feasibility of endoscopic assisted condylar repair is presented. An expanded role for open anatomic repair of condylar fractures using this method is proposed.

KEYWORDS

Condylar fracture - endoscopic plastic surgery - trauma

REFERENCES

• 1 Silvennoinen U, Raustia A M, Lindqvist C, Oikarinen K. Occlusal and temporomandibular joint disorders in patients with unilateral condylar fracture. A prospective one-year study.  Int J Oral Maxillofac Surg . 1998;  27 280-285
• 2 Hayward J R, Scott R F. Fractures of the mandibular condyle.  J Oral Maxillofacial Surg . 1993;  51 57-61
• 3 Thomson H G, Farmer A W, Lindsay W K. Condylar neck fractures of the mandible in children.  Plast Reconstr Surg . 1964;  4 452
• 4 Leake D, Doykos J, Habal M B, Murray J E. Long-term follow-up of fractures of the mandibular condyle in children.  Plast Reconstr Surg . 1971;  47 127
• 5 Lindahl L, Hollender L. Condylar fractures of the mandible. II. Radiographic study of remodelling processes in the temporomandibular joint.  Int J Oral Surg . 1977;  6 153-165
• 6 Hall M B. Condylar fractures: surgical management.  J Oral Maxillofac Surg . 1994;  52 1189-1192
• 7 Members of the Chalmers J Lyons Club. Fractures of the mandibular condyle: a post-treatment survey of 120 cases.  J Oral Surg . 1947;  5 45-73
• 8 Zide M F, Kent J N. Indications for open reduction of mandibular condyle fractures.  J Oral Maxillofac Surg . 1983;  41 89-98
• 9 Walker R V. Condylar fractures: nonsurgical management.  J Oral Maxillofac Surg . 1994;  52 1185-1188
• 10 Dahlstrom L, Kahnberg K E, Lindahl L. 15 year follow-up on condylar fractures.  Int J Oral Maxillofac Surg . 1989;  18 18-23
• 11 Ellis III E, Carlson D S. The effects of mandibular immobilization on the masticatory system. A review.  Clin Plast Surg . 1989;  16 133-146
• 12 Ellis III E, Palmieri C, Throckmorton G. Further displacement of condylar process fractures after closed treatment.  J Oral Maxillofac Surg . 1999;  57 1307-1316
• 13 Ellis III E, McFadden D, Simon P, Throckmorton G. Surgical complications with open treatment of mandibular condylar process fractures.  J Oral Maxillofac Surg . 2000;  58 950-958
• 14 Ellis III E, Throckmorton G S, Palmieri C. Open treatment of condylar process fractures: assessment of adequacy of repositioning and maintenance of stability.  J Oral Maxillofac Surg . 2000;  58 27-34
• 15 Konstantinovic V S, Dimitrijevic B. Surgical versus conservative treatment of unilateral condylar process fractures.  J Oral Maxillofac Surg . 1992;  50 349-352
• 16 Ellis III E, Dean J. Rigid fixation of mandibular condyle fractures.  Oral Surg Oral Med Oral Pathol . 1993;  76 6-15
• 17 Lee C H, Lee C, Trabulsy P P. Endoscopic-assisted repair of a malar fracture.  Ann Plast Surg . 1996;  37 178-183
• 18 Jacobovicz J, Lee C, Trabulsy P P. Endoscopic repair of mandibular subcondylar fractures.  Plast Reconstr Surg . 1998;  101 437-441
• 19 Lee C H, Lee C, Trabulsy P P, Alexander J T, Lee K. A cadaveric and clinical evaluation of endoscopically assisted zygomatic fracture repair.  Plast Reconstr Surg . 1998;  101 333-345
• 20 Lee C, Stiebel M, Young D M. Cranial nerve VII region of the traumatized facial skeleton: optimizing fracture repair with the endoscope.  J Trauma . 2000;  48 423-431
• 21 Lee C, Jacobovicz J, Mueller R V. Endoscopic repair of a complex midfacial fracture.  J Craniofac Surg . 1997;  8 170-175
• 22 Chen C T, Chen Y R. Endoscopically assisted repair of orbital floor fractures.  Plast Reconstr Surg . 2001;  108 2011-2018
• 23 Troulis M J, Kaban L B. Endoscopic approach to the ramus/ condyle unit: clinical applications.  J Oral Maxillofac Surg . 2001;  59 503-509
• 24 Woelfel J B, Scheid R C. Dental Anatomy: Its Relevance to Dentistry.  Baltimore, MD: Williams & Wilkins 1997: 24-26
• 25 Lindahl L. Condylar fractures of the mandible. I. Classification and relation to age, occlusion, and concomitant injuries of the teeth and teeth-supporting structures, and fractures of the mandibular body.  Int J Oral Surg . 1977;  6 12-21
• 26 Bos R R, Ward Booth R P, de Bont G L. Mandibular condyle fractures: a consensus.  Br J Oral Maxillofac Surg . 1999;  37 87-89
• 27 Ellis III E. Complications of mandibular condyle fractures.  Int J Oral Maxillofac Surg . 1998;  27 255-257
• 28 Newman L. A clinical evaluation of the long-term outcome of patients treated for bilateral fracture of the mandibular condyles.  Br J Oral Maxillofac Surg . 1998;  36 176-179
• 29 Throckmorton G S, Ellis E. Recovery of mandibular motion after closed and open treatment of unilateral mandibular condylar process fractures.  Int J Oral Maxillofac Surg . 2000;  29 421-427
• 30 Ellis III E, Throckmorton G. Facial symmetry after closed and open treatment of fractures of the mandibular condylar process.  J Oral Maxillofac Surg . 2000;  58 729-730
• 31 Mitchell D A. A multicentre audit of unilateral fractures of the mandibular condyle.  Br J Oral Maxillofac Surg . 1997;  35 230-236
• 32 Engevall S, Fischer K. Dislocation of the mandibular condyle into the middle cranial fossa: review of the literature and report of a case.  J Oral Maxillofac Surg . 1992;  50 524-527
• 33 Ellis III E, Simon P, Throckmorton G S. Occlusal results after open or closed treatment of fractures of the mandibular condylar process.  J Oral Maxillofac Surg . 2000;  58 260-268
• 34 Takenoshita Y, Ishibashi H, Oka M. Comparison of functional recovery after nonsurgical and surgical treatment of condylar fractures.  J Oral Maxillofac Surg . 1990;  48 1191-1195
• 35 Worsaae N, Thorn J J. Surgical versus nonsurgical treatment of unilateral dislocated low subcondylar fractures.  J Oral Maxillofac Surg . 1994;  52 353-360
• 36 Samchukov M L, Cope J B, Cherkashin A M. St. Louis, MO: Mosby 2001: xix
• 37 Sandler N A. Endoscopic-assisted reduction and fixation of a mandibular subcondylar fracture: report of a case.  J Oral Maxillofac Surg . 2001;  59 1479-1482
• 38 Lauer G, Schmelzeisen R. Endoscopic-assisted fixation of mandibular condylar process fractures.  J Oral Maxillofac Surg . 1999;  57 36-39