Outcome of surgically treated fractures of the condylar process by an endoscopic assisted transoral approach

Publication date: Available online 24 August 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Blumer Michael, Guggenbühl Tobias, Wagner Maximilian, Rostetter Claudio, Rücker Martin, Gander Thomas

Abstract

Aim of the study: Fractures of the condylar process are frequent. Ideal management of these fractures, as discussed in literature, is controversial. Some recent meta-analyses favour open reduction and internal fixation using various approaches. A strict transoral approach is described to minimise scarring and the risk of facial nerve injury but has restricted visibility.

This retrospective study analyses outcomes of patients with unilateral mandibular condyle fractures who have been treated by an open reduction and internal fixation through an endoscopic assisted transoral approach.

Materials and Methods

This study included 40 patients who were operated on between January 2015 and December 2016. All patients were operated for a condylar process fracture using an endoscopic assisted transoral approach. Fracture classification, demographic, and outcome data were collected.

Results

Most condylar process fractures were caused by falls of under 3 m. The majority were condylar base fractures and classified after Spiessl and Schroll as classes I and II. Sixteen patients showed a preoperative malocclusion, whereas in just 2 cases a slight postoperative malocclusion was found. In cases where only 1 plate could be placed, the proximal fragment was shorter. With higher Spiessl and Schroll classification, a tendency towards longer operation times was noted. Postoperative outcomes revealed 1 temporary facial palsy as the worst complication (2.5 %), 2 cases with a minimal occlusional interference (5 %) and a deviation in mouth opening in 1 case (2.5 %). The ramus height was restored in all cases. No chronic pain could be found in any of the cases.

Discussion

It is feasible to treat condylar process fractures in a safe manner by a transoral approach with endoscopic assistance and angled instruments without facial scarring and at a low complication rate. The endoscope improves the reduced visibility of the transoral approach, although a learning curve is necessary. This applies especially to dislocated fractures or to fractures with a short proximal fragment.

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