Minimally invasive fracture treatment with cannulated lag screws in intracapsular fractures of the condyle

Purpose: We examined the use of cannulated lag screw osteosynthesis for the treatment of fractures of the mandibular condylar head in providing a high-quality durable fixation, while,it the same time reducing the trauma necessary for an open approach to the fracture site. Patients and Methods: A preauricular approach was used for exposure, reduction, and osteosynthesis in 5 cases of type B condylar fractures. A cannulated screw system was used that allowed optimum placement of the self-cutting cannulated lag screw following insertion of a guiding wire and using clinical control to ensure its correct position. The joints were submitted to functional exercises immediately following surgery and postoperative radiologic, axiographic, and clinical follow-ups were performed. Results: Radiologic follow-up revealed correct reduction and fixation in all 5 cases. Axiographic and clinical follow-up showed an initial limitation, but normal mobility of the condyles was achieved within 3 months postoperatively, with a maximum mouth opening of 41.2 +/- 9.4 mm after 6 months. There were no occlusal disturbances, no trismus, no lateral deviations of the mandible, and no nerve lesions. Intraoperatively, the method applied shortened the time necessary for and simplified the procedure of reduction and osteosynthesis. Conclusion: By using a cannulated lag screw, it was shown that the major factor in the extent of the trauma relating to surgical access was the reduction of the fracture fragments. The method ensured stable fixation of the fracture with a minimum Of osteosynthesis material, while reducing the operative time. In combination with intraoperative imaging techniques it can also successfully be applied to other fractures in maxillofacial surgery. (C) 2006 American Association of Oral and Maxillofacial Surgeons.