Five-year experience with the transoral endoscopically assisted treatment of displaced condylar mandible fractures

Background: From April of 1998 to May of 2003, the minimally invasive transoral approach for encloscopically assisted reduction and osteosynthesis of 62 displaced condylar mandible fractures was performed in 58 patients. Methods: By means of limited transoral incision, die endoscopically assisted reduction and fixation of condylar fractures was performed using 30- and 45-degree angled endoscopes. Twenty-five fractures were condylar and 37 were subcondylar. The condylar neck of the proximal fragment was displaced medially in 17 fractures and laterally in 45 fractures. Four patients presented bilateral condylar mandible fractures. Using angled endoscopes, good visibility of the fracture site was obtained, which allowed for precise anatomical reduction in all patients. An angulated drill and screwdriver facilitated miniplate fixation by means of the transoral approach. The mean operating time was measured in the last 30 consecutive cases: I hour 5 minutes. Results: Postoperatively, all patients showed quick recovery to preinjury occlusion. Normal temporomandibular joint function was noted 6 months after surgery in all patients. Conclusions: The transoral endoscopically assisted treatment using an angulated drill and screwdriver is the method of choice for surgical management of displaced condylar fractures, even in fractures with medial override. Facial nerve injury mid visible scars are avoided by using the transoral approach.