The Endoscopic Repair of Mandibular Subcondylar Fracture through Intraoral Approach

Kim, Hyung Soo; Kim, Sung Soo; Shin, Young Jin

Abstract

The Endoscopic Repair of Mandibular Subcondylar Fracture through Intraoral Approach. The treatment of the mandibular subcondylar fractures has been controversal. But, recently open reduction and rigid internal fixation was advocated as a reliable method of anatomically restoring condylar position, early restoration of T-M joint function without intermaxillary fixation or with short intermaxillary fixation period. The endoscopic repair of mandibular subcondylar fractures not only provides better visualization in the surgical field, but also makes rigid fixation, avoids facial scarring and facial nerve injury. From March of 1996 to November of 2001, the endoscope was used successfully to assist in the repair of mandibular subcondylar fractures in twelve patients. An intraoral incision was made in the anterior aspect of the mandibular ramus, and a 5.0mm, 30-degree telescope was introduced by means of this intraoral incision to aid in the dissection and to visualize the fracture site over the subcondylar area. After subcondylar reduction by lateral force of the preauricular trocar and inferior traction of the mandibular angle, a 2mm miniplate was used to stabilize the fracture site with the help of a percutaneous trocar. The proper alignment of the posterior border of the ramus could also be checked under direct endoscopic vision. Intermaxillary fixation was maintained for 5 days postoperatively in the first four patients. All the patients were followed up for minimum of 2 months, and there were no facial palsy. The mean of maximal mouth opening was 44 mm within 6 weeks and the stab incision wound in the preauricular and angle area were inconspicuous. All patients obtained normal range of motion of temporomandibular joint. Although requirement of endoscopic equipments and surgical skills is necessary, the use of endoscope may reduce the disadvantages of open reduction and should be considered in the treatment of mandibular subcondylar fractures.