Endoscopic-assisted approach in the treatment of subcondylar fractures: our experience.

Abstract

Introduction: The management of subcondylar fractures has been very controversial in the maxillofacial literature. The open reduction and internal fixation (ORIF) technique has been considered by many authors the gold standard in selected cases. However, with the rise in endoscopic techniques in the craniomaxillofacial area, new boundaries and less invasive techniques are being explored. The endoscopic approach of subcondylar fractures has proved overall good and similar results to open approaches whilst reducing complications such as facial nerve injury. In this article we purpose to describe our experience with the endoscopic approach to subcondylar fractures. Patients and methods: We retrospectively analyzed 11 patients with subcondylar fractures treated at our department via an endoscopic approach. The number and type of plates used in each patient is recorded. Results and complications observed for all patients are described as well as functional outcomes in terms of mouth opening at 1 week, 3 months and 6 months postoperatively. Results: One patient presented with transient damage to the marginal and frontal branches of the facial nerve. 18.2 % of patients had their hardware removed due to pain or infection at the fracture site. No cases of salivary fistula or sialocele were found in this study. Mean mouth opening at one week postoperatively was 31.8 mm which increased to 37.8 mm at 6 months after surgery, meaning an increase of 18.86 % through the follow-up. Also, 18.2 % of patients presented with persistent deviation with mouth opening and one patient presented with postoperative persistent malocclusion that was treated with intermaxillary fixation and elastics. Conclusion: The endoscopic management of subcondylar fractures is a safe alternative to the open approach, specially in favorable cases, which reduces the risk of complications associa ted to open approaches, such as unfavorable scarring, salivary gland complications and facial nerve damage. In our series only one patient presented with transient damage to the facial nerve. 18.2 % of the plates were removed, which is a high percentage and should be evaluated, although the small size of the series should be taken into account. Maxillofacial surgeons should be encouraged to learn and trained in endoscopic techniques and include the endoscopic assisted approach in their surgical armamentarium.