Technical Refinements and new instruments for the transoral endoscopic assisted open treatment of condylar fractures

Aims: Refinements of the transoral endoscopic assisted open reduction and miniplate fixation of condylar mandible fractures using new instruments is demonstrated. Subject: The transoral endoscopic assisted treatment in 12 consecutive patients with condylar fractures was performed at the University Hospital Freiburg. From February 2000 to January 2002 new instruments (Synthes USA) for the endoscopic reduction and fixation of condylar fractures were used by limited transoral incisions. In eight out of the12 patients no intermaxillary fixation (IMF) was performed after a stable anatomic reduction was demonstrated endoscopically at the posterior border of the ascending ramus. In four patients IMF was performed for five days postoperatively due to bone loss at the fracture side or reduced dentition. Results: The mean operating time without IMF was 1 h 50 min. Anatomic reduction and uneventful healing with early recovery of the patients were noted clinically and by postoperative radiographs. There were no signs of malocclusion in the group of eight patients without IMF. Good postoperative function with mouth opening without deviation and limitation on lateral extrusion was evaluated after 4 weeks. Conclusions: The endoscopic assisted transoral approach proved to be a reliable surgical method for the open treatment of condylar fractures. Special instruments for the fracture reduction and angulated drills and screw driver facilitated the management of the condylar fractures. Keywords: condylar fractures, endoscopic approach, instruments for reduction, minimal invasive surgery