Applications of the endoscope in facial fracture management

The aesthetic necessity to preserve an undisturbed facial appearance and function has led to the progressive adoption of less-conspicuous incisions and decreasingly aggressive exposure in the treatment of facial injuries. The goals of proper anatomic reduction and stable fixation, however, must not be omitted. The introduction of endoscopic techniques has allowed a harmonious union of these two seemingly competing objectives. In condylar injuries, the endoscope may be used to restore preinjury condylar height and angulation, avoiding the feared risks of facial nerve injury and visible scarring. Treatment of complex zygoma and LeFort III fracture cases may be facilitated by repairing the zygomatic arch through remote stab incisions, obviating the need for an extensive coronal exposure. Endoscopically assisted treatment and diagnosis of orbital floor fractures decreases the risks of lower eyelid malpositioning without predisposing to the development of enophthalmos or hypoophthalmos. Similarly, depressed frontal sinus injuries may be reduced or camouflaged via hidden incisions, significantly reducing stigmata of surgical entry. In the overview to follow, the application of endoscope-assisted techniques to the treatment of the above fractures will be presented. The rationale for use, specific operative indications, bailout strategies, and outcome studies will be discussed.