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Endoscope-Assisted Transoral Fixation of Mandibular Condyle Fractures: Submandibular Versus Transoral Endoscopic
Na-Hyun Hwang1, Yoon-Hwan Lee, Hi-Jin You
1Department of Plastic and Reconstructive Surgery, Korea University Medical Center, Ansan-si, Korea.
The Journal of Craniofacial Surgery
|July 6, 2016
Summary
The submandibular endoscopic intraoral approach (SEI) offers improved visualization and instrument maneuverability for condylar fracture treatment compared to the standard transoral endoscopic (TE) method. This technique facilitates easier screw fixation, with comparable surgical times and outcomes.
Area of Science:
- Oral and Maxillofacial Surgery
- Minimally Invasive Surgical Techniques
- Endoscopic Procedures
Background:
- Endoscope-assisted transoral approach for condylar fracture treatment is gaining attention but presents technical challenges.
- The standard transoral endoscopic (TE) approach involves instrument crowding, hindering endoscope maneuverability.
- A novel submandibular endoscopic intraoral (SEI) approach is proposed to overcome these limitations.
Purpose of the Study:
- To evaluate the advantages of the submandibular endoscopic intraoral (SEI) approach for treating condylar fractures.
- To compare the SEI approach with the standard transoral endoscopic (TE) approach regarding visualization, instrument use, and surgical outcomes.
Main Methods:
- A comparative study involving 15 patients treated with the SEI approach and 15 patients treated with the standard TE approach for condyle neck and subcondyle fractures.
- The SEI approach utilizes a small submandibular stab incision for the endoscope and traction wires, alongside an intraoral incision for fixation.
- Surgical time, visualization quality, instrument requirements, complications, and surgical outcomes were assessed.
Main Results:
- The SEI approach provided clearer visualization of the posterior ramus and condyle, with a visual axis parallel to the condyle-ramus unit.
- Surgical times were comparable between the SEI (128 minutes) and TE (120 minutes) groups (P > 0.05).
- The SEI group required fewer trocar systems (2/15) compared to the TE group (15/15), with 13/15 patients in the SEI group using an angulated screwdriver (P < 0.05).
Conclusions:
- The submandibular endoscopic approach offers enhanced visualization and greater surgical space.
- It facilitates the use of instruments like the angulated screwdriver, potentially simplifying fixation.
- The SEI approach demonstrates comparable surgical outcomes and complication rates to the standard TE approach, with potential advantages in instrument handling.
