Abstract
Introduction: Application of endoscopes in otolaryngology continues to expand, and recently being used in the field of maxillofacial trauma including orbital trauma, frontal sinus, arch, angle and subcondylar fractures have previously been described in literature. The purpose of this study was to assess the efficacy of endoscopic approach in medially displaced condylar fractures.
Methods and Findings: A prospective case study was done on 17 patients, study followed the Declaration of Helsinki on medical protocol and ethics and was approved by the regional Ethical Review Board of our hospital after all participants signed an informed consent agreement. 4 mm 30 degree endoscope (karl storz) was used to locate medially displaced condyle with transosseous wiring at angle region (in 2cases). statistical analysis by student t test,50% reduction in operating time was noted. Mean Maximal mouth opening (MMO) was noted on post op 7th day and on last follow up.
Result: Post op 7th day Mean MMO = 31.18 mm with Standard Deviation (SD) = 5.76 & coefficient of variation = 0.18 and on last follow up Mean MMO = 41 mm with SD = 1.67 and coefficient of variation = .04 The mandibular movements like protrusion, retrusion and lateral excursion were satisfactory. 4 patients turned with wound dehiscence, temporary facial nerve palsy and soft tissue abscess which were managed by antibiotics and incisional drainage.
Conclusion: Based on our experience, endoscopes use is challenging, but worthwhile. It can be concluded that combination technique with endoscope gives significant results with reduced operating time, MMO and minimal/no complications.
Keywords: Condyle, Endoscope, Medially Displaced, Extracorporeal, Facial, Fractures.
References
- Abdel-Galil K, LoukotaR. Fractures ofthe mandibular condyle: evidence base and current concepts of management. Br J Oral Maxillofac Surg 2010;48:520–6.
- Park JM, Jang YW, Kim SG, Park YW, Rotaru H, Baciut G, Hurrubeanu. Comparative study of the prognosis of an extracorporeal reduction and a closed treatment in mandibular condyle head and/or neck fractures. J Oral Maxillofac Surg 2010;68: 2986–93.
- Danda AK, Muthusekhar MR, Narayan V, Baig MF, Siddareddi A. Open versus closed treatment of unilateralsubcondylar and condylar neck fractures: a prospective, randomized clinical study. J Oral Maxillofac Surg 2010;68:1238–41.
- Schneider M, Erasmus F, Gerlach KL, Kuhlisch E, Loukota RA, Rasse M, SchubertJ, Terheyden H, Uwe E. Open reduction and internal fixation versus closed treatment and mandibulomaxillary fixation of fractures of the mandibular condylar process: a randomized, prospective, multicenter study with special evaluation of fracture level. J Oral Maxillofac Surg 2008;66:2537–44.
- Alkan A, Metin M, Muglali M, Ozden B, Celebi N. Biomechanical comparison of plating techniques for fractures of the mandibular condyle. Br J Oral Maxillofac Surg 2007;45:145–9.
- Choi BH, Kim KN, Kim HJ, Kim MK. Evaluation of condylar neck fracture plating techniques. J Craniomaxillofac Surg 1999;27: 109–12.
- Pilling E, Eckelt U, Loukota R, Schneider K, Stadlinger B. Comparative evaluation of ten different condylar base fracture osteosynthesis techniques. Br J Oral Maxillofac Surg 2010;48:527–31.
- Haug RH, Peterson GP, Goltz M. A biomechanical evaluation of mandibular condyle fracture plating techniques. J Oral Maxillofac Surg 2002;60:73–80.
- Hyde N, Manisali M, Aghabeigi, et al. The role of open reduction and internal fixation in unilateral fractures of the mandibular condyle : a prospective study. British Journal of Oral & Maxillofacial Surgery 2002;40: 19-22.
- Vikas KS, Ruchika et al. Endoscopic assisted approach to facial fractures. University J Dent Scie 2020; Vol. 6, Issue 1
- Martin M, Lee C. Endoscopic mandibular condyle fracture repair. Atlas Oral Maxillofac Surg Clin North Am. 2003;11(02):169–178.
- You H J, Moon K C, Yoon E S, Lee B I, Park S H. Clinical and radiological outcomes of transoral endoscope-assisted treatment of mandibular condylar fractures. Int J Oral Maxillofac Surg. 2016;45(03):284–291.
- Mueller R V, Czerwinski M, Lee C, Kellman R M. Condylar fracture repair: use of the endoscope to advance traditional treatment philosophy. Facial Plast Surg Clin North Am. 2006;14(01):1–9.
- Colletti G, Battista V M, Allevi F, Giovanditto F, Rabbiosi D, Biglioli F. Extraoral approach to mandibular condylar fractures: our experience with 100 cases. J Craniomaxillofac Surg. 2014;42(05):e186–e194.
- Boehle A P, Herrmann E, Ghanaati S, Ballon A, Landes C A. Transoral vs. extraoral approach in the treatment of condylar neck fractures. J Craniomaxillofac Surg. 2015;43(02):224–231.
- Ellis E, III, McFadden D, Simon P, Throckmorton G. Surgical complications with open treatment of mandibular condylar process fractures. J Oral Maxillofac Surg. 2000;58(09):950–958.
- Troulis M J, Kaban L B. Endoscopic approach to the ramus/condyle unit: clinical applications. J Oral Maxillofac Surg. 2001;59(05):503–509.
- Miloro M. Endoscopic-assisted repair of subcondylar fractures. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;96(04):387–391.
- Aboelatta Y A, Elbarbary A S, Abdelazeem S, Massoud K S, Safe I I. Minimizing the submandibular incision in endoscopic subcondylar fracture repair. Craniomaxillofac Trauma Reconstr. 2015; 8(04):315–320.
- Schön R, Gutwald R, Schramm A, Gellrich N C, Schmelzeisen R. Endoscopy-assisted open treatment of condylar fractures of the mandible: extraoral vs intraoral approach. Int J Oral Maxillofac Surg. 2002;31(03):237–243.
Corresponding Author
Dr Gaurang Thanvi
Department of Oral and Maxillofacial Surgery, Mahatma Gandhi Dental College and Hospital, RIICO Industrial area, Sitapura, Jaipur, Rajasthan
DOI: https://dx.doi.org/10.18535/jmscr/v10i4.21
