Patient benefit from endoscopically assisted fixation of condylar neck fractures--a randomized controlled trial.
OBJECTIVE
Owing to the risk of facial nerve damage and the creation of visible scars, surgical treatment of condylar mandible fractures using an extraoral approach remains controversial. The transoral endoscopically assisted approach of condylar fractures has been reported to avoid these complications. A prospective, randomized controlled, multicenter trial was performed to quantify the patient benefit after open reduction and internal fixation of condylar mandible fractures using endoscopically assisted treatment compared with surgical treatment without endoscopic assistance.


METHODS
Patients with dislocated uni-/bilateral condylar neck fractures were randomized to receive either nonendoscopic open reduction and internal fixation using an extraoral (submandibular, preauricular, retromandibular) approach or a transoral endoscopic procedure. The primary functional outcome measure was investigated using the asymmetric Helkimo dysfunction score at 8 to 12 weeks and 1 year after surgery.


RESULTS
A total of 74 patients were recruited between 2003 and 2006; the nonendoscopic extraoral group included 34 patients and the endoscopically assisted open reduction group included 40 patients. Comparable functional results were noted in both groups without any statistical significance. Endoscope-assisted treatment proved to be more time consuming. For the extraoral group, visible scars were rated by most of these patients as being cosmetically acceptable; however, a greater number of facial nerve injuries were reported.


CONCLUSIONS
The treatment of condylar mandible fractures with a minimal invasive endoscopically assisted technique is reliable and may offer advantages for selected cases, particularly concerning the lower occurrence of facial nerve damage.
Schmelzeisen
Rainer
R
Universitätsklinik für Mund-, Kiefer-, Gesichtschirurgie, Klinik für Mund-, Kiefer-, Gesichtschirurgie, Freiburg, Germany. rainer.schmelzeisen@uniklinik-freiburg.de
Cienfuegos-Monroy
Ricardo
R
Schön
Ralf
R
Chen
Chien-Tzung
CT
Cunningham
Larry
L
Goldhahn
Sabine
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D008335:Mandibular Condyle / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D008337:Mandibular Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D019647:Oral Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D011446:Prospective Studies; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D018709:Statistics, Nonparametric; D013704:Temporomandibular Joint / Q000293:injuries / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult