title: Transoral open reduction with rigid internal fixation for subcondylar fractures of the mandible using a small angulated screwdriver system: is endoscopic assistance necessary?
abstract: OBJECTIVE
  Although endoscopically assisted transoral open reduction and internal fixation of condylar mandible fractures is currently a popular technique, the need for it and its benefits remains unclear. This prospective study evaluated the efficacy and safety of open reduction and rigid internal fixation of subcondylar fractures of the mandible using a new small angulated screwdriver system without endoscopic assistance.
  
  
  METHODS
  Fifteen patients with 15 linear subcondylar fractures were treated using this intraoral approach from June 2007 through March 2010 at the Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, Kagawa, Japan. The anatomic reduction of the displaced condylar segments and rigid fixation with 2 2.0-mm locking miniplates were performed using a small angulated screwdriver system, with an average follow-up of 13 months (range, 6 to 30 months).
  
  
  RESULTS
  Correct anatomic reduction of the condylar segments at centric occlusion followed by immediate functional recovery was achieved in all patients. Mean operating time was 50 minutes (range, 35 to 70 minutes) when performed by the consultant surgeon and the residents. In addition, all patients had good temporomandibular joint articular function, with no harmful clinical symptoms or deviation.
  
  
  CONCLUSIONS
  The surgical treatment of linear subcondylar fractures of the mandible can be achieved with an intraoral approach alone, using a small angulated screwdriver system, without endoscopic assistance, offering reliable clinical results and safe and minimally invasive surgery.
authors.affiliation: Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa, Japan. t-kanno@chp-kagawa.jp
authors.forename: Takahiro
authors.initials: T
authors.lastname: Kanno
authors.forename: Shintaro
authors.initials: S
authors.lastname: Sukegawa
authors.forename: Masako
authors.initials: M
authors.lastname: Fujioka
authors.forename: Kazumichi
authors.initials: K
authors.lastname: Takabatake
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Furuki
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D003768:Dental Occlusion, Centric; D004724:Endoscopy / Q000379:methods*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D008297:Male; D008335:Mandibular Condyle / Q000293:injuries* / Q000601:surgery; D008337:Mandibular Fractures / Q000145:classification / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D011862:Radiography, Panoramic; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function / Q000502:physiology; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D058106:Wound Closure Techniques; D055815:Young Adult