Available online 13 May 2024
Author links open overlay panel, , SummaryPurposeThis study aimed to assess the reliability and safety of transoral endoscopic-assisted reduction internal fixation (TERIF) for treating short-segment condylar neck fractures (CNF), including hardware removal.
Materials and MethodsPatients with displaced CNF and short condylar segments treated using TERIF were included in the study. Clinical evaluation covered dental occlusion, range of mouth opening, deviation during mouth opening, protrusion, laterotrusion, pain, and chewing. Radiological evaluation was used to assess fracture displacement, angulation, head dislocation, postoperative reduction, fixation stability, and bone healing. The same technique was used to treat 15 patients with 18 CNF and short condylar segments. Hardware removal was performed for nine fractures in eight patients after fracture healing using the same approach.
ResultsAll patients regained satisfactory, pain-free mouth opening with no deviation and complete bone healing. Computed tomographic images displayed adequate reduction and stable fixation during the follow-up period for all patients. No temporary or permanent facial nerve impairment occurred in any of the patients.
ConclusionTERIF is a reliable and safe treatment for CNF with short condylar segments, even in the presence of head dislocation, medial override, and malunited fractures; hardware can be safely removed after healing using the same approach.
Section snippetsINTRODUCTIONThe management of fractures involving the mandibular condyle is a subject of significant debate within the field of maxillofacial trauma. Condylar fractures constitute 25% to 40% of all mandibular fractures (Vanpoecke et al., 2020). These fractures are typically treated using three treatment approaches: these include mandibular physical therapy with range-of-motion exercises and no maxillomandibular fixation; a period of maxillomandibular fixation followed by mandibular physical therapy; and
Study designThis study was designed as a retrospective case series that drew its study sample from the patient population treated for condylar neck fractures with short condylar segments using transoral endoscopic-assisted reduction and fixation at our clinic between 2018 and 2022. Ethical approval for this study was waived by the local institution where it was conducted, and the guidelines outlined in the World Medical Association Declaration of Helsinki were adhered to throughout the study. The study
RESULTSThe study comprised 15 patients (11 male, 4 female) with ages ranging from 18 to 43 years, who were admitted from December 2018 to September 2022. Among these patients, five presented with left-sided condylar fractures, seven had right-sided condylar fractures, and three exhibited bilateral fractures. The majority of patients were admitted within the first week following the injury, while one patient presented 6 weeks after the trauma, and another patient was admitted 3 months after the trauma.
DISCUSSIONThe purpose of the present study was to evaluate the outcomes of transoral endoscopically assisted reduction and fixation of high condylar neck fractures, as well as hardware removal using the same approach in adult patients. The findings suggest that this approach is safe and effective in achieving anatomical and functional restoration, with a low risk of complications. Furthermore, the successful hardware removal procedure demonstrates the feasibility of this approach in the long-term
CONCLUSIONIn conclusion, the use of endoscopically assisted reduction and internal fixation was proved to be a beneficial treatment option for severely displaced condylar neck fractures. This technique allows for clear visualization of the fracture site, facilitating precise anatomical reduction and fixation through a secure incision, resulting in satisfactory cosmetic outcomes. It can be used safely to remove the hardware, avoiding the complications of hardware proximity to the articular surface.
Uncited referenceHaug and Brandt, 2007.
Declaration of Competing InterestNone
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