Clinical outcomes of endoscopic vs retromandibular approach for the treatment of condylar fractures—a randomized clinical trial

Abstract

Condylar fractures remain the most controversial topic in maxillofacial trauma. Open reduction and internal fixation (ORIF) with use of an extraoral approach has certain benefits over the nonsurgical treatment. Concerns, however, remain about the risk of facial nerve injury, postoperative facial nerve weakness, and facial scarring when operating in this region despite the various extraoral approaches that have been developed. The recently popularized endoscope-assisted open reduction and internal fixation (EAORIF) is claimed to provide better results because it is minimally invasive, provides excellent visibility, and eliminates surgical scarring and the risk of facial nerve injury. This study, therefore, aims to compare the retromandibular (extraoral) approach and EAORIF for the treatment of condylar fractures. A prospective analysis of 32 cases of condylar fractures that reported to the SDM Craniofacial Centre (Dharwad, India) was carried out. Sixteen patients had been treated with the retromandibular (RM) approach, and 16 had undergone EAORIF in the period from 2012-2017. Patients were evaluated for clinical parameters, such as fracture site, displacement, and surgical duration, as well as for functional parameters, such as occlusion, maximum interincisal opening, deviation of mouth on lateral movements, temporomandibular joint (TMJ) pain and clicking, and facial nerve weakness. Statistical significance was elicited with P < .05. The patients subjected to either approach had suffered fractures of the low condylar neck and the subcondyle. Maximum interincisal opening, mandibular deviation, occlusion, and TMJ function at postoperative month 6 were comparable between the groups. Although no permanent facial nerve injury was seen in this study, the incidence of transient facial nerve weakness was higher in the RM group (56.25%) compared with the EAORIF group (6.25%) (P = .036). The surgical time was longer in the EAORIF group (RM: 107+/- 19.7 minutes and EAORIF: 155 +/- 18.2 minutes) (P = .04). The rest of the parameters were comparable between both groups. Although there is consensus on closed reduction in pediatric and adult condylar head fractures, the role of a surgical approach to treatment of displaced condylar neck and subcondylar fractures remains controversial. In our study, both surgical approaches were found to be suitable for the treatment of these fractures.