Surgical Evolution in the Treatment of Mandibular Condyle Fractures

Evaristo Belli; Gianmauro Liberatore; Mici Elidon; Giovanni Dell'Aversana Orabona; Pasquale Piombino; Fabio Maglitto; Luciano Catalfamo; Giacomo De Riu

Disclosures

BMC Surg. 2015;15(16) 

In This Article

Background

In the International Literature, fractures of the mandible that involve the condyle ranges from 20% to 35%.[1] The condyle represents a structural weak point in the mandibular skeleton because of its shape and the slenderness of its neck, and sometimes its being fractured avoids more serious consequences such as fractures of the base of the skull which can traumatically interrupt propulsive strength.[2] The position of the fracture is related not only to the location and severity of the trauma but also to the position and action of the masticatory muscles as well as the presence of dental elements. Various surgical options are possible according to the varying pathological situations. Among cases of intracapsular fracture in which the most advisable treatment to date ranges from an approach to preserve the function to an almost compulsory surgical reduction in cases of bilateral condylar dislocation due to panfacial trauma, there are several possibilities and options which have inspired differing attitudes on the part of various authors, particularly as regards indications for "open" surgical therapy.

Up to the present, numerous techniques have been used for the surgical treatment of condylar fractures: from osteosynthesis using metal wire, to mini-systems with rigid internal fixing, or various types of pin inserted through cutaneous approaches – whether pre-auricular, sub-mandible, trans-parotid or the use of a system of rigid external fixing after an open reduction through preauricular access, introduced in Italy in 1990 by Cascone.[3] Later on, in 1999, was presented a surgical technique to reposition extra-capsular condylar fractures by an endoral approach under video-endoscopic control featuring a rigid inter-maxillary blockage. Belli in 2007 introduced the navigation system combined to endoscopy for condylar approaches.[4] In this work we are proposing a combination of these two surgical techniques, modifying them and thus obtaining two fundamental advantages with respect to the individual methods: an inter-maxillary blockage – so psychologically "bothersome" for the patient – is no longer necessary, and it becomes possible to avoid a pre-auricular cutaneous incision which can produce scarring, scarcely visible though it may be.

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