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

Conclusions

Analysing the evolution of thinking on therapeutic approaches proposed over the last few years, we began to consider condylar fractures a more and more delicate problem, and the therapeutic approach the preferable choice, since it seems to us to be the one which aims at obtaining a morphofunctional recovery leading to a situation which is the most similar to that before the trauma. In this vision, the targeted surgical approach is gathering consensus, but the originality of the method we have introduced lies above all in trying to avoid immobilising the complex temporalmandibular joint system, in making external cutaneous incisions to reduce to a minimum both scarring and lesions of certain branches of the facial nerve, plus the use of a rigid external fixation system (REF), already used extensively in the recovery of fractures in other areas of the body by our orthopaedic colleagues. Endoscopic assistance allows a good positioning control of the REF although the endoscopy permits an optimal control of the condyle-meniscal complex mobility after REF application. Endoscopy nowadays is commonly used in maxillofacial surgery, such as oncology, trauma.[16–21] The main indications for using our method are isolated mono- or bi-condylar extra-capsular dislocated fractures, or for other fractures of the mandible which require rigid internal containment, and which present notable functional limitation. In our opinion, the rigid external fixation system is better than an internal one, because it is less restrictive in precise anatomical reduction, since with an REF the condylar fragment is kept in the correct anatomical position but is not obliged to maintain that exact position, and therefore it is possible to carry out all the repair mechanisms listed above. This method can also be used for paediatric patients without producing anti-aesthetic scars or fibrosis from excessive deperiostation, and, furthermore, the rigid fixator is rapidly removed in the clinic without interfering with skeletal growth in infant patients. Aesthetical results must be considered in facial trauma management.[19] Reduction in adult patients must aim at precise anatomical recovery in order to avoid generating functional alterations of the complex temporal-mandibular joint system and thus cause a TMA. The application of Rigid External Fixation can be performed by intraoral approach under endoscopic control and offers good results. Although sometimes in panfacial fractures or in pre existing scars we have to perform pre auricular incision.

Ethics Statement

All patients granted written specific consent for all video, photographs and personal data to be used in every medical publications, journal, textbook and electronic publications. The study was conducted in accordance with the ethical principles provided by the Declaration of Helsinki and the principles of good clinical practice. Study design, inclusion and exclusion criteria and treatment protocol were reviewed and approved by a council of senior specialists at the Maxillofacial Surgery Department, Sant'Andrea Hospital of Rome, Italy.

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