Clinical Outcomes of Endoscopic vs. Retromandibular Approach for the Treatment of Condylar Fractures - A Randomized clinical trial

ABSTRACT Purpose Condylar fractures remain the most controversial topic in maxillofacial trauma. Open reduction and internal fixation (ORIF) using an extra-oral approach has certain benefits over the nonsurgical treatment. Concerns, however, remain about the risk of facial nerve injury, post operative facial nerve weakness and facial scarring when operating in this region, despite the various extra-oral approaches developed for the same. The recently popularized Endoscope assisted open reduction and internal fixation (EAORIF) is claimed to provide better results as it is minimally invasive, provides excellent visibility, eliminates surgical scarring and the risk of facial nerve injury. This study, therefore, aims to compare the Retromandibular (extra-oral) approach and EAORIF for the treatment of condylar fractures. Method A Prospective analysis of 32 Cases of Condylar fractures that reported to SDM Craniofacial Centre, Dharwad, India, was carried out. 16 patients were treated by the Retromandibular (RM) approach and 16 patients underwent EAORIF in the time period of 2012 to 2017. Patients were evaluated for clinical parameters like fracture site, displacement, surgical duration and functional parameters like 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 Results The patients subjected to either approach included fractures of low condylar neck and subcondyle. Maximum interincisal opening, mandibular deviation, occlusion, and TMJ function at 6 months post operative period were comparable between the groups. Although no permanent facial nerve injury was seen in this study, incidence of transient facial nerve weakness was higher in the RM group (56.25%) as compared to the EAORIF group (6.25%)(p=0.036) .The surgical time was longer in EAORIF group (RM- 107+/- 19.7 min & EAORIF- 155 +/- 18.2 min) (p=0.04). The rest of the parameters were comparable in both groups. Conclusion Although there is consensus on closed reduction in paediatric condylar and adult condylar head fractures, the role of surgical approach to displaced condylar neck and subcondylar fractures remains controversial. In our study, both the surgical approaches were found to be suitable for treatment of these fractures.