Condylar Fracture Repair: Use of the Endoscope to Advance Traditional Treatment Philosophy

Treatment of facial fractures has progressed significantly over the last 25 years largely because of the pioneer efforts of Paul Manson and Joseph Gruss. The systematic principles of wide exposure, visualized anatomic reduction, rigid internal fixation, and primary bone grafting of critical size defects—introduced by these surgeons— revolutionized the field of craniomaxillofacial surgery. The results achieved using their techniques far surpassed the outcomes of closed reduction and nonrigid fixation. Until recently, however, this standard of care was not applied to all areas of facial trauma; most notably omitted were the zygomatic arch and the mandibular condyle. Closed treatment of mandibular fractures with maxillomandibular fixation (MMF) has a long and successful history, but it is not without significant morbidity. The best results have been achieved in skeletally immature children, where condylar remodeling often can restore condylar anatomy to near normal, even in the face of little or no fracture reduction. Despite almost miraculous condylar remodeling in children, the outcomes in adults have not been uniform, and a significant percentage suffers long-term aesthetic and functional problems [1–5]. Few studies exist comparing similar fractures treated by open versus closed methods. Most show equal or better outcomes after open treat-