Retromandibular Approach versus an Endoscope-assisted Transoral Approach to Treat Subcondylar Fractures of the Mandible

Abstract Retromandibular Approach versus an Endoscope-assisted Transoral Approach to Treat Subcondylar Fractures of the Mandible Dong-Woo Kim, Dae-Song Park, Sang-Chil Lee, Sung-Yong Kim, Ho-Yong Lim, Hak-Yeol Yeom, Hyeon-Min Kim Department of Oral and Maxillofacial Surgery, Gachon University Gil HospitalPurpose: Patients who had a subcondylar fracture with a displaced or de viated condylar segment were treated with a retro-mandibular approach (RMA) or an endoscope-assisted transoral ap proach (EATA) in our department of oral and maxillofacial surgery. The clinical results of the approaches were compared. A comparative study of specific approaches for subcondylar fractures has not been published before in Korea.Methods: Twenty-one patients with subcondylar fractures of the mandible were included. Ten patients were treated with the retromandibular approach and 11 were treated with an endosc ope-assisted transoral approach. We examined patient age, gender, fracture sites, classifications, period of maxillomandi bular fixation, facial nerve (FN) or greater auricular nerve (G AN) injuries, maximal mouth opening, deflection, occlusal changes, number of plates, follow-up period, and other complications. Preoperative computed tomography and pre-operative, post-operat ive, and follow-up panoramic views were taken of each patient.Results: Mean maximal mouth openings were similar between the two appro aches. FN and GAN injuries were more frequent in the RMA group but the deflective rate with mouth opening was higher in the EATA than that in RMA group. Two cases of post-operative infection occurred in the EATA group, and occ lusal changes were observed in one case for both approaches.Conclusion: The RMA offers more direct access and visualization of the sur gical field but it can cause scars and retractive injuries of the FN and GAN. But, EATA did not result in consequ ent nerve injuries or scars postoperatively, but unfavorable fractures such as medial override condyles were more difficult to reduce endoscopically. Except cases of an expected difficult reduction, the treatment of choice for a displaced subcondylar fracture may be an EATA.Key words:Subcondylar fractures, Retromandibular, Endoscope, Transoral, O pen reduction internal fixation