Transoral open reduction with rigid internal fixation for subcondylar fractures of the mandible using a small angulated screwdriver system: is endoscopic assistance necessary?

PURPOSE: Although endoscopically assisted transoral open reduction and internal fixation of condylar mandible fractures is currently a popular technique, the need for it and its benefits remains unclear. This prospective study evaluated the efficacy and safety of open reduction and rigid internal fixation of subcondylar fractures of the mandible using a new small angulated screwdriver system without endoscopic assistance.

PATIENTS AND METHODS: Fifteen patients with 15 linear subcondylar fractures were treated using this intraoral approach from June 2007 through March 2010 at the Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, Kagawa, Japan. The anatomic reduction of the displaced condylar segments and rigid fixation with 2 2.0-mm locking miniplates were performed using a small angulated screwdriver system, with an average follow-up of 13 months (range, 6 to 30 months).

RESULTS: Correct anatomic reduction of the condylar segments at centric occlusion followed by immediate functional recovery was achieved in all patients. Mean operating time was 50 minutes (range, 35 to 70 minutes) when performed by the consultant surgeon and the residents. In addition, all patients had good temporomandibular joint articular function, with no harmful clinical symptoms or deviation.

CONCLUSIONS: The surgical treatment of linear subcondylar fractures of the mandible can be achieved with an intraoral approach alone, using a small angulated screwdriver system, without endoscopic assistance, offering reliable clinical results and safe and minimally invasive surgery.