Extraoral versus endoscopic-assisted transoral treatment modalities for mandibular condylar fractures: a current opinion

Introduction

The management of mandibular condylar process fractures is one of the most contentious subjects in the specialty of oral and maxillofacial surgery. From an epidemiological standpoint, condylar fractures account for 29%–40% of all facial fractures [1]. Perhaps the most debated topic is the decision to perform open versus closed treatment for condylar fractures. At present, with advances in technology and healthcare, there has been a clear paradigm shift from closed treatment to open treatment, which involves open reduction and rigid internal fixation. Now that is clear that open treatment is favored by most surgical teams, the second argument relates to choosing the approach of open treatment, and in particular whether to choose an extraoral approach or an intraoral/transoral approach. Although the literature has presented relevant indications for choosing an approach, the maxillofacial surgical community is becoming more inclined towards the intraoral approach using an endoscope. A possible explanation for this trend relates to the complications of open surgical treatment. Perhaps the most dreaded complication of the extraoral approach is the risk of damage to the facial nerve, as the facial nerve branches are directly encountered in this approach [2]. In contrast, using an intraoral approach, the facial nerve is not encountered during dissection, obviating that risk. Furthermore, the extraoral approach also leaves an unesthetic scar on the face, which can be unpleasant for patients [2] [3]. With the intraoral approach, the surgical incision is made transorally; hence, the problem of the surgical scar is handled. Although the intraoral approach seems to have quite favorable benefits, the surgical procedure with an endoscope is complicated and requires a steep learning curve.

Publication History

Received: 30 April 2021

Accepted: 30 August 2021

Article published online:
22 May 2022

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