April 2020 HSC Section 4 - Plastic and Reconstructive Problems

Strohl & Kellman

are in comparison with the 12% to 48% risk of facial nerve injury in an open approach. 15 Scarring is also minimized by only using stab incisions on the external skin, which generally heal well.

fixation versus closed treatment of mandibular condylar process fractures–a prospective double- center study. J Oral Maxillofac Surg 2012;70(2): 384–95 . 7. Dahlstrom L, Kahnberg KE, Lindahl L. 15 years follow-up on condylar fractures. Int J Oral Maxillofac Surg 1989;18(1):18–23 . 8. Brandt MT, Haug RH. Open versus closed reduction of adult mandibular condyle fractures: a review of the literature regarding the evolution of current thoughts on management. J Oral Maxillofac Surg 2003;61(11):1324–32 . 9. Scho¨n R, Gutwald R, Schramm A, et al. Endoscopy- assisted open treatment of condylar fractures of the mandible: extraoral vs intraoral approach. Int J Oral Maxillofac Surg 2002;31(3):237–43 . 10. You HJ, Moon KC, Yoon ES, et al. Clinical and radio- logical outcomes of transoral endoscope-assisted treatment of mandibular condylar fractures. Int J Oral Maxillofac Surg 2016;45(3):284–91 . 11. Kellman RM. Endoscopically assisted repair of sub- condylar fractures of the mandible: an evolving technique. Arch Facial Plast Surg 2003;5(3):244–50 . 12. Kang SH, Choi EJ, Kim HW, et al. Complications in endoscopic-assisted open reduction and internal fixation of mandibular condyle fractures. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 113(2):201–6 . 13. Gonzalez-Garcia R, Sanroman JF, Goizueta- Adame C, et al. Transoral endoscopic-assisted man- agement of subcondylar fractures in 17 patients: an alternative to open reduction with rigid internal fixa- tion and closed reduction with maxillomandibular fix- ation. Int J Oral Maxillofac Surg 2009;38(1):19–25 . 14. Lee C, Stiebel M, Young DM. Cranial nerve VII re- gion of the traumatized facial skeleton: optimizing fracture repair with the endoscope. J Trauma 2000; 48(3):423–31 [discussion: 431–2] . 15. Shi D, Patil PM, Gupta R. Facial nerve injuries asso- ciated with the retromandibular transparotid approach for reduction and fixation of mandibular condyle fractures. J Craniomaxillofac Surg 2015; 43(3):402–7 .

SUMMARY

In the past, the treatment of subcondylar fractures was heavily biased toward closed management. This bias was likely due to the technical difficulty of open repairs with high risks of complications, including facial nerve injury. Recent literature sug- gests that open repair achieves better functional outcomes overall. The advent of endoscopic repair has provided a mechanism to perform open reduction while minimizing surgical risk. Overall, this will lead to better outcomes for patients. 1. Zide MF, Kent JN. Indications for open reduction of mandibular condyle fractures. J Oral Maxillofac Surg 1983;41(2):89–98 . 2. Schneider M, Erasmus F, Gerlach KL, et al. Open reduction and internal fixation versus closed treat- ment and mandibulomaxillary fixation of fractures of the mandibular condylar process: a randomized, prospective, multicenter study with special evalua- tion of fracture level. J Oral Maxillofac Surg 2008; 66(12):2537–44 . 3. Eckelt U, Schneider M, Erasmus F, et al. Open versus closed treatment of fractures of the mandib- ular condylar process-a prospective randomized multi-centre study. J Craniomaxillofac Surg 2006; 34(5):306–14 . 4. Zrounba H, Lutz JC, Zink S, et al. Epidemiology and treatment outcome of surgically treated mandibular condyle fractures. A five years retrospective study. J Craniomaxillofac Surg 2014;42(6):879–84 . 5. Kyzas PA, Saeed A, Tabbenor O. The treatment of mandibular condyle fractures: a meta-analysis. J Craniomaxillofac Surg 2012;40(8):e438–52 . 6. Kokemueller H, Konstantinovic VS, Barth EL, et al. Endoscope-assisted transoral reduction and internal REFERENCES

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