Skip to main content
SpringerLink
Log in

Endoscopically Assisted Treatment of Condylar Base and Neck Fractures: A Single Institution Analysis of Outcomes and Complications

Journal of Maxillofacial and Oral Surgery volume 20, pages 665–673 (2021)Cite this article

Abstract

Background

Conservative treatment, including observation and closed treatment, as well as open reduction and internal fixation are existing options for treating condylar process fractures. Extraoral approaches are widely preferred for open reduction and internal fixation. Transoral access for condylar base and neck fractures is not yet commonly used as it is technically demanding and requires special equipment.

Purpose

In this study, the transoral endoscopically assisted approach is described, and its outcomes and complications were investigated. Imaging data and clinical records of 187 patients with condylar process fractures, treated via endoscopically assisted transoral approach between 2007 and 2017 were analyzed. Parameters included diagnosis and fracture classification, treatment, osteosynthesis configuration and postoperative complications.

Results

Early complications, including infection, transient postoperative malocclusion, pain and limited mouth opening, occurred in 35 patients (18.7%). Late onset complications, such as screw loosening were documented in only 4 patients (2.1%). Revision surgery following postoperative 3D imaging was required in only 3 cases (1.6%). Fragment length ranged from 15.5 to 38.3 mm. In 57.7% of patients with condylar fragment length < 20 mm, a single osteosynthesis plate was used, with no elevated complication rate. Two osteosynthesis plates with 4 screws each was used as standard in longer fragments.

Conclusion

Endoscopically assisted transoral treatment of condylar process fractures is a reliable, yet technical demanding technique. It allows for reduction and fixation of fractures with a condylar fragment length of > 15 mm with low postoperative complication and revision rates.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Availability of Data and Material

Not applicable.

References

  1. Bormann KH, Wild S, Gellrich NC et al (2009) Five-year retrospective study of mandibular fractures in Freiburg, Germany: incidence, etiology, treatment, and complications. J Oral Maxillofac Surg 67(6):1251–1255

    Article  PubMed  Google Scholar 

  2. Neff A, Cornelius CP, Rasse M et al (2014) The comprehensive AOCMF classification system: condylar process fractures—level 3 tutorial. Craniomaxillofac Trauma Reconstr 7(7):S44–S58

    Article  Google Scholar 

  3. Loukota RA, Eckelt U, De Bont L et al (2005) Subclassification of fractures of the condylar process of the mandible. Br J Oral Maxillofac Surg 43(1):72–73

    Article  CAS  PubMed  Google Scholar 

  4. Spiessl B, Schroll K (1972) Gelenkfortsatz- und Kieferköpfchenfrakturen. In: Nigst H (ed) Spezielle Frakturen- Und Luxations- Lehre, Bd I/1. Gesichtsschädel. Thieme, Stuttgart, p 136

    Google Scholar 

  5. Loukota RA, Neff A, Rasse M (2010) Nomenclature/classification of fractures of the mandibular condylar head. Br J Oral Maxillofac Surg 48(6):477–478

    Article  CAS  PubMed  Google Scholar 

  6. He D, Yang C, Chen M et al (2009) Intracapsular condylar fracture of the mandible: our classification and open treatment experience. J Oral Maxillofac Surg 67(8):1672–1679

    Article  PubMed  Google Scholar 

  7. Neff A, Cornelius C-P, Rasse M et al (2017) Kiefergelenkfortsatzfrakturen nach der AO-CMF-trauma-Klassifikation condylar process fractures according to the AO CMF trauma classification. Der MKG-Chirurg 10(2):113–126

    Article  Google Scholar 

  8. Pepper L, Zide MF (1985) Mandibular condyle fracture and dislocation into the middle cranial fossa. Int J Oral Surg 14(3):278–283

    Article  CAS  PubMed  Google Scholar 

  9. Zide MF, Kent JN (1983) Indications for open reduction of mandibular condyle fractures. J Oral Maxillofac Surg 41(2):89–98

    Article  CAS  PubMed  Google Scholar 

  10. Kokemueller H, Konstantinovic VS, Barth EL et al (2012) Endoscope-assisted transoral reduction and internal fixation versus closed treatment of mandibular condylar process fractures-a prospective double-center study. J Oral Maxillofac Surg 70(2):384–395

    Article  PubMed  Google Scholar 

  11. Ellis E, Dean J (1993) Rigid fixation of mandibular condyle fractures. Oral Surg Oral Med Oral Pathol 76(1):6–15

    Article  PubMed  Google Scholar 

  12. Ellis E (2009) Method to determine when open treatment of condylar process fractures is not necessary. J Oral Maxillofac Surg 67(8):1685–1690

    Article  PubMed  Google Scholar 

  13. Hidding J, Wolf R, Pingel D (1992) Surgical versus non-surgical treatment of fractures of the articular process of the mandible. J Cranio-Maxillofac Surg 20(8):345–347

    Article  CAS  Google Scholar 

  14. Widmark G, Bågenholm T, Kahnberg KE et al (1996) Open reduction of subcondylar fractures a study of functional rehabilitation. Int J Oral Maxillofac Surg 25(2):107–111

    Article  CAS  PubMed  Google Scholar 

  15. Baker AW, McMahon J, Moos KF (1998) Current consensus on the management of fractures of the mandibular condyle: a method by questionnaire. Int J Oral Maxillofac Surg 27(4):258–266

    Article  CAS  PubMed  Google Scholar 

  16. Berner T, Essig H, Schumann P et al (2015) Closed versus open treatment of mandibular condylar process fractures: a meta-analysis of retrospective and prospective studies. J Cranio-Maxillofac Surg 43(8):1404–1408

    Article  Google Scholar 

  17. Al-Moraissi EA, Ellis E (2015) Surgical treatment of adult mandibular condylar fractures provides better outcomes than closed treatment: a systematic review and meta-analysis. J Oral Maxillofac Surg 73(3):482–493

    Article  PubMed  Google Scholar 

  18. Hammer B, Schier P, Prein J (1997) Osteosynthesis of condylar neck fractures: a review of 30 patients. Br J Oral Maxillofac Surg 35(4):288–291

    Article  CAS  PubMed  Google Scholar 

  19. Rai A (2012) Comparison of single vs double noncompression miniplates in the management of subcondylar fracture of the mandible. Ann Maxillofac Surg 2(2):141

    Article  PubMed  PubMed Central  Google Scholar 

  20. Ellis E, Sinn DP (1993) Treatment of mandibular angle fractures using two 2.4-mm dynamic compression plates. J Oral Maxillofac Surg 51(9):969–973

    Article  PubMed  Google Scholar 

  21. Choi BH, Kim KN, Kim HJ et al (1999) Evaluation of condylar neck fracture plating techniques. J Cranio-Maxillo-Facial Surg 27(2):109–112

    Article  CAS  Google Scholar 

  22. Ehrenfeld M, Manson PN, Prein J (eds) (2014) Principles of internal fixation of the craniomaxillofacial skeletonace, 2012th edn. Georg Thieme Verlag, Stuttgart

    Google Scholar 

  23. Poxleitner P, Voss PJ, Steybe D et al (2019) Catching condyle—endoscopic-assisted transoral open reduction and rigid fixation of condylar process fractures using an auto reposition and fixation osteosynthesis plate. J Cranio-Maxillofac Surg 47(5):778–785

    Article  Google Scholar 

  24. Al-Moraissi EA, Louvrier A, Colletti G et al (2018) Does the surgical approach for treating mandibular condylar fractures affect the rate of seventh cranial nerve injuries? A systematic review and meta-analysis based on a new classification for surgical approaches. J Cranio-Maxillofac Surg 46(3):398–412

    Article  Google Scholar 

  25. Kanno T, Sukegawa S, Tatsumi H et al (2014) The retromandibular transparotid approach for reduction and rigid internal fixation using two locking miniplates in mandibular condylar neck fractures. Int J Oral Maxillofac Surg 43(2):177–184

    Article  CAS  PubMed  Google Scholar 

  26. Al-Moraissi EA, Ellis E, Neff A (2018) Does encountering the facial nerve during surgical management of mandibular condylar process fractures increase the risk of facial nerve weakness? A systematic review and meta-regression analysis. J Cranio-Maxillofac Surg 46(8):1223–1231

    Article  Google Scholar 

  27. Pau M, Navisany K, Reinbacher KE et al (2016) Use of a modified high submandibular approach to treat condylar base fractures: experience with 44 consecutive cases treated in a single institution. J Cranio-Maxillofac Surg 44(10):1641–1645

    Article  Google Scholar 

  28. Schön R, Gutwald R, Schramm A et al (2002) Endoscopy-assisted open treatment of condylar fractures of the mandible: extraoral vs intraoral approach. Int J Oral Maxillofac Surg 31(3):237–243

    Article  PubMed  Google Scholar 

  29. Eckelt U, Schneider M, Erasmus F et al (2006) Open versus closed treatment of fractures of the mandibular condylar process-a prospective randomized multi-centre study. J Cranio-Maxillofac Surg 34(5):306–314

    Article  Google Scholar 

  30. Lauer G, Schmelzeisen R (1999) Endoscope-assisted fixation of mandibular condylar process fractures. J Oral Maxillofac Surg 57(1):36–39

    Article  CAS  PubMed  Google Scholar 

  31. Ikebe K, Matsuda KI, Murai S et al (2010) Validation of the Eichner index in relation to occlusal force and masticatory performance. Int J Prosthodont 23(6):521–524

    PubMed  Google Scholar 

  32. Niezen ET, Bos RRM, van Minnen B et al (2018) Fractures of the mandibular condyle: a comparison of patients, fractures and treatment characteristics between Groningen (The Netherlands) and Dresden (Germany). J Cranio-Maxillofac Surg 46(10):1719–1725

    Article  Google Scholar 

  33. Konstantinović VS, Dimitrijević B (1992) Surgical versus conservative treatment of unilateral condylar process fractures: clinical and radiographic evaluation of 80 patients. J Oral Maxillofac Surg 50(4):349–352

    Article  PubMed  Google Scholar 

  34. Zachariades N, Mezitis M, Mourouzis C et al (2006) Fractures of the mandibular condyle: a review of 466 cases. Literature review, reflections on treatment and proposals. J Cranio-Maxillofac Surg 34(7):421–432

    Article  Google Scholar 

  35. Schneider M, Erasmus F, Gerlach KL et al (2008) Open reduction and internal fixation versus closed treatment and mandibulomaxillary fixation of fractures of the mandibular condylar process: a randomized, prospective, multicenter study with special evaluation of fracture level. J Oral Maxillofac Surg 66(12):2537–2544

    Article  PubMed  Google Scholar 

  36. Cuéllar J, Santana J, Núñez C et al (2018) Tratamiento quirúrgico o conservador para fracturas de cóndilo mandibular. Medwave 18(7):e7352

    Article  PubMed  Google Scholar 

  37. Weinberg MJ, Merx P, Antonyshyn O et al (1995) Facial nerve palsy after mandibular fracture. Ann Plast Surg 34(5):546–549

    Article  CAS  PubMed  Google Scholar 

  38. Schön R, Fakler O, Gellrich NC et al (2005) Five-year experience with the transoral endoscopically assisted treatment of displaced condylar mandible fractures. Plast Reconstr Surg 116(1):44–50

    Article  PubMed  CAS  Google Scholar 

  39. Danda AK, Muthusekhar MR, Narayanan V et al (2010) Open versus closed treatment of unilateral subcondylar and condylar neck fractures: a prospective, randomized clinical study. J Oral Maxillofac Surg 68(6):1238–1241

    Article  PubMed  Google Scholar 

  40. Haug RH, Assael LA (2001) Outcomes of open versus closed treatment of mandibular subcondylar fractures. J Oral Maxillofac Surg 59(4):370–375

    Article  CAS  PubMed  Google Scholar 

  41. Ellis E, Throckmorton G (2000) Facial symmetry after closed and open treatment of fractures of the mandibular condylar process. J Oral Maxillofac Surg 58(7):719–728

    Article  PubMed  Google Scholar 

  42. Ellis E, Karas N (1992) Treatment of mandibular angle fractures using two mini dynamic compression plates. J Oral Maxillofac Surg 50(9):958–963

    Article  PubMed  Google Scholar 

Download references

Funding

No funding received.

Author information

Author notes

  1. Michael-Tobias Neuhaus and Alexander-Nicolai Zeller have contributed equally.

Authors and Affiliations

  1. Department for Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany

    Michael-Tobias Neuhaus, Alexander-Nicolai Zeller, Lena Desch, Philipp Jehn, Nils-Claudius Gellrich & Rüdiger Zimmerer

  2. Sri Guru Ram Das Institute of Dental Sciences and Research, Amritsar, India

    Amit Dhawan

Authors
  1. Michael-Tobias Neuhaus
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alexander-Nicolai Zeller
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lena Desch
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Amit Dhawan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Philipp Jehn
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nils-Claudius Gellrich
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Rüdiger Zimmerer
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by [M-TN], [LB] and [RZ]. The first draft of the manuscript was written by [M-TN] and [RZ] and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Michael-Tobias Neuhaus.

Ethics declarations

Code Availability

Not applicable.

Conflict of interest

The authors declare that they have no conflict of interest.

Consent to Participate

Not applicable.

Consent for Publication

Not applicable.

Ethical Approval

This study was approved by the local ethical review committee (study nr: 8163_BO_K_2018).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Neuhaus, MT., Zeller, AN., Desch, L. et al. Endoscopically Assisted Treatment of Condylar Base and Neck Fractures: A Single Institution Analysis of Outcomes and Complications. J. Maxillofac. Oral Surg. 20, 665–673 (2021). https://doi.org/10.1007/s12663-020-01398-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12663-020-01398-9

Keywords

search

Navigation