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

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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.

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Funding

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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

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  1. Michael-Tobias Neuhaus
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  2. Alexander-Nicolai Zeller
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  3. Lena Desch
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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.

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Correspondence to Michael-Tobias Neuhaus.

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

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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

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