The result of endoscope-assisted open reduction and internal fixation (EAORIF) of lateral overridden subcondyle fracture

Eun-Joo Choi; In-Ho Cha; Woong Nam

doi:10.5125/jkaoms.2011.37.1.62

Journal List > J Korean Assoc Oral Maxillofac Surg > v.37(1) > 1032521

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Choi, Cha, and Nam: The result of endoscope-assisted open reduction and internal fixation (EAORIF) of lateral overridden subcondyle fracture

Original Article

J Korean Assoc Oral Maxillofac Surg 2011;37(1):62-66.

Published online: 10 January 2011

DOI: https://doi.org/10.5125/jkaoms.2011.37.1.62

The result of endoscope-assisted open reduction and internal fixation (EAORIF) of lateral overridden subcondyle fracture

Eun-Joo Choi¹, In-Ho Cha^1,², Woong Nam^1,²

¹Department of Oral and Maxillofacial Surgery, Yonsei University, Seoul, Korea

²Oral Cancer Research Institute, College of Dentistry, Yonsei University, Seoul, Korea

Woong Nam Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University 250 Seongsanno, Seodaemoon-gu, Seoul, 120-752, Korea TEL: +82-2-2228-3140 FAX: +82-2227-8022 E-mail: omsnam@yuhs.ac

Received 4 October 2010 Revised 12 January 2011 Accepted 21 January 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Introduction

Endoscope-assisted open reduction and internal fixation (EAORIF) reduces the amount of facial scaring, but limitations, such as the possibility to convert to the open technique and the large learning curve, remain.

Materials and Methods

The medical records of 19 patients diagnosed as lateral overridden subcondyle fractures and treated with endoscope-assisted open reduction and internal fixation at Yonsei University Health System from December 2006 to August 2010 were reviewed.

Results

11 patients underwent temporary discomfort or pain such as limitation of mouth opening, temporomandibular joint discomfort, lip paresthesia or facial weakness, but the symptoms disappeared within 3 months. There was no severe long-term complication except 2 patients with refractures of operated subcondyles.

Conclusion

Subcondyle fracture with lateral overridden proximal segment is a better indication of endoscope-assisted open reduction and internal fixation than a condylar head/neck fracture, or medial overridden subcondyle fracture: allowing an anatomic reduction.

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Keywords: Subcondyle fracture, Endoscope-assisted, Lateral-override, Endoscope-assisted open reduction and internal fixation (EAORIF)

References

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5. Kellman RM, Cienfuegos R. Endoscopic approaches to subcondylar fractures of the mandible. Facial Plast Surg. 2009; 25:23–8.

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7. Cho-Lee GY, Rodrl′guez Campo FJ, Gonza′lez Garcl′a R, Mun ̃oz Guerra MF, Sastre Pe′rez J, Naval Gl′as L. Endoscopically-assisted transoral approach for the treatment of subcondylar fractures of the mandible. Med Oral Patol Oral Cir Bucal. 2008; 13:E511–5.

8. Troulis MJ. Endoscopic open reduction and internal rigid fixation of subcondylar fractures. J Oral Maxillofac Surg. 2004; 62:1269–71.

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10. Paeng JY, Ok YJ, Myoung H, Hwang SJ, Seo BM, Choi JY, et al. Endoscopic-assisted open reduction and internal fixation (EAORIF) for condylar fracture. J Korean Assoc Oral Maxillofac Surg. 2006; 32:474–81.

11. Schoen R, Fakler O, Metzger MC, Weyer N, Schmelzeisen R. Preliminary functional results of endoscope-assisted transoral treatment of displaced bilateral condylar mandible fractures. Int J Oral Maxillofac Surg. 2008; 37:111–6.

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Fig. 1.

A computed tomography image of lateral-overrided subcondyle fracture in a patient.

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Fig. 2.

Endoscopic view after EAORIF of lateral-overridden subcondyle fracture.(EAORIF: endoscope-assisted open reduction and internal fixation)

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Fig. 3.

A images of preoperative (left), postoperative (right) 3-dimensional computed tomography image of lateral-over-rided subcondyle fracture in a patient.

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Fig. 4.

Panoramic view of the patient who was diagnosed as subcondyle refracture 1 month after EAORIF. A. Before operation. B. Five days after operation. C. One month after operation.(EAORIF: endoscope-assisted open reduction and internal fixation)

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Fig. 5.

EAORIF of subcondyle fracture was done with a 6-hole miniplate.(EAORIF: endoscope-assisted open reduction and internal fixation)

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Fig. 6.

EAORIF was done with one 4-hole miniplate and one 2-hole miniplate.(EAORIF: endoscope-assisted open reduction and internal fixation)

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Table 1.

Results of EAORIF of lateral override subcondylar fracture (n=19)

Patients	Age	Sex	Operated Sites	Number of Plates	Number of Screws	Periods of IMF	Temporary Complications¹	Long-term Complications	Operation Time (minutes)	Follow Up Periods (months)
1	27	M	Lt. Sc + P	1	4	0	TMJ pain	−	125	8
2^*	36	M	Rt. Sc	1	4	14	−	Premature contact, refracture	106	14
3	59	F	Rt. Sc + S	1	3	14	Lip paresthesia	−	138	7
4	34	F	Lt. Sc + P	2	7	7	Limited lateral movement		218	9
5	26	M	Lt. Sc	1	3	7	Limited opening	Premature contact	143	9
6	66	F	Rt. Sc	2	7	3	−	Premature contact	122	6
7	27	F	Rt. Sc + P	1	4	14	Limited opening	−	229	4
8	22	M	Rt. Sc	1	5	0	−	Premature contact	102	12
9	27	F	Lt. Sc + S	1	5	0	Intermittent TMJ pain	−	197	3
10	60	M	Rt. Sc + P	1	5	0	TMJ pain, facial nerve weakness, chin paresthesia		261	4
11	29	M	Lt. Sc + S	2	6	10	Infection	−	171	5
12	32	M	Rt. Sc	2	6	0	−	−	150	7
13	37	M	Lt. Sc + P	2	5	0	Limited opening	−	56	4
14	24	M	Lt. Sc +P	2	6	0	Intermittent TMJ pain limited opening		144	6
15	79	F	Lt. Sc	2	7	0	−	−	144	6
16	46	F	Rt. Sc	2	6	0	−	refracture	150	5
17	28	M	Lt. Sc	2	6	0	−	−	100	3
18	24	M	Rt. Sc + P	2	7	0	−	−	180	5
19	28	M	Lt. Sc + S	2	6	0	−	−	120	4

Temporary Complications

¹ presented before postoperative 1 month, and disappeared in postoperative 3 months, 2

^* the case whose internal fixation was done with 2.4 mm biodegradable plate, EAORIF: endoscope-assisted open reduction and internal fixation, IMF: intermaxillary fixation, Sc: subcondyle, S: symphysis, P: parasymphysis, TMJ: temporomandibular joint)

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