Pitfalls in Endoscopic Treatment of Mandibular Subcondylar Fractures

Objectives: The facial trauma surgeon should be able to list indications for endoscopic treatment of mandibular condyle fractures and discuss the limitations and complications of the technique. Background: The ideal treatment of mandibular subcondylar fractures continues to be debated. Acceptable results are often obtained with conservative measures such as mandibular maxillary fixation followed by elastics. On the other hand, an open approaches result in potential risk injury to the facial nerve. These 2 arguments have cautioned many surgeons from open treatment of condylar fractures. Recent advances in endoscopic techniques have made the mandibular condyle more accessible with less risk to the facial nerve. As with any new technique, endoscopic treatment of mandibular subcondylar fractures is not without its own limitations and complications. Methods: This was a retrospective case series. Results: Three patients with mandibular subcondylar fractures with complications following endoscopic treatment were reviewed. There were a total of 4 condylar fractures (1 patient had bilateral fractures). There was 1 incidence of temporary facial nerve paresis, 1 failure of hardware positioning, 1 screw placement into the mandibular foramen, 2 condyles where adequate reduction of the fracture was impossible, and 1 failure to secure a screw into the proximal fracture segment. Conclusions: Endoscopic management of mandibular subcondylar fractures is a novel treatment with novel types of complications. Although promising, endoscopic treatment of mandibular subcondylar fractures should be approached prudently to avoid potential pitfalls.