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ITALIAN JOURNAL OF MAXILLOFACIAL SURGERY
A Journal on Maxillofacial Surgery
Official Journal of the Italian Society of Maxillofacial Surgery
Rivista Italiana di Chirurgia Maxillo-Facciale 2005 January-December;16(1-3):15-25
Intraoral surgical reduction of mandibular condylar fractures with and without rigid fixation
Brusati R., Biglioli F., Autelitano L., Colletti G.
Maxillo Facial Surgery University of Milan, San Paolo Hospital, Milan, Italy
Aim. Treatment of mandibular condylar fractures is debated among maxillofacial surgeons. Nonsurgical management is indicated in certain cases but does not allow anatomical repositioning of fractured fragments and in more dislocated fractures results are less than satisfactory. Converely, external surgical approaches to the condyle present surgical risks and frequent long term resorption. Intraoral approach is a safer procedure but can be technically demanding. The use of endoscope, increasing surgical view, can widen the indications for surgical treatment of these fractures.
Methods. From January 1999 to July 2003 11 patients have been treated by means of intraoral surgical reduction for 11 condylar fractures. In 5 cases endoscope was used to improve view. In 2 cases coronoidotomy was performed for the same reasons. In 5 patients osteo-sinthesis was performed after reduction; in 6 patients only self retentive reduction was performed. A period of intensive functional rehabilitation was mandatory.
Results. Good anatomical healing and functional results have been observed in all patients except one who could not follow functional rehabilitation. In one patient extraoral access had to be added.
Conclusion. Intraoral surgical reduction of mandibular condylar fractures, with the aid of endoscope and coronoidotomy in difficult cases, is a safe but not always easy procedure.