Endoscope-Assisted or Skin-Approach Osteosynthesis of Mandibular Condylar Fracture—A Comparison

Open reduction and internal fixation (ORIF) for mandibular condyle fractures remains a controversial and challenging issue, with the exception of basal and low-neck fractures. Currently, there is a consensus that fractures causing irreparable malocclusion or dislocation, when the fracture line runs through the base or lower neck of the condyle, require ORIF. Due to the different characteristics of fractures, various surgical approaches and their modifications are available. The use of a minimally invasive intraoral approach during endoscope-assisted procedures is considered safer for the facial nerve and provides good esthetic results without facial scarring. This study aimed to compare two surgical approaches-retromandibular and intraoral-to examine post-operative outcomes and to guide surgical decision-making in the treatment of simple fractures of the base and low-neck condylar process of the mandible. Forty-nine patients (thirteen female, thirty-six male) were analyzed: eighteen were treated with the intraoral approach, and thirty-one with the retromandibular approach. There were no statistical differences in the duration of surgery, but intraoperative blood loss was significantly lower in patients treated endoscopically compared with those treated with an extraoral approach. Post-operative facial nerve and TMJ function were comparable in both groups. The endoscope-treated patients were at a higher risk of fracture non-union, but these findings should be considered with connection with the small sample size. The intraoral approach is a valuable option for basal or low-neck fractures but demands significant surgical experience due to its technical complexity.