Clinical and functional outcomes following transoral endoscopically-assisted treatment of mandibular subcondylar fractures: A single-center experience

Purpose Evidence on the outcomes of transoral endoscopically-assisted treatment of mandibular subcondylar fractures remains limited. The primary aim of this study was to evaluate surgical outcomes, complication rates, revision rates, and long-term functional results following transoral endoscopically-assisted treatment of subcondylar fractures. The secondary aim was to identify predictors of postoperative complications, revision surgery, and craniomandibular dysfunction. Methods This monocentric observational study comprised a retrospective and a prospective study arm. The retrospective cohort included all patients with mandibular subcondylar fractures treated by transoral endoscopically-assisted open reduction and internal fixation without transbuccal trocars between December 2014 and August 2024. Fractures were classified using the AO CMF and Spiessl–Schroll Classification Systems based on preoperative CT imaging. Demographic, clinical, radiographic, surgical, and postoperative data were collected. The prospective cohort consisted of patients who underwent standardized clinical follow-up at least 12 months after surgery, including assessment of temporomandibular disorders, mandibular function, occlusion, pain, and maximum mouth opening using standardized DGFDT examination protocols. Primary outcomes were postoperative complications and revision surgery; long-term functional outcome was evaluated as a tertiary endpoint. Descriptive statistics, exploratory bivariate analyses, and multivariable logistic regression were performed to identify factors associated with postoperative complications. Results A total of 132 patients with 144 subcondylar fractures were included. Postoperative complications occurred in 43.8 % of fractures, whereas intraoperative revision following 3D C-arm imaging and postoperative revision surgery were required in 15.3 % and 2.8 % of cases, respectively. The most common complications were malocclusion (20.1 %), osteosynthesis material failure (15.3 %), and wound infection (14.6 %). Multivariable analysis identified longer intermaxillary fixation as the only independent predictor of postoperative complications (OR 1.052, 95 % CI 1.008–1.109; p = 0.036). Follow-up examinations demonstrated generally favorable long-term functional outcomes, although 22.7 % of patients showed signs of temporomandibular disorders and 31.8 % presented with objective occlusal disturbances. Conclusions Transoral Endoscopically-assisted open reduction and internal fixation provided reliable surgical management of subcondylar mandibular fractures, with a low revision rate and favorable long-term functional outcomes. Prolonged postoperative intermaxillary fixation was the only independent predictor of postoperative complications, while routine intraoperative 3D imaging supported accurate fracture reduction and implant positioning.