**7. Summary**

**•** Third, altered globe position may occur.

504 A Textbook of Advanced Oral and Maxillofacial Surgery Volume 2

and safe alternative to external repairs.

corners and reduced duration of hospital stay.

bimanual instrumentation without an assistant.

institutional review board approval is necessary.

**mandibular condylar process fractures**

zygomatic fractures. [57]-[58]

reasons.

Exophthalmos of greater than 2 mm is another indication for surgery, mostly for cosmetic

Endoscopic repair of orbital blowout fractures represents an innovative and highly successful

Early applications for endoscopic treatment of facial trauma include subcondylar fractures of the mandible, [47]-[50] orbital blow-out fractures, [51]-[56] frontal sinus fractures, [57]-[58] and

**Advantages** of endoscopic repair include the following: More accurate fracture visualization, small external incisions, reduced soft tissue dissection, potential for visualization around

**Disadvantages** of endoscopic repair include the following: Need for delicate instrumentation, moderate learning curve for the techniques, narrow field of view and limited ability for

**Indications** for endoscopic repair are generally related to fracture location, size, degree of comminution, and the surgeon's ability. Some of the techniques described herein are still under development, and surgeons contemplating the use of these techniques must determine if

Owing to the risk of facial nerve damage and the creation of visible scars, surgical treatment of condylar mandible fractures using an extraoral approach remains controversial. The transoral endoscopically assisted approach of condylar fractures has been reported to avoid these complications. **Kokemueller** studied closed treatment of mandibular condylar neck fractures by endosurgical treatments. Treatment options may yield acceptable results for displaced condylar neck fractures. Especially in patients with severe malocclusion directly after trauma, endoscope-assisted transoral open reduction and fixation seems to be the

The treatment of condylar mandible fractures with a minimal invasive endoscopically assisted technique is reliable and may offer advantages for selected cases, particularly concerning the lower occurrence of facial nerve damage.[61] In the treatment of condylar injuries, the endoscope is not only an aid; it alters the treatment philosophy, from the conservative MMF to anatomic repair. Each surgeon will have to decide on his or her indications for endoscopic repair, and indeed this may depend heavily on his or her experience and patient preference. The authors feel that anatomic reduction and fixation are the best ways to restore preinjury facial aesthetics and mandibular dynamics and to prevent late sequelae of internal derange‐

**6. Endoscope-assisted transoral reduction and internal fixation of**

appropriate treatment for prevention of occlusal disturbances.[59], [60]

The use of endoscopes has become one of many standard methods for treatment of fractures within the head and neck. As the boundaries of endoscopic surgery expand further, patients will receive the benefits of shorter incisions, less pain and earlier recovery. And, as the surgeons become more and more facile with the instruments, more indications for this type of repair are justified, and more patients ultimately benefit from less invasive surgery. Traditional lid incisions may lead to rates as high as 5 to 10% of lid malposition, which is quite high, consid‐ ering that the fractures in themselves have a very low rate of complications. Initial reports on transantral approaches were met with some skepticism, but new endoscopic techniques are much easier to perform and interest in this technique has re-emerged. The main advantages of these endoscopic techniques for the orbital fractures are: no skin incisions, easy visualization of the defect, and direct view of the posterior ledge. Despite all these benefits, endosurgery requires training experience and skill of the surgeon.
