Endoscopically Assisted Surgery of the Ramus/Condyle Unit Using the TROULIS Method

In endoscopically assisted surgery of the ramus/condyle unit using the TROULIS method, a small, submandibular incision is made, which significantly reduces both the length of incision and the amount of bleeding and swelling. The maxillomandibular position can be established prior to fixation. This simultaneously permits access for a number of reconstruction procedures on the ramus/condyle unit. With more experience, these procedures could be performed under local anesthesia with intravenous immobilization, because there is no intraoral bleeding. Furthermore, the approach allows the surgeon to visualize the operating site “en face”, which offers the most convenient orientation. In the case of mandibular condyle fractures, access and vision are difficult and the facial nerve is at risk with open procedures. Most patients are therefore treated with closed reduction and the jaw is immobilized.

The minimally invasive approach to these fractures requires a much smaller incision with considerably less risk to the facial nerve and substantially reduces the need for immobilization of the jaw.

Maria J. TROULIS, D.D.S., M.Sc.
Massachusetts General Hospital, Boston, USA