Cranial nerve VII region of the traumatized facial skeleton: Optimizing fracture repair with the endoscope

Objective: Cranial nerve VII (CN VII) is anatomically positioned adjacent t o the condylar neck of the mandible and arch of the midface, Fracture treat ment of this region of the facial skeleton remains controversial because of difficult surgical access. Conservative management rarely achieves anatomi c fracture repair and can result in irreversible structural deformity and d ysfunction, Traditional operative methods require access through very visib le facial incisions and risk injury to the facial nerve. We report endoscop ic methods of facial fracture repair in the region of CN VII that achieve e xcellent fracture reduction and stabilization, with minimal risk of facial nerve injury by using hidden incisions. Methods: A. consecutive series of 65 endoscopically assisted facial fractur e repairs were analyzed. Endoscopic repairs of the condylar neck (n = 40) o f the mandible were performed through an intraoral incision. Endoscopic arc h repairs (n = 25) of the midface were performed through a preauricular inc ision. Outcomes were evaluated by postoperative fracture reduction on radio graphs, occlusion, interincisal jaw opening, and facial nerve function. Results: Thirty-seven of 40 condylar neck mandible fractures went on to ana tomic bone union, whereas 3 of 40 had either incomplete fracture reduction or re-fracture through the plate. There was one temporary palsy of CN VII t hat completely resolved spontaneously. Jaw opening; exceeded 40 mm by the 8 th postoperative week. Computed tomographic images demonstrated anatomic ar ch repair in all 25 endoscopically repaired cases, Six of seven endoscopica lly repaired Le Fort III facial fractures went on to restoration of their p remorbid occlusion, One of seven had an excellent restoration of the occlus al interface but a cant to the occlusal plane. Two of seven had improved bu t incomplete restoration of the malar prominence and enopthalmos ipsilatera l to the side of endoscopic arch repair. Eight of 25 endoscopic arch repair s developed temporary paralysis of the frontal branch of CN VII that recove red completely by the 10th postoperative week. Conclusion: We have developed novel endoscopically assisted techniques to f acilitate repair of facial fractures in the region of CS VII, These techniq ues have been successfully applied to accurately restore the facial skeleto n to its preinjury anatomic position in the region of CN VII with minimal r isk of facial paralysis by using limited and well-hidden incisions.