The Subcondylar/Ramus Fixation System is comprised of instrumentation to support endoscopic treatment of fractures and orthognathic procedures involving the ramus and subcondylar regions of the mandible.

Open reduction and internal fixation of subcondylar and ramus fractures and osteotomies of the mandible have proven challenging to surgeons; often requiring surgical approaches that provide sufficient exposure in order to permit clear visualization of the reduction and application of the fixation device. Open reduction is often controversial due to the difficult access to this area and the potential morbidity related to nerve damage. In addition, large incisions often resulting in collateral tissue damage and scarring are regarded as costs that must be weighed against the benefits of the procedure.

Endoscopic technology significantly reduces the invasive aspect of many surgical procedures. Appropriate instrumentation to support endoscopic, minimally invasive surgical techniques in treating subcondylar fractures are available.

Fig 1
Panoramic radiograph preoperatively of a severely dislocated bilateral condyle fracture. Lag screw fixation of the median mandibular fracture was performed prior to admission in another clinic. Note the severely dislocated fragments with medial override on the right and medial displacement with shortening of the ascending ramus on the left side.

Fig 2
Intraoperative view by a 30 degree angled endoscope of the dislocated condyle fracture on the right side. The condylar fragment was dislocated with medial override.

Fig 3
The condylar fragment was reduced by the special instruments of the Subcondylar / Ramus Fixation System. Endoscopic view after osteosynthesis with a 2.0mm titanium miniplate. The alignment of the fragments was controlled endoscopically at the posterior aspect of the ascending ramus.

Fig 4
Panoramic radiograph postoperatively after endoscopic assisted reduction and fixation of both condylar fractures.