CONDYLAR FRACTURES

ORAL AND MAXILLOFACIAL SURGERY

1. GOOD MORNING

2. SEMINAR CONDYLAR FRACTURES SUBMITTED BY YASMIN MOIDIN 2008 Batch Al Azhar Dental College

3. CONTENTS INTRODUCTION CLASSIFICATION INVESTIGATIONS ETIOLOGY CLINICAL EXAMINATION PRINCIPLES OF TREATMENT TREATMENT TREATMENT PROTOCOL COMPLICATIONS

4. Classification Unilateral and bilateral fractures Intracapsular fracture and extra capsular fractures. Simple, compound or comminuted fractures of the condyle.

5. Lindhal’s classification Based on anatomic location of the fracture(level of condylar fracture) Condylar head Condylar neck Subcondylar ., Based on the relationship of the condylar segment to the mandibular fragment Non displaced Deviated Displaced with medial or lateral overlap Displacement with anterior or posterior overlap No contact between the fracture segments

6. Based on the relationship between the condylar head and glenoid fossa . Non displaced Displacement Dislocation MacLennan system Non displaced Fracture deviation Fracture displacement Fracture dislocation

7. Aetiology Injury caused by a moving object as in caes of first injury, violence, sports etc Injury caused when an individual falls or hits a surface while in motion as in cases of parade ground fracture where the soldier falls on the ground from an upright position due to syncope without making any effort to protect the face. Injury resulting due to the combined forces of the above mentioned causes.

8. Signs and Symptoms Unilateral condylar fracture Swelling and tenderness over the TMJ area. Haemorrhage from ear on that side ( results from laceration of the anterior wall of the external auditory meatus.

9. Bleeding originating in the external auditory canal from the middle ear haemorrhage . Ecchymosis of the skin just below the mastoid process on the same side. This particular physical sign also occur with fractures of the base of the skull when it is known as ‘Battle’s sign’.

10. If the condylar head is dislocated medially and all oedema has subsided due to passage of time, a chacteristic hollow over the region of the condylar head is observed. Deviation of the mandible on opening towards the side of the fracture. unilateral posterior crossbite and retrognathic occlusion Paraesthesia of the lower lip in the absence of fracture of the body or angle of mandible on that side.

11. Gagging of the occlusion on the ipsilateral molar teeth. Painful limitation of protrusion and lateral excursion to the opposite side. Mandible will be locked and middle ear bleeding may present externally . Tenderness over the condylar area on palpitation

12. Bilateral condylar fracture The signs and symptoms for unilateral fracture may be present on both sides. Swelling over fracture sites Overall mandibular movement is usually more restricted than in unilateral fracture.

13. Pain and limitation of opening and restricted protrusion and lateral excrusions . Appearance of an elongated face may be the result of bilateral subcondylar fracture. Bilateral condylar fractures are frequently associated with fracture of the symphisis or parasymphisis .

14. Principle of treatment of condylar fracture Conservative Functional Surgical

15. TREATMENT OF CONDYLAR PROCESS FRACTURE Closed Technique(conservative treatment) Unilateral or bilateral fractures Active jaw movement Excessive pain or gross malocclusion is present, intermaxillary fixation is recommended

16. INDICATIONS Condylar fracture with minimum displacement and minimum occlusal disturbance and in case of the mandible opening the mouth.

17. Open Reduction The objective of surgical treatment is achieved by exposure of the condylar fragment, reduction to the normal relationship and fixation in that position.

18. ABSOLUTE INDICATION Dislocation of the condyle into the middle cranial fossa . Inability to achieve occlusion by closed reduction. Lateral fracture dislocation of the condyle Compound fracture of the condyle like that due to gun shot wounds or invasion by other foreign objects

19. Surgical approaches Preauricular approach Alkayat - Bramley Rowe’s extension Obwegeser’s modification Hockey stick Retromandibular approach Submandibular approach Bicoronal

20. Methods of immobilization of condyle INTRA MAXILLARY FIXATION Transosseous wiring Kirschner wire Intramedullary screw Bone pins Bone plating

21. Treatment protocol for different types of condylar fracture. For children under 10 years of age. This age group is more likely to develop ankylosis due to the condylar fracture. The treatment is completely functional for both unilateral and bilateral condylar fractures. IMF may be required for a period of 7 to 10 days in case of extreme pain.

22. Adolescents between 10 and17 years of age The treatment protocol is same for this group. However, malocclusion interferes with the treatment, and therefore IMF is indicated for a period of 2 to 3 weeks in such cases.

23. Unilateral intracapsular fractures in adult This kind of fracture deosnot cause much of a deformity. Therefore, conservative treatment is considered appropriate and IMF for a period of 2 to 3 weeks in case of malocclusion.

24. Bilateral intracapsular fractures in adult An intermaxillary fixation for a period of 3 to 4 weeks is recommended as the amount of displacement of both the condyles may be different. Physiotherapy after IMF prevents any restricted of mouth opening

25. Unilateral extracapsular in adult A low condylar neck fracture is treated by open reducion method in case of severe malocclusion caused by the fracture or dislocation . No effective treatment is undertaken, if the fractured segment are not displaced, and there is no disturbance to to occlusion.

26. Bilateral extracapsular in adult Usually this fracture results in instabilty and gross displacement of the mandible. IMF is not reliable for the proper reduction of the fractured site though it may establish the normal height is recommended and then the treatment protocol is same that for unilateral extracapsular fracture. When bilateral extracapsular fracture is associated with other gross midfacial fracture, open reduction of the both the sides should be considered.

27. COMPLICATIONS ANKYLOSIS OF THE TMJ- Age of the patient Greater in younger patients(10 yrs) Intra capsular fractures Prolonged immobilisation-Ankylosis

28. Damage to meniscus 2.interferance with growth