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Condylar fracturesCondylar fractures

11Dr. DemerewDr. Demerew

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Classication SchemesClassication Schemes

Condylar fractures:Condylar fractures:

General classication:General classication:

In order from most inferior toIn order from most inferior to

superiorsuperior SubcondylarSubcondylar

Condylar neckCondylar neck IntracapsularIntracapsular

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Condylar ProcessCondylar Process

FracturesFractures Incidence:Incidence:

epresent 2!"#!$ ofepresent 2!"#!$ of

all mandibleall mandiblefracturesfractures

%ocation:%ocation: 1&$ intracapsular1&$ intracapsular

'&1$ in c(ildren )1*+'&1$ in c(ildren )1*+

2&$ condylar neck2&$ condylar neck'#,$ in adults -!*+'#,$ in adults -!*+

2$ subcondylar2$ subcondylar

,&$ unilateral,&$ unilateral

1$ bilateral1$ bilateral##Dr. DemerewDr. Demerew

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Cont.Cont.

. S(ift of occlusion towards t(e. S(ift of occlusion towards t(eipsilateral side wit( possible cross bite.ipsilateral side wit( possible cross bite.

8. 9lood in t(e eternal auditory canal.8. 9lood in t(e eternal auditory canal.

,. 7ain on palpation o0er t(e fracture,. 7ain on palpation o0er t(e fracture

site.site.

;. %ack of condylar mo0ement upon;. %ack of condylar mo0ement uponpalpationpalpation

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Cont.Cont.

1*. Di

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FracturesFractures Classications:Classications:

>assmund Sc(eme:>assmund Sc(eme:

I" minimal displacement of (ead '1*"&!?+I" minimal displacement of (ead '1*"&!?+ II" fracture wit( tearin3 of medial @ointII" fracture wit( tearin3 of medial @oint

capsule '&!";*?+ bone still contactin3capsule '&!";*?+ bone still contactin3

III" bone fra3ments not contactin3 condylarIII" bone fra3ments not contactin3 condylar

(ead outside of capsule medially and(ead outside of capsule medially andanteriorly displacedanteriorly displaced

IA" (ead is anterior to t(e articular eminenceIA" (ead is anterior to t(e articular eminence

A" 0ertical or obliBue fractures t(rou3(A" 0ertical or obliBue fractures t(rou3(

condylar (eadcondylar (ead 88Dr. DemerewDr. Demerew

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%inda(l classication:%inda(l classication:

I" nondisplacedI" nondisplaced II" simple an3ulation of displacement noII" simple an3ulation of displacement no

o0erlapo0erlap

III" displaced wit( medial o0erlapIII" displaced wit( medial o0erlap

IA" displaced wit( lateral o0erlapIA" displaced wit( lateral o0erlap A" displaced wit( anterior or posteriorA" displaced wit( anterior or posterior

o0erlapo0erlap

AI" no contacts between se3mentsAI" no contacts between se3ments

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5ac%ennan classication:5ac%ennan classication: I" nondisplacedI" nondisplaced II" de0iation of fractureII" de0iation of fracture

III" displacement but condyle still inIII" displacement but condyle still in

fossafossa

IA" dislocation outside of 3lenoid fossaIA" dislocation outside of 3lenoid fossa

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FracturesFractures Goals of condylar fracture repair:Goals of condylar fracture repair:

1+ 7ain"free mout( openin3 wit(1+ 7ain"free mout( openin3 wit(

openin3 of &*mm or 3reateropenin3 of &*mm or 3reater 2+ Good mandibular motion of @aw in2+ Good mandibular motion of @aw in

all ecursionsall ecursions

#+ estoration of pre in@ury occlusion#+ estoration of pre in@ury occlusion &+ Stable 456s&+ Stable 456s

!+ Good facial and @aw symmetry!+ Good facial and @aw symmetry

1*1*Dr. DemerewDr. Demerew

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FracturesFractures Growt( alteration from condylarGrowt( alteration from condylar

fractures:fractures:

/stimated t(at !"2*$ of all se0ere/stimated t(at !"2*$ of all se0eremandibular asymmetry is frommandibular asymmetry is from

condylar traumacondylar trauma

9elie0ed to be from s(ortenin3 of9elie0ed to be from s(ortenin3 oft(e ramus or alterations in musclet(e ramus or alterations in muscle

action leadin3 to 3rowt( c(an3esaction leadin3 to 3rowt( c(an3es


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FracturesFractures4reatment alternati0es:4reatment alternati0es:

on"sur3ical" diet obser0ation andon"sur3ical" diet obser0ation and

p(ysical t(erapyp(ysical t(erapy Closed reduction" utilies a period ofClosed reduction" utilies a period of

I5 t(e p(ysical t(erapyI5 t(e p(ysical t(erapy

Epen reductionEpen reduction


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FracturesFractures Closed reduction:Closed reduction:

Indications:Indications:

Split condylar (eadSplit condylar (ead Intracapsular fractureIntracapsular fracture comminuted condylecomminuted condyle

4reated wit( s(ort course of I5 wit(4reated wit( s(ort course of I5 wit(

post"operati0e p(ysical t(erapypost"operati0e p(ysical t(erapy

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FracturesFractures Epen reduction:Epen reduction:

Fide?s relati0e indications:Fide?s relati0e indications:

1+ bilateral condylar fractures w(ere t(e1+ bilateral condylar fractures w(ere t(e0ertical facial (ei3(t needs to be restored0ertical facial (ei3(t needs to be restored

2+ associated in@uries t(at dictate early or2+ associated in@uries t(at dictate early orimmediate functionimmediate function

#+ medical conditions t(at indicate open#+ medical conditions t(at indicate openproceduresprocedures

&+ delayed treatment wit( malali3nment&+ delayed treatment wit( malali3nmentof se3mentsof se3ments

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Malunion (Dysarthrosis orMalunion (Dysarthrosis or

Meta-arthrosis) andMeta-arthrosis) and

PseudoarthrosisPseudoarthrosis Dysart(rosis:ere morp(olo3icalDysart(rosis:ere morp(olo3ical

c(an3e is seen in unreduced fracturec(an3e is seen in unreduced fracture

dislocation producin3 nonarticulatin3dislocation producin3 nonarticulatin3deformed condyle.deformed condyle.

4(e malunion results in disturbance in4(e malunion results in disturbance in

anatomy as well as in function. 7atientanatomy as well as in function. 7atient

will (a0e pain and limitation ofwill (a0e pain and limitation ofmo0ements of lower @aw.mo0ements of lower @aw.

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5eta"art(rosis:It is result of (ealed5eta"art(rosis:It is result of (ealed

fracture in malposition but it producesfracture in malposition but it produces

no symptoms. 4(ese are t(e type ofno symptoms. 4(ese are t(e type of

@oints wit( altered anatomy but@oints wit( altered anatomy butfunctionally acceptable 'anatomicallyfunctionally acceptable 'anatomically

altered transformed modied @oints+altered transformed modied @oints+

7seudoart(rosis:alse @oint 0ery painful7seudoart(rosis:alse @oint 0ery painfuldurin3 normal ecursions.durin3 normal ecursions.

Condylectomy may be reBuiredCondylectomy may be reBuired

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FracturesFractures Epen reductionEpen reduction

tec(niBues:tec(niBues:

5ultiple5ultipleapproac(es andapproac(es and

ation (a0eation (a0e

been de0elopedbeen de0eloped

and usedand used

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FracturesFractures Studies (a0e s(own t(at closedStudies (a0e s(own t(at closed

reduction tec(niBues rarely producereduction tec(niBues rarely produce

pain limit function or produce 3rowt(pain limit function or produce 3rowt(disturbancesdisturbances

Epen reductions tec(niBues s(ow anEpen reductions tec(niBues s(ow an

early return to normal function but areearly return to normal function but are

tec(niBue sensiti0e time etensi0etec(niBue sensiti0e time etensi0eand can lead to facial ner0eand can lead to facial ner0e

dysfunction dependin3 upon sur3icaldysfunction dependin3 upon sur3ical

approac(approac(1;1;Dr. DemerewDr. Demerew

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ComplicationsComplications

Due to dirty en0ironment of oralDue to dirty en0ironment of oral

ca0ity mandible fractures s(ould beca0ity mandible fractures s(ould be

on antibiotics to decrease infectionson antibiotics to decrease infectionsespecially wit( fractures in t(eespecially wit( fractures in t(e

dento"al0eolar portion.dento"al0eolar portion.

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5alocclusion:5alocclusion: 5ore di

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5alunion and nonunion:5alunion and nonunion:

5ost nonunions occur from infections5ost nonunions occur from infections

of t(e fracture or teet( in t(e line ofof t(e fracture or teet( in t(e line offracturefracture

5alunions are usually tolerated well by5alunions are usually tolerated well by

t(e patient most malunions of t(et(e patient most malunions of t(e

body symp(ysis or an3le can result inbody symp(ysis or an3le can result inmalocclusions. 4(is is (arder for t(emalocclusions. 4(is is (arder for t(e

patient to tolerate. 5ore common wit(patient to tolerate. 5ore common wit(

improper use of ation tec(niBue.improper use of ation tec(niBue.2222Dr. DemerewDr. Demerew

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