1. Differentiate B/W displaced and dislocated condyle fracture,and how will you manage bilateral condylar fractures

2. Management of bilateral condylar fractures History: ATLS protocol i. Primary survey A.airway and cervical spine B. breathing and ventilation C.circulation and haemorrhage control D. Disabilty due to neurological deficit E. Exposure and Environmental control 3. ii. Secondary survey Carried out after initial resuscitation Head to Toe examination Neurological assessment through GCS and pupil response Maxillofacial region Examination Extraoral Examination Intraoral Examination 4. Extraoral Examination On Inspection. Restricted and painful jaw movement Asymetry Open mouth(bilateral condylar fractures) Lengthening of face Swelling Bleeding from the ear Hematoma in external auditory meatus Facial nerve examination 5. Palpation Tenderness over both condylar regions Anterior and posterior palpation and check up for the condyle movements Step deformity Crepitations 6. IntraoralAnterior open bite Check for any hematoma and laceration Symphysis and parasymphysis area should be examined Gagging of the occlusion on the ipsilateral side in unilateral fracture Mandible deviated to the affected side in case of unilateral condylar fracture Limitaion of lateral excursion to the opposite side 7. Radiographic Examination OPG PA Face Reverse townes view CT Scan(for head and intracapsular #) MRI(for disc position) Diagnosis 8. Classification of condylar # Spiessl and schroll classification Type I: Fracture without displacement Type II: Low Fracture with displacement Type III: High Fracture with displacement Type IV: Low Fracture with dislocation Type V: high Fracture with dislocation Type VI: intracapsular fracture 9. Lindhal classification Level of condylar fracture Condylar head Condylar neck Subcondylar Relationship of condylar segment to mandibular ramus Nondisplaced Deviated Displaced with medial or lateral overlap Displaced with anterior or posterior overlap No contact B/W fracture segments 10. Relationship B/W condylar head and glenoid fossa Non displaced Displaced Dislocated 11. On the basis of age and Occlusion Age A) under 10 years B) 10-17 years C) Adult Occlusion Disturbed Undisturbed 12. Dislocated condylar fractures A dislocted condylar fracture is one in wich condyle is driven out of the glenoid fossa but still in capsule. Displaced Fractures A fracture in wich the fracture in wich the fracture segments are pull apart from each other or override each other . It is measured in degrees and mm Displaced dislocated fracture 13. Treatment of bilateral condyle fracture Closed treatment ORIF Closed treatment Intracapsular fractues: If occlusion is undisturbed Conservative treatment without immobiliztion If occlusion is slightly disturbed 2-3 wks immobiliztion Can lead to chronic limitation of movements Post reduction physiotherapy with simple jaw excerciser 14. In case of children under 10 year of age Strict followup is necessary to monitor the growth of mandible 6month to 1 year If growth reduced it should be treated with myofunctional appliances 15. Extracapsular fracture In fracture without displacement IMF 3-4 wks Functional treatment if lateral deviation or anterior open bite is present In case of fracture with displacement Same treatment as above 16. For children under 10 year of age IMF is indicated to control pain for 7-10 days In children 10-17 year of age IMF for 2-3 wks Adults 3-4 wks In edentulous patients Gunning splints Patient own denture Zygomaticomaxillary suspension Cirumferential wiring 17. Gunnings splints 18. ORIF Absolute indications a) Displacement of the condyle into middle cranial fossa b) Impossibility of restoring occlusion c) Lateral extracapsular displacement d) Invasion by foreign body e) Displacement more than 5 mm and 30degree deviation 19. Relative indications a) When IMF is contraindicated for medical reasons b) Bilateral fractures with associated midface fractures c) Bilateral fractures with severe open bite d) Bilateral fracture with preinjury malocclusion. 20. Various surgical approaches to Condyle fracture Submandibular approach Retromandibular approach Pre auricular and auricular approach Coronal 21. Reduction For reduction of condylar head fracture the ramus is needed to be pull down Fixation a) Miniplates b) Lag screw c) Transosseous wiring d) K wire 22. Complications I. Ankylosis(less than 12 year) II. Growth restriction III. Disturbance in mandibular movements 23. THANK YOU