Condylar Fracture

CONDYLAR FRACTURES
PRESENTED BY DR- MUFTAH

.KHAMAIRA MDS.OMFS
CONTENTS
1) INTRODUCTION
2) SURGICAL ANATOMY
3) MECHANISM OF INJURY
4) ETIOLOGY
5) BIOMECHANICS
6) CLASSIFICATION OF CONDYLAR FRACTURES
7) RADIOGRAPHIC EVALUATION
8) CLINICAL FEATURES
9) ADAPTATION OF FRACTURES
10) MANAGEMENT
11) PEDIATRIC CONDYLAR FRACTURES
12) COMPLICATIONS
Introduction
Condylar and subcondylar fractures
constitute 26-40% of all mandible
fractures • Given the unique geometry of
the mandible and temporomandibular
joints (TMJs), these fractures can result in
marked pain, dysfunction, and deformity
if not recognized and treated
appropriately.
Surgical Anatomy
Represents inferior articular surface
of TMJ. Its axis is perpendicular to
ramus, to which connected by thin
neck.
Oblique directed medially and slightly
backwards, forming angle of 25◦ with
frontal plane • Surface is convex &
displays 3 parts from front to back.
I. Front- fossa of lateral pterygoid
muscle.
II. Anterior slope of condyle, in lined at
angle of 45◦ from horizontal & meeting
the temporal articular tubercle.
III. Back – posterior side of condyle,
rounded crest separating the two slopes
IV. It has 2 poles, lateral & medial to which
disc is attached with strong ligaments
Muscle attachments
Lateral pterygoid muscle :

Protrusion & lateral excursive
movements
Etiology
1) Trauma
2) Motor vehicle accident
3) Interpersonal violence
4) Fall from heights
5) Ballistic injuries
6) Sports injury
Diagnosis
1) History
2) Clinical examination
3) Radiographic examination
Unilateral condylar fracture
Inspection
1) Swelling over the TMJ area.
2) Hemorrhage from ear on that side.

I. bleeding from external auditory canal
II. middle ear hemorrhage

3) Hematoma on the involved side
4) Ecchymosis of skin just below the mastoid process •
5) Characteristic hollow over the region of condylar head.
Palpation
1) Tenderness over the condylar
area.
2) Mandibular movements:
1) Protrusion.
2) Lateral excursion.
3) Determine the displacement of the
condylar head.
Intra – orally
1) Mandible deviates on opening
towards the side of fracture.
2) Painful protrusion or lateral
excursion to the opposite side.
3) Premature contact of the molar
teeth on the side of fracture.
Bilateral condylar fractures
 Inspection & palpation are same as
unilateral.
 Overall mandibular movement is
usually more restricted than in case of
unilateral.
 Mandible may not be deviated.
 The midlines are often coincident,
and premature contact is present
bilaterally on the posterior dentition
with an anterior open bite.
Signs & symptoms
1) Evidence of facial trauma especially in the area of mandible &
symphysis.
2) Localized pain & swelling in the region of TMJ.
3) Limitation in mouth opening..
4) Blood in the external auditory canal.
5) Pain on palpations. Lack of condylar movement on palpation
6) Difficulty in lateral excursion as well as protrusion.
7) Occurrence of anterior open bite with bilateral subcondylar fractures.
8) Persistent cerebrospinal fluid leak through the ear: associated
fracture of the middle cranial fossa.
Radiographic imaging
1) OPG
2) Bilateral lateral oblique.
3) Towne view.
4) Reverse Towne view.
5) Computed Tomography.
6) TMJ views
7) CBCT
CT Scan
INTRACAPSULAR FRACTURES
A. Fracture line run above attachment point of lateral pterygoid.
1) Tenderness in auricular region.
2) Painful limitation of mouth opening.
3) Occlusal derangement.
4) No functional loss.
B. Fracture line below the attachment of lateral pterygoid.

1) Functional loss of the muscle during opening of mouth.
2) Lateral deviation of mandible to injured side.
Objectives of management
AAOMS 2017 Parameters
A. Favorable therapeutic outcomes.
I. Osseous union.
II. Restored joint anatomy & physiology.
III. Primary Healing.
IV. Normal speech, deglutition & respiration.
V. Pre injury occlusion
VI. Limited period of disability
VII.Adequate mobilization
B. Limit Complications
I. Ankylosis
II. Nonunion
III. Growth disturbance
IV. Facial asymmetry
Conservative therapy
 Involves no surgical intervention of the fracture site.

 It reduces the fracture taking occlusion as a key factor.
 Immobilization usually involves fixation with arch bars, eyelet wires
or splints.
 Period of immobilization varies from 7-17 days
:Indications
1) Non displaced or incomplete fractures.
2) Condylar neck fractures with little or no displacement .
3) Fractures occurring in children (10-12 yrs).
4) Isolated Intracapsular fractures.
5) Medical illness or injury that inhibits the ability to receive extended
GA
Conservative-functional management
 Exercise
I. Increasing mouth opening •

II. Push the jaws laterally
 Diet: Soft diet.
 Analgesics: Anti-inflammatory •
 Soft diet and mouth exercises
I. Teeth into normal occlusion

II. Adequate Range of motion.
 Elastic MMF for 2-3 weeks.
I. When occlusion is found to be altered.

CONSERVATIVE TREATMENT Achieved by:
1) Wiring:
I. Ivy loop wiring.
II. Gilmer wiring.
III. Continuos ivy loop wiring.
2) Arch bars: Erich arch bar.

3) Splints:
I. Cap splints in pediatric patients.
II. Gunning splints in edentulous patients.
Functional exercise:
 > 40 mm interincisal distance (adult).
 >10 mm lateral excursion.
 > 12 mm protrusion.
Types of exercise:
 Maximal mouth opening.
 Right lateral excursion.
 Left lateral excursion.
 Protrusive action
INDICATIONS FOR NON SURGICAL
TREATMENT
1) Non displaced or incomplete fractures.
2) Isolated intracapsular fractures without loss of ramus height.
3) Condylar neck fractures in children ( < 12 yrs. )
4) Reproducible occlusion.
5) Medical illness or injury that inhibits ability to receive extended
general anesthesia
Open Reduction
:Advantage
1) direct approach to the facture site.
2) prevent complications such as respiration disorder, pronunciation
disorder, and severe nutritional imbalance by shortening
intermaxillary fixation period via rigid fixation.
:Disadvantage
3) injury of nerves or blood vessels during operation, and postoperative
complications including infection.
4) permanent scar
PEDIATRIC CONDYLAR FRACTURE
 Adequate range of motion and occlusion

 Immobilization- acrylic splint with circumandibular wiring.
 2-5 years- teeth can be used for fixation.
 6- 12 years- primary roots are being resorbed.
 Combinations of MMFs used to immobilize jaw.
 Anchors – primary molars and incisors.
 MMF – 7 to 14 days to reduce pain and to correct minor
maloclusion

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CONDYLAR FRACTURES

PRESENTED BY DR- MUFTAH

Lateral pterygoid muscle :

2) Hemorrhage from ear on that side.

II. middle ear hemorrhage

B. Fracture line below the attachment of lateral pterygoid.

 Involves no surgical intervention of the fracture site.

I. Increasing mouth opening •

I. Teeth into normal occlusion

I. When occlusion is found to be altered.

2) Arch bars: Erich arch bar.

 Adequate range of motion and occlusion

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