1. CCOONNDDYYLLEE FFRRAACCTTUURREE
Dr V.RAMKUMAR
CONSULTANT DENTAL&FACIOMAXILLARY
SURGEON
REG NO: 4118- TAMILNADU- INDIA( ASIA)

2. ETIOLOGY - MMEECCHHAANNIISSMM OOFF IINNJJUURRYY
LINDAHL (1977) PROPOSED 3 MECHANISMS OF INJURY TO THE CONDYLE.
1. Kinetic energy imported to the static individual by a moving
object.
2. Kinetic energy derived from the movement of the individual and
expended upon a static object.
3. Kinetic energy which is a summation of forces derived from a
combination of 1 & 2.

3. CCLLIINNIICCAALL CCLLAASSSSIIFFIICCAATTIIOONN
SSppiieessssll && SScchhrroollll 11997722
Type I - No displacement
Type II - Fracture deviation
Type III - Fracture displacement
Type IV - Fracture dislocation

4. COMPREHENSIVE
CLASSIFICATION (LINDAHL
1977)
FRACTURE LEVEL
Condylar head or intracapsular
fracture
Condylar neck fracture
Subcondylar fracture

5. RELATIONSHIP OF CONDYLAR
FRAGMENT TO MANDIBLE
Undispladed fracture
Deviated – simple angulation
Displaced: - medial or lateral
overlap.
- anterior or
posterior overlap
No contact between fragments

6. RELATIONSHIP OF
CONDYLAR HEAD TO FOSSA
> No displacement
> Displacement
> Dislocation

7. CLINICAL FEATURES OOFF SSUUBBCCOONNDDYYLLAARR
FFRRAACCTTUURREESS
* Contusion, abrations, laceration of chin, ecchymosis and
hematoma in the temperomandibular joint region
* Laceration or bleeding of external auditory canal.
* Swelling over TMJ - secondary to hematoma, edema, in
indicating laterally dislocated condylar head.
* Facial asymmetry - secondary to foreshortening of
mandibular ranus.
* Pain and tenderness spontaneously or in response to
pressure.
* Deviation of mandibular midline towards the fracture side.
.

8. SCHOOL OOFF TTHHOOUUGGHHTTSS IINN
MMAANNAAGGEEMMEENNTT
CONSERVATIVE - FUNCTIONAL -
SURGICAL

9. DDIIAAGGNNOOSSTTIICC AAIIDDSS AANNDD IITTSS
RROOLLEEDD IINN TTRREEAATTMMEENNTT PPLLAANN
* CONVENTIONAL RADIOGRAPHY (in common use)
- Orthopantomogram
- Lateral oblique view mandible
- Reverse towens view mandible
- P.A. view skull
- Trans cranial views of TMJ

10. *CONVENTIONAL TOMOGRAPHY
- Coronal or saggital plane may provides useful
information
- Three dimensional CT scans indicates shift of the
condyle either anteriorly or medially deciding the
treatment plan.
* ARTHROGRAPHY
- Evaluates soft tissue components especially disk
position, function and shape during capsular
damage

11. AABBSSOOLLUUTTEE AANNDD RREELLAATTIIVVEE IINNDDIICCAATTIIOONN OOFF
OOPPEENN RREEDDUUCCTTIIOONN((ZZIIDDEE AANNDD KKEENNTT))
ABSOLUTE INDICATIONS:
* To restore vertical and anterioposterior
facial dimention
* When stability of occlusion is limited (less
than 3 teeth per quadrant, gross,
periodontal diseases, skeletal abnormality)
* When rigid internal fixation is used to
address other facial fractures affecting the
occlusion
* when manipulation and closed treatment
cannot re-establish the pre tramatic
occlusion
* Invation of the foreign body

12. RREELLAATTIIVVEE IINNDDIICCAATTIIOONNSS
((ZZIIDDEE AANNDD KKEENNTT))
* Edentulous jaws
* Uncontrolled seizure disorders
* Status asthmaticus.
* Psycologic compromise

13. ROLE OF FUNCTIONAL
SCHOOL OF THOUGHT IN
MANAGEMENT
WHEN - WHY -
HOW?

14. OOPPEENN RREEDDUUCCTTIIOONN
AAPPPPRROOAACCHHEESS AANNDD AADDVVAANNTTAAGGEESS
PRE AURICULAR APPROACH
* An incision of the Alkayat & Bramley type for high condylar
and neck fractures.
* Condyle can be exposed for almost half of its depth in
addition to lateral aspects
* Branches of facial nerve are avoided
* Postoperative scar hidden

15. OOPPEENN RREEDDUUCCTTIIOONN
AAPPPPRROOAACCHHEESS AANNDD AADDVVAANNTTAAGGEESS
RETROMANDIBULAR APPROACH
* A Risdon type submandibular incision gives good access of
low sub condylar fractures. (Basal # dislocation)
* Osteosynthesis with wire ligature or mini plates may be
accomplished

16. OOPPEENN RREEDDUUCCTTIIOONN
AAPPPPRROOAACCHHEESS && AADDVVAANNTTAAGGEESS
BICORONAL APPROACH

17. RRIIGGIIDD IINNTTEERRNNAALL FFIIXXAATTIIOONN
DDIIVVIICCEESS && AADDVVAANNTTAAGGEESS
COMPRESSION PLATE OSTEOSYNTHESIS

18. 33 DDIIMMEENNSSIIOONNAALL PPLLAATTIINNGG
COMPRESSION PLATE OSTEOSYNTHESIS

19. TRANSOSSEOUS WIRING

20. PPEETTZZEEDD LLAAGG SSCCRREEWWSS
OOSSTTEEOOSSYYNNTTHHEESSIISS
INTRA MEDUALLARY SCREWS

22. KRISCHNER WIRE

23. CCLLOOSSEEDD RREEDDUUCCTTIIOONN && MMAAXXIILLLLOO
MMAANNDDIIBBUULLAARR FFIIXXAATTIIOONN
DDIISSAADDVVAANNTTAAGGEESS
- FAILURE OF INDIRECT REDUCTION.
* When Condyle has incompletely penetrated the capsule
assumes a cuff-life position around the neck of the condyle
interfering with repositioning.
* Connection between the peripheral mandibular fragment and
dislocated small fragment is torn so that force is not
transmitted to the fragment.
* The rate of dyfunction like malocclusion, reduced mouth
opening, deviation, impaired masticatory function, pain over
affected joint.

24. CCLLOOSSEEDD RREEDDUUCCTTIIOONN && MMAAXXIILLLLOO
MMAANNDDIIBBUULLAARR FFIIXXAATTIIOONN
AADDVVAANNTTAAGGEESS
- The Risks associated with surgical intervention are
compensated.
- Economic point of view hospitalization can be dispensed with,
were two periods of hospitalization are necessary for surgical
treatment.

25. RREETTRROOSSPPEECCTTIIVVEE SSTTUUDDYY 66
YYEEAARRSS ((11999966 -- 22000022))
- Total number of # in 6 years - 435 cases
- Condylar fractures 72
Types of Condylar fractures - undisplaced = 34
- displaced = 24
- deviated = 8
- dislocated = 6
Type of treatment - Conservative = 59
- Functional = 7
- Surgical = 6

26. 70
60
50
40
30
20
10
0
Conservative Functional Surgical
No. of condylar fractures

27. CCOOMMPPLLIICCAATTIIOONN
CCOONNSSEERRVVAATTIIVVEE VVSS OOPPEENN RREEDDUUCCTTIIOONN
- Conservative method - necrosis of high condylar segment
- occlusal derangement
- Open reduction - Plate infection
(Warranted plate removal)
- Transient facial nerve palsy
(zygomatico temporal)

28. - Complication % of
Open Reduction - 15%
- Complication % of
Conservative Management - 6%

29. HHaavvee wwee
rreeaacchheedd ttoo aa
ccoonncclluussiioonn??