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
o Based on anatomic location of the fracture(level of
condylar fracture)
Condylar head
Condylar neck
Subcondylar.,
o 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

7. o 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

8. 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.

9. 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.

10. 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’.

11. 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.

12. 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

13. 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.

14. 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.

18. Principle of treatment of condylar fracture
Conservative
Functional
Surgical

19. 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

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

21. 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.

22. 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

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

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

33. 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.

34. 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.

35. 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.

36. 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

37. 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.

38. 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.

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

40. Damage to meniscus
2.interferance with growth