condylar fractures

1. Classification of Condylar
Fractures

2.  The topic of Mandibular Condylar fracture has
generated more discussion and controversy than
any other in the field of maxillofacial trauma.
 Condylar and Subcondylar fractures accounting
for approx 30% (DENTATE)to 37%
(EDENTATE)of all mandibular fractures.
 Condyle is the major growth centre for the
mandible.

4.  Condylar fractures can be extracapsular or
intracapsular, undisplaced, deviated,
displaced, or dislocated.Treatment depends
on the age of the patient, the co-existence of
other mandibular or maxillary fractures,
whether the condylar fracture is unilateral
or bilateral,the level and displacement of
fracture,the state of dentition and dental
occlusion.

6.  As mandibular condyle fracture may cause
long-term complications such as
malocclusion, particularly open bite, reduced
posterior facial height, and facial asymmetry
in addition to chronic pain and mobility
limitation, great caution should be taken…

7. 1-K.E imparted by moving
object
2-K.E derived from
movement of the individual
3-K.E as a summation of
both forces

10. (ROW and KILLEYS’
CLASSIFICATION)

11.  5Types
Wassmunds Classification – 1934
• Type I – Fracture of condyle with slight displacement of
head with angle of 10-45 degree between head and ramus
– reduces spontaneously
•Type II – Angle of 45 – 90 degree between head and ramus,
tearing of medial portion of capsule
•Type III – Fragments not in contact, head displaced
medially and forward due to lat. Pterygoid pull/spasm,
fragments is within glenoid fossa, capsule is torn and head
is out side the capsule – open reduction advocated
•Type IV –Fractured head articulates on/forward to articular
eminence
•TypeV –Vertical/oblique fracture through head of condyle
– rare

12.  Lindhal’s classification:- Comprehensive
classification (1977) Lindahl proposed a
classification based on several factors namely
1. The anatomic location of the fracture
2. The relation of the condylar segment to the
mandibular segment
3. The relation of the condylar head to the
articular fossa

13.  1-BASED ON ANATOMICAL LOCATION Depending
on fracture level i. ii. iii. Condylar head # Condylar
neck # Subcondylar #(below neck)RESPECTIVELY.
 2-BASED ON RELATIONSHIP OF CONDYLAR
FRAGMENTTO MANDIBLE:
 i. Undisplaced (fissure fracture) (B) ii. Deviated –
simple angulation of the condylar process in i.r.t distal
mandibular segment without overlap.(C) iii. Displaced
with medial overlap (D) iv. Displaced with lateral
overlap (E) v. Antero-posterior overlap – possible but
are seldom seen. (F) vi.Without contact between
fragments

14.  RELATIONSHIP OF CONDYLAR HEADTO
FOSSA:
 i. No displacement- condylar head appears in
normal prelation with fossa ii. Displacement
– condylar head is in fossa but there is
alteration of joint space. Joint space is
increased iii. Dislocation –The condylar
process is completely out of the fossa.

15.  INJURYTO MENISCUS:
It may be torn, ruptured or herniated in forward
or backward direction.

16.  MacLennan Classification: 1952 –Clinical Classification
Type I: No displacement Type II: Fracture deviation –
simple angulation of the fracture segments without
overlap or separation. Ex. Green stick fracture in children
Type III: Fracture displacement –when there is overlap of
fracture fragments.This overlap may be in an anterior,
posterior, lateral or medial. Medial is commonest. Type IV:
Fracture dislocation – here the condylar head is
completely dislocated out of the articular fossa and out of
the capsular confines. Again dislocation can be medial or
lateral and rarely anterior or posterior. TypeV : High
condylar fracture with luxation TypeVI : Head fracture or
intracapsular fracture

17.  Evidence of soft tissue injury ex chin
lacerations.
 Facial asymmetry with chin deviation.
 Noticeable swelling over the affectedTMJ.
 Pain and swelling over affectedTMJ.
 Malocclusion
 Deviation of mandible to same side during
opening.
 Bleeding from ExternalAuditory canal.
 Inability to palpate condylar movement.
 Limited Mouth Opening and pain due to
muscle splinting.

18. CONVENTIONAL RADIOGRAPHY
 P.A view
 LateralOblique
 Panoramic
 ReverseTownes
 TMJ views
CT
MRI

19.  Concerning the treatment for Condylar
Fracture,”it seems that the battle will rage
forever between the extremists who urge
non-operative treatment in particularly every
case and the other extremists who advocate
open reduction in almost every case ! “ Malkin

20. Open Reduction is a must if:
 BilateralCondylar fracture
 Gunshot injury/compound fracture
 Lateral displacement of condyle
 Open bite
 Condyle displaced in middle cranial fossa
 Interlocked condyle
 In case of any medical concern,i-e
COPD,Asthma,seizures,mental/neurological/
learning problem.

21. Whether going for Open or Closed Reduction,
the goals of Rx should always be :
 Relief from pain
 Stable occlusion
 Restoration of inter-incisal opening
 Full range of mandibular movement
 To minimize deviation
 Avoid growth disturbances
 Avoid Ankylosis