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Its a question on wich i made this presentation .need guideline to improve it further

Its a question on wich i made this presentation .need guideline to improve it further



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Dr.athar Dr.athar Presentation Transcript

  • Differentiate B/W displaced and dislocated condyle fracture,and how will you manage bilateral condylar fractures
  • 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
  • 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
  • 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
  • Palpation  Tenderness over both condylar regions  Anterior and posterior palpation and check up for the condyle movements  Step deformity  Crepitations
  • IntraoralAnterior 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
  • Radiographic Examination  OPG  PA Face  Reverse townes view  CT Scan(for head and intracapsular #)  MRI(for disc position)   Diagnosis
  • 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
  • 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
  • Relationship B/W condylar head and glenoid fossa  Non displaced  Displaced  Dislocated
  • On the basis of age and Occlusion Age  A) under 10 years  B) 10-17 years  C) Adult Occlusion  Disturbed  Undisturbed
  • 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
  • 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
  • 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
  • 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
  • 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
  • Gunnings splints
  • 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
  • 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.
  • Various surgical approaches to Condyle fracture Submandibular approach Retromandibular approach Pre auricular and auricular approach Coronal
  • 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
  • Complications I. Ankylosis(less than 12 year) II. Growth restriction III. Disturbance in mandibular movements