Dr.athar

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Dr.athar

  1. 1. Differentiate B/W displaced and dislocated condyle fracture,and how will you manage bilateral condylar fractures
  2. 2. 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
  3. 3. 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
  4. 4. 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
  5. 5. Palpation  Tenderness over both condylar regions  Anterior and posterior palpation and check up for the condyle movements  Step deformity  Crepitations
  6. 6. 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
  7. 7. Radiographic Examination  OPG  PA Face  Reverse townes view  CT Scan(for head and intracapsular #)  MRI(for disc position)   Diagnosis
  8. 8. 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
  9. 9. 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
  10. 10. Relationship B/W condylar head and glenoid fossa  Non displaced  Displaced  Dislocated
  11. 11. On the basis of age and Occlusion Age  A) under 10 years  B) 10-17 years  C) Adult Occlusion  Disturbed  Undisturbed
  12. 12. 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
  13. 13. 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
  14. 14. 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
  15. 15. 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
  16. 16. 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
  17. 17. Gunnings splints
  18. 18. 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
  19. 19. 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.
  20. 20. Various surgical approaches to Condyle fracture Submandibular approach Retromandibular approach Pre auricular and auricular approach Coronal
  21. 21. 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
  22. 22. Complications I. Ankylosis(less than 12 year) II. Growth restriction III. Disturbance in mandibular movements
  23. 23. THANK YOU

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