Condylar fractures new 3 (nx power-lite) /certified fixed orthodontic courses by Indian dental academy


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  • Condylar fractures new 3 (nx power-lite) /certified fixed orthodontic courses by Indian dental academy

    1. 1. Surgical Approaches INDIAN DENTAL ACADEMY Leader in continuing dental education
    2. 2. Surgical Approaches The various incisions to approach the condyle are :1. Submandibular 2. Preauricular 3. Endaural 4. Retromandibular 5. Intra oral 6. Hemicoronal approach
    3. 3. Surgical Approaches Submandibular approach Most suitable for ramus fractures and for low fractures of the condylar neck Can be combined with an endaural incision for total joint reconstruction
    4. 4. Surgical Approaches Preauricular & Endaural   appropriate for repositioning and fixing intracapsular and very high condylar fractures Under certain conditions it can also be used, together with a sub­ mandibular access, for high temporomandibular joint fractures that access are difficult to reduce Incision Dissection
    5. 5. Surgical Approaches Preauricular & Endaural Dissection above the arch - to sup temp plane Below the arch – just superficial to tragal cartilage To the bone – The structures within the flap raised off the arch contain skin, supf templ vessels and nerves, Facial n braches, Sup temp fascia & if taken more superiorly – temporal fascia
    6. 6. Surgical approaches Retromandibular / Posterior mandible approach This approach is indicated for low and high condylar fractures incision begins 0.5 cm below the lobe of the ear and continues inferiorly for 3-3.5 cm.
    7. 7. Surgical Approaches Intra oral approach Only for low fractures of the TMJ It was initially proposed by Steinhauser • Advantage No visible scars but this is offset by the lack of good vision
    8. 8. Treatment options 1. NoNsurgical/coNservative/closed Soft diet Intermaxillary fixation Post treatment jaw exercise Physiotherapy 2. surgical/ opeN Open reduction- hooks, forceps.. Osteosymthesis- wires, Lag screw, Miniplates, pin fixation..
    9. 9. Treatment Modalities Surgical approach Conservative-functional approach Open reduction of fracture segment with osteosynthesis The main objective is to perform a repositioning of the fractured condyle as near to its anatomical position as possible to produce an acceptable functional psuedoarthrosis by re-educating the neuromuscular pathways “The main aim encourage movement of the early as possible” is to active jaw as
    10. 10. Methods of Reduction
    11. 11. Methods of Osteosythesis
    12. 12. Methods of Osteosythesis – Miniplate fixation
    13. 13. Methods of Osteosythesis – Wiring First - Perthes and Wassmund - Wires in 1924 and 1927 A. Silverman(1925) B. Thoma(1942)
    14. 14. Methods of Osteosythesis – K Wire K wire fixation -- Stephenson
    15. 15. Methods of Osteosythesis – Lag Screw Lag Screw fixation - Eckelt
    16. 16. Controversies in Treatment
    17. 17. Controversies in Treatment “There has been too much discussion in the literature relative to the treatment of condylar fracture. Two schools of thought..” “ The debate continues about the best way to manage condylar process fractures; Is open reduction a superior method of treatment compared with closed reduction?”
    18. 18. Controversies in Treatment The limitations that existed in the early days  Rudimentary radiographic techniques  hazards of anasthesia  vulnerability to infection - preantibiotic era  lack of rigid fixation The advances in the modern era  Better diagnosis & management for facial injuries  Safer intra & post operative anesthetic management  Decreased risk of infections  More precise methods of fixation
    19. 19. Controversies in Treatment Landmark Studies Edward Ellis III & Gaylord Thockmorton-JOMS 2005 “Treatment of condylar process fractures” Summary of current treatment options1. 2. 3. A period of MMF followed by functional therapy Functional therapy without MMF Open reduction & Internal fixation
    20. 20. Goals of treatment
    21. 21. Goals of treatment 1. 2. 3. 4. 5. 6. 7. Obtain stable & functional occlusion Restore maximal interincisal opening Establish a full range of mandibular excursive movements Minimize deviation of the mandible Produce a pain-free articular apparatus at rest and during function Avoid internal derangement of the TMJ on the injured or the contralateral side Avoid the long-term complications of growth disturbance
    22. 22. Indications of Open Method - Zide & Kent, Raveh et al Absolute indications 1. Limitation of function secondary to the following: Fracture into middle cranial fossa Foreign body within the joint capsule Lateral extracapsular dislocation of condylar head 2. Other fracture dislocations in which a mechanical stop is present on opening which is confirmed radiographically 3. Inability to bring the teeth into occlusion for closed reduction 4. Open injury (penetrating, avulsive, lacerating) to the
    23. 23. Indications of Open Method Relative indications 1. 2. 1. 2. 3. Bilateral condylar fractures with comminuted midface fractures in which rigid internal fixation of the midface is not possible Situations when intermaxillary fixation is not feasible as a result of the following: Medical restrictions Poorly controlled seizure disorder Psychiatric disorders Severe mental retardation Concomitant injuries such as head injury or chest injury Displaced fractures where dentures or splints are not feasible because of severe mandibular atrophy Bilateral fractures in which it is impossible to determine what the proper occlusion is
    24. 24. Closed Method  Range of treatment options available - observation and soft diet, variable periods of immobilization &/or intense physiotherapy  Close supervision is mandatory  Need for immobilization - when malocclusion, deviation with function, &/or pain is present.  The period of immobilization - must be long enough to allow initial union of the fracture segments but short enough to prevent complications  Active functional therapy allows a return of mandibular range of motion and functional movements  Guiding elastics should be used to direct the mandible to its maximal intercuspation.
    25. 25. Special considerations
    26. 26. Special considerations – Children •Condylar fractures are relatively common •Green stick fractures are more common Mandibular fracture incidence in children    Hall et al – 20.7% (<14 yrs) Kaban et al – 32% (< 16 yrs) Carroll et al – 26.5% Condylar fractures in children Amaratunga - Hall ~ 40-60% Etiology Falls (30-50%) Vehicle accidents (26-34%) Sports related injury (15%) Assault (3%)
    27. 27. Special considerations – Children Suggested protocol for treatment of condylar fractures in children  Nearly all cases- conservatively treated with immediate function & analgesics  In cases with pain & malocclusion – brief period of IMF – 7-10 days followed by active function  As for adults, close supervision & follow up is mandatory  Early mobilization & active physical therapy aimed at increased range of mandibular motion & prevents ankylosis & growth alteration
    28. 28. Complications EARLY COMPLICATIONS Complications that occur concurrent with or early after treatment of condylar fractures include the following 1. Fracture of the tympanic plate - otorrhea 2. Fracture of the glenoid fossa with or without dis­placement of the condylar segment into the middle cranial fossa – nuerological signs 3. Damage to cranial nerves V and VII – traumatic/post op 4. Vascular injury
    29. 29. Complications LATE COMPLICATIONS Late complications of condylar fractures commonly include the following: 1. 2. 3. Malocclusion Growth disturbances Temporomandibular joint dysfunction (Internal derangement) 4. Ankylosis
    30. 30. Thank you For more details please visit