This document discusses condylar fractures, including signs and symptoms, diagnostic aids, imaging techniques, treatment protocols, and surgical approaches. Common signs are pain, limited jaw movement, muscle spasms, jaw deviation, and malocclusion. Diagnostic aids include panoramic x-rays, CT scans, and MRI. Treatment may involve physical therapy, closed reduction with jaw fixation, open reduction with plates or screws, or endoscopic-assisted reduction. Surgical approaches for open reduction are preauricular for the condylar head or retromandibular for the neck.

1. Atef Fouda
Part II

3. Condylar fracture:
Signs and symptoms:
-Pain or tenderness.
-Restriction of movement.
-Muscle spasms.
-Mandibular deviation.
-Malocclusion.
-Pathologic alterations of the TMJ.
-Facial asymmetry.
-Ankylosis may be evident later.
Diagnosis:

4. Condylar fracture:
Diagnostic aids
Panoramic x-ray
Towne’s view-AP view.

5. C.T scan.
Indications:
Plain x-ray with negative results.
Pain with function.
Tenderness on TMJ region.
Swelling at the area of TMJ
Deviation to the affected side.
Cerebro spinal fluid leak [otorrhea].
Bleeding from external auditory canal [Otorrhagia].
Decrease in hearing acuity or hearing loss.
Coronal cut
Axial and sagittal cuts
Fracture head of the condyle
Fracture of the auditory canal

6. C.T scan.
Coronal cut
Fracture head of the condyle

7. C.T scan.
Axial cut
Fracture of the auditory canal
Condyle
Auditory canal
Sagittal cut
Auditory canal
Condyle
Facial

8. MRI imaging.
Indications:
Patients that will be treated with closed reduction.
[Intra-capsular condition].
Synovitis with effusion

9. MRI imaging.
Retrodiscal effusion
Indications:

10. Condylar fracture:
Etiology of condylar fracture:
It is not frequent to detect condylar fracture as
result of direct trauma, most probably due to
indirect trauma to the mandibular symphyses.

11. Ankylosis.
Injury to the facial nerve and bleeding.
Growth inhibition.
Complications related to the condylar fracture are:
Condylar fracture:
Tympanic bone fracture.
Fracture of auditory bony canal
Fracture of articulating fossa of temporal bone
Dislocation of the condylar segment into the
middle cranial fossa.
Unwanted changes in the condylar head
position.

12. 1- Physical therapy and supportive treatment.
2-Closed reduction with maxillo-mandibular fixation
(MMF).
3-Open reduction with internal fixation (ORIF).
4-Endoscopic-assisted reduction with internal fixation
(ERIF)
Treatment protocol:
Condylar fracture:

13. 1- Physical therapy and supportive treatment.
Isolated Intra-capsular Fractures
Condylar fracture:

14. 2-Closed reduction with maxillo-mandibular
fixation (MMF). For Extra-capsular fracture
Condylar fracture:
Towne’s view + MRI.
Favorable fracture.
•Intra-capsular findings [4 weeks]
•without intra-capsular findings[6 weeks].
Proper reduction should be confirmed by
post-op Towne’s view.

15. Condylar fracture:
3-Open reduction with internal fixation (ORIF).
Indications:
Displaced condyle.
In case of concomitant fractures treated with open
reduction.

16. Principles for selection of the proper mean of
internal fixation.
The mean of fixation should:
1-Be perpendicular to the direction of muscular pull
[displacing] forces.
2- Resist rotation [torsion] forces.
3-Be rigid enough to resist masticatory [tension] forces.

17. Condylar fracture:
Principles for selection of the proper mean of
internal fixation.
Lateral pterygoid
displacing forces
torsion
M MM

18. Condylar fracture:
Lag screw
1-Accessibility is difficult.
2-Rotation of the condylar head
couldn’t be prevented
3-Two lag screw required to prevent
rotation which is not applicable

19. Condylar fracture:
Three-dimensional plates are considered
to give more stability than conventional
two mini plates, however displacement
couldn’t be prevented.
The early rehabilitation and functional loading
was possible after a week of immobilization.
Plate design:
X plate
square plate
linear plate
To avoid immobilisation period two plates
required for fixation with more hardware and
inconvenience.

20. Condylar fracture:
Open reduction and rigid internal
fixation with three-dimensional stability is
absolutely necessary for any sub-condylar
fractures if early functional rehabilitation
required.
Plate design:
square plate
[2000]
M
X plate

21. Condylar fracture:
Delta plate
Plate design:
Delta plate
Used for rigid internal fixation of condylar fractures of
the mandible and fulfills the principles of a functional
and stable osteosynthesis. It has functional and aesthetic
properties.

22. Condylar fracture:
Delta plate
Plate design:
Delta plate
Used for rigid internal fixation of
condylar fractures of the mandible
and fulfills the principles of a
functional and stable
osteosynthesis.

23. Condylar fracture:
Delta plate
Delta plate

24. The modified delta plate with lock system adds more
advantages to the plate.
Lock Delta plate.
The locking plate has the advantages of greater
stability and decreased likelihood of screw
loosening.
Condylar fracture:

25. Condylar fracture:
Rhombic 3D Condylar Fracture Plate.
Martin Rhombic 3D Condylar Fracture Plate
Plate design:
Lock rhombic plate.

26. Condylar fracture:
TCP [Trapezoid-Compression – Plate].

27. Surgical approach
Condylar fracture:
3-Open reduction with internal fixation (ORIF).
Pre auricular approach was
considered the standard and
preferred approach to the head of
the condyle [or intra capsular
fracture].

28. Surgical approach
Condylar fracture:
3-Open reduction with internal fixation (ORIF).
The retro-mandibular [Risdon]
approach was considered the
standard and preferred approach
to the neck of the condyle.

29. 4-Endoscopic-assisted reduction with internal fixation
(ERIF).
Condylar fracture:
Advantages:
1-No ugly scar.
2- Decrease possibility of facial nerve damage.
3-Resist displacing muscular forces.
1-Difficulity in plate removal.
2-Dangerous spaces could be infected.
3-Post operative trismus is frequent.
4-possibility of mandibular nerve damage.
Disadvantages:
1998

30. Disadvantages of open reduction .
Condylar fracture:
1-Ethetic problem from the scar.
2-Risk of facial nerve damage.
3-Foreign material left after treatment.