CONDYLAR FRACTURES

INDIAN DENTAL ACADEMY
Leader in continuing dental education
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www.indiandent...
Surgical Anatomy

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Differences in Adult and
Pediatric Condyles

Parameter

Child

Adult

1 Cortical bone

Thin

Thick

2 Condylar neck

Broad...
Differences in Adult and
Pediatric Condyles

www.indiandentalacademy.com
MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Condylar Fractures
Etiology
Classification
Clinical features
Radiological inve...
MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Condylar Fractures
Etiology
Indirect injury - Chin
Direct injury - Zygoma

www...
Mechanism of fractures

A few com on injury patterns
m

 A direct blow to the TMJ region – fracture of condyle
 A blow t...
Mechanism of injury
  According to Lindahl, the forces causing damage to
the joint are of three main types
 
1. Kinetic en...
Mechanism of injury
2. Kinetic energy derived from the moving individual striking
a static object
ex a child slipping and ...
Mechanism of injury
3. Kinetic energy, which is the sum of, forces due to
combination of factors 1 and 2
Ex RTA where a pe...
MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Condylar Fractures
Etiology
Classification
Clinical features
Radiological inve...
MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Condylar Fractures
Classification
Anatomical: Intra / extra capsular
Unilatera...
MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Condylar Fractures
Classification
Level of #

Head

HEAD (Intra capsular)

Nec...
MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Condylar Fractures
Classification
Relationship to mandible
Undisplaced
Deviate...
MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Condylar Fractures
Classification
Relationship to glenoid fossa

Undisplaced

...
www.indiandentalacademy.com
MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Condylar Fractures
Etiology
Classification
Clinical features
Radiological inve...
MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Condylar Fractures
Clinical features
Pain & Tenderness
Painful limitation in m...
MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Condylar Fractures
Clinical features - Unilateral # condyle
Deviation to affec...
MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Condylar Fractures
Clinical features - Bilateral # condyle
Gagging of posterio...
MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Condylar Fractures
Radiographic investigations
2 radiographs @ right angles
OP...
www.indiandentalacademy.com
MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Condylar Fractures
Etiology
Classification
Clinical features
Radiological inve...
MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Condylar Fractures

Management (Conservative)
No active treatment
Immobilizati...
Closed Method
• Range of treatment options available - observation and soft diet,
variable periods of immobilization &/or ...
MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Condylar Fractures

Management (Surgical)
Open reduction & fixation
Grossly di...
Indications of Open Method
1.
2.

1.
2.
3.

Relative indications

Bilateral condylar fractures with comminuted midface
fra...
Surgical Approaches
The various incisions to approach the condyle
are :1. Submandibular
2. Preauricular
3. Endaural
4. Ret...
Surgical Approaches
Submandibular approach
Most suitable for ramus fractures and for low fractures of the
condylar neck
Ca...
Surgical Approaches
Preauricular & Endaural
• appropriate for repositioning and fixing intracapsular and very high
condyla...
Surgical Approaches
Preauricular & Endaural

Dissection above the arch - to sup temp plane
Below the arch – just superfici...
Surgical approaches
Retromandibular / Posterior mandible approach
This approach is indicated for low and high condylar
fra...
Surgical Approaches
Intra oral approach

Only for low fractures of the TMJ
It was initially proposed by
Steinhauser
• Adva...
Methods of Osteosythesis –
Miniplate fixation

www.indiandentalacademy.com
Special considerations –
Children
Suggested protocol for treatment of condylar fractures in
children
• Nearly all cases- c...
MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Condylar Fractures
Etiology
Classification
Clinical features
Radiological inve...
MAXILLOFACIAL INJURIES
MANDIBULAR FRACTURES
Condylar Fractures
Complications
Malocclusion
Damage to teeth
TMJ pain
Ankylos...
Complications
EARLY COMPLICATIONS
Complications that occur concurrent with or early after
treatment of condylar fractures ...
Complications
LATE COMPLICATIONS

Late complications of condylar fractures commonly
include the following:
1.
2.
3.

Maloc...
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Leader in continuing dental education

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www.indiandentalacademy.com
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Condylar fractures /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
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  • Condylar fractures /certified fixed orthodontic courses by Indian dental academy

    1. 1. CONDYLAR FRACTURES INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
    2. 2. Surgical Anatomy www.indiandentalacademy.com
    3. 3. Differences in Adult and Pediatric Condyles Parameter Child Adult 1 Cortical bone Thin Thick 2 Condylar neck Broad Thin 3 Articular surface Thin Thick 4 Capsule Highly vascular Less vascular 5 Periosteum Highly active – in osteogenic phase Less active in latent stage 6 Intracapsular hemarthrosis. fracture & Very common 7 Remodelling capacity following Present trauma www.indiandentalacademy.com Likely 8 Disturbance in growth Rare Absent N.A
    4. 4. Differences in Adult and Pediatric Condyles www.indiandentalacademy.com
    5. 5. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Condylar Fractures Etiology Classification Clinical features Radiological investigations Treatment options Complications www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
    6. 6. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Condylar Fractures Etiology Indirect injury - Chin Direct injury - Zygoma www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
    7. 7. Mechanism of fractures A few com on injury patterns m  A direct blow to the TMJ region – fracture of condyle  A blow to the mandibular body in a horizontal direction – ipsilateral body & contralateral condyle fracture  A force on the parasymphysis region can cause ipsilateral or bilateral condylar fracture as well as localized parasymphysis fracture  An axially directed force to the parasymphysis – bilateral Condylar fracture with symphyseal or parasymphyseal fracture It can further be associated with fracture of the glenoid fossa with penetration into the middle cranial fossa or fracture of the tymphanic plate causing damage to the external acoustic meatus www.indiandentalacademy.com
    8. 8. Mechanism of injury   According to Lindahl, the forces causing damage to the joint are of three main types   1. Kinetic energy imparted by a moving object through the tissues of a static individual. Ex by a fist, cricket bat or ball www.indiandentalacademy.com
    9. 9. Mechanism of injury 2. Kinetic energy derived from the moving individual striking a static object ex a child slipping and striking the pavement or a fall during an epileptic fit or parade ground fracture www.indiandentalacademy.com
    10. 10. Mechanism of injury 3. Kinetic energy, which is the sum of, forces due to combination of factors 1 and 2 Ex RTA where a person in a moving car strikes his chin across the dashboard www.indiandentalacademy.com
    11. 11. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Condylar Fractures Etiology Classification Clinical features Radiological investigations Treatment options Complications www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
    12. 12. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Condylar Fractures Classification Anatomical: Intra / extra capsular Unilateral / bilateral Radiographic 2 radiographs @ Right angle OPG, PA mandible 1) Level of # 2) Relationship to mandible www.indiandentalacademy.com 3) Relationship to glenoid fossa MAXFAC SDM DHARWAD
    13. 13. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Condylar Fractures Classification Level of # Head HEAD (Intra capsular) Neck Sub Condylar NECK SUB CONDYLAR # www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
    14. 14. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Condylar Fractures Classification Relationship to mandible Undisplaced Deviated Displaced www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
    15. 15. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Condylar Fractures Classification Relationship to glenoid fossa Undisplaced Displaced www.indiandentalacademy.com Dislocated GK / MAXFAC SDM DHARWAD
    16. 16. www.indiandentalacademy.com
    17. 17. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Condylar Fractures Etiology Classification Clinical features Radiological investigations Treatment options Complications www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
    18. 18. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Condylar Fractures Clinical features Pain & Tenderness Painful limitation in mouth opening Occlusal derangement Bleeding from ear www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
    19. 19. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Condylar Fractures Clinical features - Unilateral # condyle Deviation to affected side Midline shift Lateral movements limited GK / MAXFAC SDM DHARWAD www.indiandentalacademy.com
    20. 20. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Condylar Fractures Clinical features - Bilateral # condyle Gagging of posterior teeth Anterior open bite Lateral movements limited GK / MAXFAC SDM DHARWAD www.indiandentalacademy.com
    21. 21. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Condylar Fractures Radiographic investigations 2 radiographs @ right angles OPG, PA mandible Optional : Trans Pharyngeal Trans Cranial Trans Orbital C.T coronal views www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
    22. 22. www.indiandentalacademy.com
    23. 23. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Condylar Fractures Etiology Classification Clinical features Radiological investigations Treatment options Complications www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
    24. 24. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Condylar Fractures Management (Conservative) No active treatment Immobilization (7-10 days) Active physiotherapy www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
    25. 25. 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. www.indiandentalacademy.com
    26. 26. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Condylar Fractures Management (Surgical) Open reduction & fixation Grossly dislocated #s www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
    27. 27. Indications of Open Method 1. 2. 1. 2. 3. Relative indications 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 www.indiandentalacademy.com
    28. 28. Surgical Approaches The various incisions to approach the condyle are :1. Submandibular 2. Preauricular 3. Endaural 4. Retromandibular 5. Intra oral 6. Hemicoronal approach www.indiandentalacademy.com
    29. 29. 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 www.indiandentalacademy.com
    30. 30. 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 www.indiandentalacademy.com Incision Dissection
    31. 31. 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 www.indiandentalacademy.com – temporal fascia taken more superiorly
    32. 32. 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. www.indiandentalacademy.com
    33. 33. 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 www.indiandentalacademy.com
    34. 34. Methods of Osteosythesis – Miniplate fixation www.indiandentalacademy.com
    35. 35. 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 www.indiandentalacademy.com ankylosis & growth alteration
    36. 36. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Condylar Fractures Etiology Classification Clinical features Radiological investigations Treatment options Complications www.indiandentalacademy.com GK / MAXFAC SDM DHARWAD
    37. 37. MAXILLOFACIAL INJURIES MANDIBULAR FRACTURES Condylar Fractures Complications Malocclusion Damage to teeth TMJ pain Ankylosis Open reduction Scar Nerve damage Intra-operative haemorrhage www.indiandentalacademy.com Avascular necrosis GK / MAXFAC SDM DHARWAD
    38. 38. 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 www.indiandentalacademy.com
    39. 39. 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 www.indiandentalacademy.com
    40. 40. www.indiandentalacademy.com
    41. 41. www.indiandentalacademy.com Leader in continuing dental education THANK YOU www.indiandentalacademy.com

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