www.indiandentalacademy.com

Condylar Fractures
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

www.indiandentalacademy.com
Contents
•
•
•
•
•
•
•
•
•
•
•
•

Introduction
Embryology & Surgical anatomy
Mechanism of injury & biomechanical considera...
Introduction
Fracture of the condyle can sometimes be the consequence of
an indirect blow…. the head of the condyle is for...
Introduction
“Concerning the treatment of condylar fractures, it seems
that the battle will rage forever between the extre...
Definition
“A structural break in the normal continuity of bone”
Bailey & Lowe
• Fractures of the mandible - 40 and 62% of...
Incidence

- Luyk NH - 1992

www.indiandentalacademy.com
Incidence
Oikarinen & Malmstrom- Percentage occurrence
of fracture based on site of occurrence -1969
1.3%
33.4%

17.4%
33....
Force Required
Line of force through the
symphysis and TMJ
• A single subcondylar fracture at
193 kg(425 lb)

• A bilatera...
Embryology of Mandibular
Condyle
• Condylar secondary cartilage -10th week i.u - primordium of
the future condyle
• Import...
Embryology of Mandibular
Condyle
• Growth rate increases at puberty , peaks b/w 12-14 years &
ceases at about 20 years of ...
Surgical Anatomy

www.indiandentalacademy.com
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
Mechanism of fractures
W should we know this?
hy
• Simplifies diagnosis
• Helps surgeon to look for parts of the mandible ...
Mechanism of fractures
Factors influencing the fracture sites
Occlusion
whether mouth was open or closed at impact
Directi...
Mechanism of fractures
A few com on injury patterns
m
 A direct blow to the TMJ region – fracture of condyle
 A blow to ...
General nature of injury Rowe & Williams
Three main groups
1. Contusion of the soft tissues of
the joint  
2.  Dislocation...
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...
Classification of condylar
fractures
Rowe & Killey’s classification (1968)
   1.Intracapsular fracture - high condylar fra...
Classification of condylar
fractures
MacLennan Classification: 1952 –Clinical Classification
Type I: No displacement
Type ...
Classification of condylar
fractures
 

Condylar neck fractures classification - Spiessl & Schroll
Type I

Condylar neck f...
Classification of condylar
fractures
Lindhal’s classification:- Comprehensive classification (1977)
Lindahl proposed a cla...
Classification of condylar
fractures
2. The relation of the condylar segment to the mandibular segment

i. Undisplaced (fi...
Classification of condylar
fractures
3. The relation of the condylar head to the articular fossa

i. No displacement- cond...
Clinical examinationExtra oral
Inspection
•
•
•
•
•
•
•
•
•
•

Swelling
Preauricular depression
ecchymosis
lacerations
fac...
Clinical examinationExtra oral
Palpation

Position : The clinician begins the examination from
behind the seated or supine...
Clinical examination –
Intra oral

•
•
•
•
•
•

malocclusion
fracture of the dentition
▲ or ▼ in inter-incisal opening
Pre...
Clinical examination –

Summary
Clinical signs to look for and to rule out - Fonseca
1.

Evidence of trauma – facial contu...
Radiologic Diagnosis
Available Options

 
1. Plain radiographs
View in two dimensions
orthopantomogram view
posterior-ante...
Plain Radiographs
• At least two views at right angles to each other are
necessary – OPG & Reverse Towne’s view
• In the m...
Orthopantomograph & Lateral
oblique views

Anteroposterior plane
Centered on condyles
Open mouth – if poss

R www.indiande...
Computed tomography
 Indications

for CT scans  

1. Significant displacement or dislocation 
2. Limited range of motion w...
Thank you

Thank you

www.indiandentalacademy.com
Leader in continuing dental education
www.indiandentalacademy.com
Upcoming SlideShare
Loading in …5
×

Condylar fractures 2 /certified fixed orthodontic courses by Indian dental academy

3,811 views

Published on


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
0091-9248678078

  • Be the first to comment

Condylar fractures 2 /certified fixed orthodontic courses by Indian dental academy

  1. 1. www.indiandentalacademy.com Condylar Fractures
  2. 2. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  3. 3. Contents • • • • • • • • • • • • Introduction Embryology & Surgical anatomy Mechanism of injury & biomechanical considerations Classification of Condylar fractures Clinical features - examination Radiologic imaging modalities Treatment considerations The controversies in treatment Special considerations Complications Summary & conclusion References www.indiandentalacademy.com
  4. 4. Introduction Fracture of the condyle can sometimes be the consequence of an indirect blow…. the head of the condyle is forced against the prominent margins of the glenoid cavity; and sometimes from a direct blow …..and impinges upon this part of the bone…… it is usually observed to occur in the narrow section which supports the condyle, and below the insertion of the external pterygoid www.indiandentalacademy.com
  5. 5. Introduction “Concerning the treatment of condylar fractures, it seems that the battle will rage forever between the extremists who urge nonoperative treament & other extremists who advocate open reduction in almost every case” www.indiandentalacademy.com
  6. 6. Definition “A structural break in the normal continuity of bone” Bailey & Lowe • Fractures of the mandible - 40 and 62% of all facial fractures • Mandibular fractures are multiple > 50% of the cases • Falls - Subcondylar fractures in 36.3% cases • Most common combinations are angle and opposite body, bilateral body, bilateral angle, and condyle and opposite body www.indiandentalacademy.com
  7. 7. Incidence - Luyk NH - 1992 www.indiandentalacademy.com
  8. 8. Incidence Oikarinen & Malmstrom- Percentage occurrence of fracture based on site of occurrence -1969 1.3% 33.4% 17.4% 33.6% www.indiandentalacademy.com
  9. 9. Force Required Line of force through the symphysis and TMJ • A single subcondylar fracture at 193 kg(425 lb) • A bilateral subcondylar fracture at 250 kg (550 lb) • symphyseal fractures – b/w 250 and 408 kg (900 lb) www.indiandentalacademy.com
  10. 10. Embryology of Mandibular Condyle • Condylar secondary cartilage -10th week i.u - primordium of the future condyle • Important growth center for the ramus and the body of mandible • Much cartilage is replaced with bone – endochondral • But its upper end “persists into adulthood, acting as both as growth cartilage and articular cartilage” • Changes in mandibular position and form are related to the direction and amount of Condylar growth www.indiandentalacademy.com
  11. 11. Embryology of Mandibular Condyle • Growth rate increases at puberty , peaks b/w 12-14 years & ceases at about 20 years of age • The subarticular appositional proliferation of cartilage endochondral bone, on whose outer surface a cortex of bone intramembranous bone is laid (functional matrix) • Bone resorbtion subjacent to the condylar head accounts for the narrowed condylar neck. • The attachment of the lateral pterygoid muscle to this neck, and the growth and action of the tongue and the masticatory muscles are functional forces implicated in this phase of mandibular growth. www.indiandentalacademy.com
  12. 12. Surgical Anatomy www.indiandentalacademy.com
  13. 13. 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 Less active in latent phase 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
  14. 14. Differences in Adult and Pediatric Condyles www.indiandentalacademy.com
  15. 15. Mechanism of fractures W should we know this? hy • Simplifies diagnosis • Helps surgeon to look for parts of the mandible most likely to fracture • About two thirds of all temporomandibular joint fractures' are associated with other fractures of the mandible • Condylar fractures are mainly due to an indirect injury • They seldom arise from direct trauma, unless accompanied by a zygomatic arch fracture. www.indiandentalacademy.com
  16. 16. Mechanism of fractures Factors influencing the fracture sites Occlusion whether mouth was open or closed at impact Direction of the impact Amount of force applied www.indiandentalacademy.com
  17. 17. 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
  18. 18. General nature of injury Rowe & Williams Three main groups 1. Contusion of the soft tissues of the joint   2.  Dislocation of the condylar head from the glenoid fossa   3.  F racture of the condyle Combination of the above can also be seen and should be ruled out before further treatment options are being considered www.indiandentalacademy.com
  19. 19. 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
  20. 20. 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
  21. 21. 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
  22. 22. Classification of condylar fractures Rowe & Killey’s classification (1968)    1.Intracapsular fracture - high condylar fracture Involving the articular surface        Fracture through the neck 2.Extracapsular fracture - low condylar fracture 3.W injury to the capsule, ligament and meniscus ith 4.Involving the adjacent bone www.indiandentalacademy.com
  23. 23. Classification of condylar fractures MacLennan Classification: 1952 –Clinical Classification Type I: No displacement Type II: Fracture deviation – simple angulation of the fracture segments without overlap or separation. Ex. Green stick fracture in children Type III: Fracture displacement –when there is overlap of fracture fragments. This overlap may be in an anterior, posterior, lateral or medial. Medial is commonest. Type IV: Fracture dislocation – here the condylar head is completely dislocated out of the articular fossa and out of the capsular confines. Again dislocation can be medial or lateral and rarely anterior or posterior. Type V : High condylar fracture with luxation Type VI : Head fracture or intracapsular fracture www.indiandentalacademy.com
  24. 24. Classification of condylar fractures   Condylar neck fractures classification - Spiessl & Schroll Type I Condylar neck fracture without serious dislocation Type II Deep-seated Condylar neck fracture with dislocation Type III High Condylar neck fracture with dislocation Type IV Deep-seated Condylar neck fracture with luxation Type V High Condylar neck fracture with luxation Type VI Head or intracapsular fracture www.indiandentalacademy.com
  25. 25. Classification of condylar fractures Lindhal’s classification:- Comprehensive classification (1977) Lindahl proposed a classification based on several factors namely 1. The anatomic location of the fracture 2. The relation of the condylar segment to the mandibular segment 3. The relation of the condylar head to the articular fossa 1. Depending on fracture level i. ii. iii. Condylar head # Condylar neck # Subcondylar # www.indiandentalacademy.com
  26. 26. Classification of condylar fractures 2. The relation of the condylar segment to the mandibular segment i. Undisplaced (fissure fracture) (B) ii. Deviated – simple angulation of the condylar process in i.r.t distal mandibular segment without overlap.(C) iii. Displaced with medial overlap (D) iv. Displaced with lateral overlap (E) v. Antero-posterior overlap – possible but are seldom seen. (F) vi. Without contact between fragments (G) www.indiandentalacademy.com
  27. 27. Classification of condylar fractures 3. The relation of the condylar head to the articular fossa i. No displacement- condylar head appears in normal prelation with fossa ii. Displacement – condylar head is in fossa but there is alteration of joint space. Joint space is increased iii. Dislocation. – The condylar process is completely out of the fossa. www.indiandentalacademy.com
  28. 28. Clinical examinationExtra oral Inspection • • • • • • • • • • Swelling Preauricular depression ecchymosis lacerations facial asymmetry pain on jaw mobilization deviation on opening Ear bleed CSF otorrhea Battle sign www.indiandentalacademy.com
  29. 29. Clinical examinationExtra oral Palpation Position : The clinician begins the examination from behind the seated or supine patient • Inability to open jaws • tenderness associated with crepitation • a limited range of motion • a significant deviation on opening – (same side) • otoscopic evaluation • firm posterior pressure on the chin will cause pain in the preauricular region www.indiandentalacademy.com
  30. 30. Clinical examination – Intra oral • • • • • • malocclusion fracture of the dentition ▲ or ▼ in inter-incisal opening Premature occlusal contacts Anterior open bite Posterior gagging of occlusion www.indiandentalacademy.com
  31. 31. Clinical examination – Summary Clinical signs to look for and to rule out - Fonseca 1. Evidence of trauma – facial contusions, abrasions, laceration of the chin, and /or ecchymosis or hematoma in the TMJ region 2. Bleeding from the external auditory canal 3. A noticeable or palpable swelling over the TMJ 4. Facial asymmetry as a result odf edema or ramal shortening 5. Pain and tenderness 6. Crepitation 7. Malocclusion 8. Deviation of the mandible 9. Muscle spasm (“splinting”) with associated pain and limited mouth opening 10. Dentoalveolar injuries www.indiandentalacademy.com
  32. 32. Radiologic Diagnosis Available Options   1. Plain radiographs View in two dimensions orthopantomogram view posterior-anterior view 2. Computed tomography To be able to exclude head or intracapsular fractures and particularly if surgical treatment is planned, it is imperative that the fracture line be demonstrated in a coronal CT scan   3. Magnetic resonance imaging Disk position can be shown by means of MRI 4. Ultasonography • Limited use – only can tell presence of fracture in TMJ region • Can be used to check position of condyle following surgery www.indiandentalacademy.com
  33. 33. Plain Radiographs • At least two views at right angles to each other are necessary – OPG & Reverse Towne’s view • In the multiple-trauma patient for whom OPG not possible, lateral oblique views may be substituted • Other radiographic views that may be useful depending on the circumstances are posteroanterior mandibular mandibular occlusal periapical Limitation Intracapsular fractures of the condylar head are often difficult to visualize accurately on plain films www.indiandentalacademy.com
  34. 34. Orthopantomograph & Lateral oblique views Anteroposterior plane Centered on condyles Open mouth – if poss R www.indiandentalacademy.com L
  35. 35. Computed tomography  Indications for CT scans   1. Significant displacement or dislocation  2. Limited range of motion with a suspicion of mechanical obstruction caused by the position of the condylar segment   3. Alteration of the surrounding osseous anatomy by other processes, such as previous internal derangement or TMJ surgery, to the degree that a pretreatment baseline is necessary   4. Inability to position the multi- trauma patient for conventional radiographs www.indiandentalacademy.com
  36. 36. Thank you Thank you www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com

×