CONDYLAR FRACTURE

2. OPEN
VS
CLOSE REDUCTION
OF MANDIBULAR CONDYLER
FRACTURES

3. BY
Brig Waseem Ahmed
AFID

4. GOALS OF TREATMENT
Functional Goal:
Reestablishment of preoperative function of
masticatory system
Anatomical Goal:
Reestablishment of preoperative occlusion and facial
symmetry

5. VARIABLES INFLUENSING THE
SELECTION OF TREATMENT
Level of #
Degree of displacement of Proximal Seg
Status of dentition
Concomitant injuries
 Age
Medical status

6. TREATMENT OPTIONS
Broadly divided into:
Conservative (Non-surgical)
Open (Surgical)

7. WHAT IS CONSERVATIVE MANAGEMENT
May be as simple as observation and soft diet
Or
variable periods of immobilization

8. SIMPLE OBSERVATION
Only responsible patients committed to period of close follow up
to be considered
Strict soft diet and medication.
Be on guard: first signs of occlusal instability, deviation with pain
or increasing paan
An immediate clinical and radiographic reevaluation has out has to
be carried out.

10. INDICATIONS OF
CONSERVATIVE MANEGMENT
Minimal condyler displacement
Easily achievable occlusion
Minimum pain
Acceptable range of mand movements
Difficult repositiong of prox segment
Fracture of Condyler head / Neck

11. IMMOBILIZATION
If some degree of malocclusion, deviation with opening or pain
IMF with any means
: Eyelet wiring, arch bars, splints
Depends on confounding factors: age, level of fracture, degree of
displacement, additional fractures etc

12. HIGH CONDYLER #

13. HIGH LEVEL FRACTURE

14. COMPLICATIOS OF
CLOSE REDUCTION
Chronic pain
Greater percentage of malocclusion
Mean shortening of Post Facial height (2-5 mm or
5%).Diagnosed as
Anatomical shortening
 Superiorly displayed Gonion.
Functional shortening
 ipsilateral persistent occlusal prematurity
 Inability to achieve contra lateral occlucion
 Asymmetry

16. WHAT IS SURGICAL MANAGEMENT
Open reduction
&
Internal fixation
(ORIF)

17. INDICATIONS OF OPEN REDUCTION
 ABSOLUTE
When occlusion by close reduction is not achievable
Condyler dislocation
Lateral extra cap displacement
Displacement Into middle cranial fossa.
Foreign body in joint cap.
 RELATIVE
Bilateral cond # in edentulous Pts.
Bilateral cond # with mid face #s
IF IMF not possible- Medically comp Pts.

18. ADVATAGES OF OPEN REDUCTION
 Posterior Facial height is maintained
Greater & early functional improvements

19. COMPLICATIONS OF OPEN
TREATMENT
Difficult surgical access
Unsightly Hypertrophic scar
Facial nerve deficit
Infection, malunion
Malocclusion
Avascular cond necrosis
Longer procedure / Expertise /Facilities

20. OPEN vs CLOSE REDUCTION
Location of fracture and degree of displacement
primarily determines selection of approach
Functional improvement by open method is greater
than with closed
Open treatment is associated with perceptible scar but
early mobility and less pain.
Closed treatment is associated with higher percentage
of malocclusion and chronic pain

21. REVIEW OF LITERATURE
There is no strong correlation between
radiographic finding and choice of treatment
Ideal management of condylar fractures is still
controversial .
Considering different variables various treatment
options are considered adequate
Focus on SIGNS & SYMPTOMS rather than on
condyler # itself.

22. CONCLUSION
A careful assessment of the literature and
experiences of surgeons indicates that there is no
significant difference between surgical and non
surgical treatment modalities.
Acceptable outcomes have been achieved with
both techniques. Assessment of factors peculiar to
the individual case must be made to determine
the mode of therapy most likely to produce a
favorable outcome.