1. Fractures of the mandibular condyle account for 20-30% of all mandibular fractures. They can be classified based on the location and degree of displacement of the condylar fragments. 2. Treatment depends on factors like the patient's age, type of fracture, and degree of displacement. Conservative treatment involving intermaxillary fixation is preferred in children and some adults with non- or minimally displaced fractures. 3. Surgical treatment involving open reduction and internal fixation may be needed for more displaced fractures or those with malocclusion. Various surgical approaches like preauricular, retromandibular, and intraoral are used depending on the location of the fracture.

1. PRESENTED BY
DR.SUJAY PATIL
II MDS

2. Fractures of mandibular condyle
are common and account for 20-
30% of all mandibular fractures.
Forms imp component for TMJ

3. • Elliptical in shape, long axis
angled backwards between 15-
33 0 to frontal plane.
• Long axes of 2 condyle meet at
basion on anterior ligament of
foramen magnum forming an
angle 0f 145-160 degrees.

4. • Mediolateral width: 15-20 mm
• Anteroposterior width: 8-10mm
• Lateral pole: roughened, bluntly pointed,
projects from plane of ramus
• Medial pole: rounded, extends from
plane of ramus
• Fibrous layer thin on posterior aspect
and thick over convexity

5. Parameter Child Adult
Cortical bone Thin Thick
Condylar neck Broad Thin
Articular surface Thin Thick
Capsule Highly vascular Less vascular
Periosteum Highly active
osteogenic phase
Less active in latent
stage
Intracapsular fracture
& hemarthrosis
Very common Rare
Remodellin capacity
following trauma
Present Absent
Disturbance in growth Likely N.A.

6. Blood supply
TMJ area is highly vascular and innervated
Mainly from
• Superficial temporal artery
• Transverse facial artery
• Posterior tympanic artery
• Posterior deep temporal artery

7. Neural structures
• Facial nerve
• Auriculotemporal nerve

8. Incidence

10. ∏ Assault
∏ RTA
∏ Sport injuries
∏ Falls
∏ Work-related incidents

11. Mechanism of injury

13. Type I- slight displacement The angle between the
head and the .long axis of the ramus :10 to 45
degrees.
Type II- angle of 45 to 90 degrees, resulting in
tearing of the medial portion of the capsule.
Type III- The fragments are not in contact, and
the head is displaced mesially and forward owing
to traction of the lateral pterygoid muscle.
confined to within the glenoid fossa.
Type IV- fractures where the condylar head
articulates in an anterior position to the articular
eminence.
Type V- vertical or oblique fractures through the
head of the condyle.

14. Type I Non-displaced fracture
Type II Fracture deviation, where there is simple angulation of the condylar
process to the major fragment. (e.g. greenstick fracture)
Type III Fracture displacement, where there is simple overlap of the condylar
process and major mandibular fragments.
Type IV Fracture dislocation, where the head of the condyle is completely
disrupted from the articular fossa.

15. Intracapsular Fractures or High Condylar
i. Fractures involving the articular surface
ii. Fractures above or through the anatomical neck,
which do not involve the articular surface
Extracapsular or Low Condylar Fractures
Fractures associated with injury to the capsule, ligament and meniscus
Fractures involving adjacent bone

16. Anatomic location of the fracture
Condylar head
Condylar neck
Subcondylar
Relationship of condylar fragment to
mandible
Nondisplaced
Deviated
Displacement with medial or
lateral overlap
Displacement with anterior or
posterior overlap
No contact between fractured
segments
Relationship of condylar head & fossa
Nondisplaced
Displacement
Dislocation

17. 1. History
2. Clinical examination
3. Radiological
examination

18. Management of Traumatic Dislocation of the Mandibular Condyle into the Middle
Cranial Fossa; Robert P. Barron, J Can Dent Assoc 2002; 68(11):676–80

19. Evidence of trauma.
Bleeding from external auditory canal.
Noticeable or palpable swelling – haemotoma / edema.
Facial asymmetry – foreshortening of ramus.
Pain & tenderness.
Crepitation over the joint.
Malocclusion
Deviation of mandibular condyle.
Muscle spasm.
Dentoalveloar injuries.

20. A. Conventional Radiography
a. P A- View
b. Lateral Oblique
c. Towne's Projection
d. Panoramic view
e. TMJ views
B. CT
C. MRI

21. Aims for surgery:
1. Relief from pain
2. Stable occlusion
3. Restoration of inter- incisal opening
4. Full range of mandibular movements
5. To minimize deviation
6. Avoid growth disturbances
7. Avoid Ankylosis

22. 2 schools of thought:
• Conservative-functional therapy
• Surgical treatment

23. Conservative-functional therapy
• Involves no surgical intervention of the fracture site
instead it reduces the fracture taking occlusion as a key
factor.
• Immobilization usually involves fixation with arch
bars, eyelet wires or splints.
• Period of immobilization varies from 7days to 4 weeks

24. Indications:
• Condylar neck # with little or no displacement
• # occuring in child (10-12 yrs)
• Intracapsular #

25. Recently thermoforming plates is used for the same
Fixation strength is less than wiring so contraindicated in bilateral
fractures
Advantage:
• Smooth surface
• Transparent
Closed treatment of condylar fractures by intermaxillary fixation with
thermoforming plates; Haruhiko Terai et al, British Journal, 2004, Pg. 61-63

26. Advantage Disadvantage
• Relatively safe
• No injury of nerves and
blood vessels
• No postoperative
complications such as
infection or scar occurs.
• Fracture, loss, and
eruption delay of the
growing teeth can be
avoided in pediatric
patients as no tooth germ
injury occurs because of
no establishment of the
crown of the permanent
teeth
• Injury of the periodontal tissue and buccal
mucosa
• Poor oral hygiene,
• Pronunciation disorder
• Imbalanced nutrition
• Growth disorder and excessive growth of the
injured mandible may occur
• Facial asymmetry may occur in pediatric
patients aged 10 to 15 years due to growth disorder
or functional disorder, and that in particular, the
growth and functional disorders of the TMJ may
occur in 20% to 25% of pediatric patients aged 7
to 10 years
Closed Reduction

31. Treatement protocol for different
type of condylar fractures
1. FOR CHILDREN UNDER 10 YEARS OF AGE
The treatment is complete functional for both
unilateral and bilateral condylar fracture IMF may be
required for 7- 10 days.
2. ADOLESCENTS BETWEEN 10 AND 17 YEARS OF
AGE
Treatment protocol is same but IMF may be
required for 2-3 weeks.

32. 3. UNILATERAL INTRACUPSULAR FRACTURE IN
ADULTS
IMF for 2-3 weeks in case of malocclusion.
4. BILATERAL INTRACAPSULAR FRACTURE IN
ADULTS
IMF for 3-4 weeks physiotherapy for preventing
restricted mouth opening.

33. 5. UNILATERAL EXTRACAPSULAR FRACTURE IN
ADULTS
open reduction in case of displaced fragment and
maloclusion.
6. BILATERAL EXTRACAPSULAR FRACTURE IN ADULTS
open reduction of atleast of 1 side to establish normal
height
If the discripancy is large both the sides should be
considered.

35. Preauricular Incision

36. Al-Kayat& Bramley -> identifiable landmarks

37. End aural Incision

38. Post auricular Incision

39. Submandibular Incision

40. Retromandibular Incision

41. Intraoral Incision
ee

42. Approach Advantage Disadvantage
Preauricular
Endaural
• Exposure of lateral and
anterior part of condyle
• Cosmetic (Endaural)
• Injury to facial nerve
• Injury to auriculotemporal
• Damage to middle ear
• Hemorrhage
• Parotid fistula
Postauricular • Esthetic
• Minimum risk of facial
nerve injury
• Permits harvest of conchal
cartilage for grafting
• Infection
• Hematoma
• Cartilage necrosis
Intraoral • No visible scar
• Adequate access to condylar
neck
• Injury to buccal, IAN
• Injury to lingual vessels
• Damage to maxillary
artery
Submandibular
(Risdon)
• Adequate access to condylar
neck & subcondyle
• Injury to MMB
Retromandibular • Adequate access to condyle
• Less risk of injury to MMB
• Scar
• Parotid fistula
The risks & benefits of surgery for temporomandibular joint internal
derangements; Simon Weinberg et al

43. CONDYLAR
TRAUMA?
Clinical Sign
Malocclusion
Deviation
Range of motion
Negative clinical
exam
(-) Malocclusion
Minimal pain
Normal range of motion
No deviation on opening
Observation
Radiographs
Lateral obliques
Panorex
CT scan
No radiographic
evidence of condylar #
R/O hemathrosis
Joint effusion
(+) Condylr fractre
Normal occlusion Malocclusion
ORIF?
ROM
Pain
Deviation
Conservative IMF (7-21 days)
ORIF Other # ?
IMF (7-21 days) Reduction/fixation
of other #
Follow up
Yes
YesNo
No
No
Yes

45. Ellis and Throckmorton conducted study with open or closed treatment
for fractures of the mandibular condylar process, in one hundred forty-six
patients, 81 treated by closed and 65 by open methods. The patients treated by
closed methods developed asymmetries characterized by shortening of the face
on the side of injury.
In the study of the Santler et al. two hundred 34 patients with fractures
of the mandibular condylar process were treated by open or closed methods. No
significant difference in mobility, joint problems, occlusion, muscle pain, or nerve
disorders were observed when the surgically and non-surgically treated patients
were compared. Surgically treated patients showed significantly more weather
sensitivity and pain on maximum mouth opening.
Renato VALIATI, 2008, The treatment of condylar fractures: to open or not to open? A
critical review of this controversy

46. To compare the occlusal relationships after open or closed treatment for
fractures of the mandibular condylar process, a total of 137 patients with unilateral
fractures of the mandibular condylar process (neck or subcondylar), 77 treated
closed and 65 treated open, were included in the study of Ellis, Simon and
Throckmorton. The patients treated by closed techniques had a significantly
greater percentage of malocclusion compared with patients treated by open
reduction, in spite of the initial displacement of the fractures being greater in
patients treated by open reduction.
Renato VALIATI, 2008, The treatment of condylar fractures: to open or not
to open? A critical review of this controversy

47. Mini-retromandibular approach to condylar fractures ; Federico BIGLIOLI,
Giacomo COLLETTI; Journal of Cranio-Maxillofacial Surgery (2008) 36, 378e383
No visible scar
Less complication rate

48. Intraoral approach for treatment of displaced Condylar fractures: case report;
valfrido pereira-filho et al; craniomaxillofacial trauma & reconstruction/volume 4,
number 2 2011

49. Condylar Fracture Repair: Use of the Endoscope to Advance Traditional Treatment
Philosophy ;Reid V. Mueller et al, Facial Plast Surg Clin N Am 14 (2006) 1–9

50. Resorbable triangular plate for osteosynthesis of fractures of the condylar neck;
Günter Lauer et al; British Journal of Oral and Maxillofacial Surgery 48 (2010) 532–535

51. Transmasseteric Anteroparotid Approach for Mandibular Condylar Fractures-
Merits and Demerits; AHMAD MAHROUS MOHAMAD, Egypt, J. Plast. Reconstr.
Surg., Vol. 35, No. 2, July: 227-232, 2011

52. Early complications:
1. Fracture of the tympanic plate
2. Fracture of the glenoid fossa with or without displacement of the
condylar segment into the middle cranial fossa
3. Damage to cranial nerves V & VII
4. Vascular injury
Late complications:
1. Malocclusion
2. Growth disturbance
3. Temporomandibular joint dysfunction
4. Ankylosis
5. Asymmetry
6. Frey’s syndrome

53. Fractures of the mandibular condyle constitute a significant
portion of mandibular fractures. A number of clinical signs and symptoms
are characteristic of injury to the condylar apparatus. The use of plain
radiographs in multiple view, or CT scans discloses most condylar
fractures and displacements, if any. A number of classification systems are
available to help in treatment planning and record keeping.
Non-surgical treatment is adequate for a majority of condylar
fractures. A period of immobilisation followed by active functional
therapy is indicated for most cases. Surgical management has specific
indications, and can be accomplished through a wide variety of
techniques. In general, complications are not common following condylar
trauma. Important among the possible complications are ankylosis,
growth disturbances and internal derangement.