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
The lower jaw frequently breaks due to accidents, assaults or sometimes due to underlying disease. Just as with other bones in the body, there are a various methods for repairing the mandible.
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine, Al-Azhar University. Condylar fractures represent one of the most controversial issues in maxillofacial traumatology regarding classification, diagnoses and therapeutic management. Classification systems of condylar fracture is discussed. Diagnosis is usually based on history clinical examination and radiographic finding. Treatment ranges from observation, jaw exercises to closed or opened interventions. For years closed reduction was thought to be essentially complication-free. Several serious complications however have been reported including temporomandibular joint ankyloses, malocclusion, mandibular deviation and the generative joint pathology. The absolute and relative indications for open reduction is given. The debate between supporters of open or closed reduction is still continuing and the issue has not been resolved. However, the final choice treatment modality should takes into account the location of the fracture, age of the patient, presence or absence of other associated injuries, cosmetic impact of the surgery and presence of other systemic medical conditions.
The lower jaw frequently breaks due to accidents, assaults or sometimes due to underlying disease. Just as with other bones in the body, there are a various methods for repairing the mandible.
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine, Al-Azhar University. Condylar fractures represent one of the most controversial issues in maxillofacial traumatology regarding classification, diagnoses and therapeutic management. Classification systems of condylar fracture is discussed. Diagnosis is usually based on history clinical examination and radiographic finding. Treatment ranges from observation, jaw exercises to closed or opened interventions. For years closed reduction was thought to be essentially complication-free. Several serious complications however have been reported including temporomandibular joint ankyloses, malocclusion, mandibular deviation and the generative joint pathology. The absolute and relative indications for open reduction is given. The debate between supporters of open or closed reduction is still continuing and the issue has not been resolved. However, the final choice treatment modality should takes into account the location of the fracture, age of the patient, presence or absence of other associated injuries, cosmetic impact of the surgery and presence of other systemic medical conditions.
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine, Al-Azhar University. Mandibular angle fractures account for 23% to 42% of all facial fractures. Fracture of mandibular angle can be classified as (A) Vertical favorable or unfavorable, (B) Horizontally favorable of unfavorable. Traditionally, mandibular angle fractures have been treated with either closed reduction and inter-maxillary fixation or open reduction and internal fixation with or without inter-maxillary fixation. Patients treated with inter-maxillary fixation have a restricted airway and loose excess weight. Rigid internal fixation and early return to function have eliminated the use of wire osteosenthysis and prolonged use of inter-maxillary fixation. The principal of rigid fixation, however, have inherent set of disadvantages including damage to the inferior alveolar nerve and the marginal mandibular branch of facial nerve. Postoperative malocclusion rates are also high. With the introduction of semi-rigid technique fracture of the mandibular angle could be treated according to Champy’s Ideal lines of osteosenthysis. The technique involves placement of a single monocortial miniplate on the superior border of the mandible. However, some studies suggested using a second miniplate along the inferior border. Wether one or two miniplates should be used is still debatable. The application of 3D plates may provide additional stability in 3 dimension and good resistance against torque forces.
Arthrocentesis of the temporomandibular jointAhmed Adawy
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine, Al-Azhar University. Arthrocentesis of the temporomandibular joint refers to lavage of the upper joint space, hydraulic pressure and manipulation to release adhesions of the “anchored disc phenomenon” and improve motion. The technique of arthrocentesis is discussed together with the indications and contraindications of the procedure. Further, the presentation includes modifications of the standard technique.
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine, Al-Azhar University. Mandibular angle fractures account for 23% to 42% of all facial fractures. Fracture of mandibular angle can be classified as (A) Vertical favorable or unfavorable, (B) Horizontally favorable of unfavorable. Traditionally, mandibular angle fractures have been treated with either closed reduction and inter-maxillary fixation or open reduction and internal fixation with or without inter-maxillary fixation. Patients treated with inter-maxillary fixation have a restricted airway and loose excess weight. Rigid internal fixation and early return to function have eliminated the use of wire osteosenthysis and prolonged use of inter-maxillary fixation. The principal of rigid fixation, however, have inherent set of disadvantages including damage to the inferior alveolar nerve and the marginal mandibular branch of facial nerve. Postoperative malocclusion rates are also high. With the introduction of semi-rigid technique fracture of the mandibular angle could be treated according to Champy’s Ideal lines of osteosenthysis. The technique involves placement of a single monocortial miniplate on the superior border of the mandible. However, some studies suggested using a second miniplate along the inferior border. Wether one or two miniplates should be used is still debatable. The application of 3D plates may provide additional stability in 3 dimension and good resistance against torque forces.
Arthrocentesis of the temporomandibular jointAhmed Adawy
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine, Al-Azhar University. Arthrocentesis of the temporomandibular joint refers to lavage of the upper joint space, hydraulic pressure and manipulation to release adhesions of the “anchored disc phenomenon” and improve motion. The technique of arthrocentesis is discussed together with the indications and contraindications of the procedure. Further, the presentation includes modifications of the standard technique.
Condylar fractures /certified fixed orthodontic courses by Indian dental ac...Indian dental academy
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
Condylar fractures /certified fixed orthodontic courses by Indian dental acad...Indian dental academy
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
Condylar fractures /certified fixed orthodontic courses by Indian dental aca...Indian dental academy
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
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
00919248678078
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
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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.
L’indemnisation du dommage corporel exige
la preuve de la réalité du dommage, mais aussi
la preuve que ce dommage est bien imputable à un événement
L’imputabilité est intimement liée à l’état pathologique antérieur qui peut aggraver le
dommage évalué.
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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.
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Orbital blow out fracture repair /certified fixed orthodontic courses by Ind...Indian dental academy
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
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
00919248678078
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.
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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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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
00919248678078
Maxillofacial Surgery
Dental Students Fifth Year First semester
Lecture Name maxillofacial trauma part 2
Al Azhar University Gaza Palestine
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Opportunity for Dentists (BDS/MDS )to relocate to United kingdom -Register as a DENTAL HYGIENIST/ DENTAL THERAPIST without Board exams and after approval you can register in GDC as a DH/DT and start working as a DH/DT Immediately and get paid.
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Indian Dental Academy
Leader in continuing dental education
www.indiandentalacademy.com
skype:indiandentalacademy
+919248678078
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
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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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
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Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
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Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
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The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
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Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
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2. INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
www.indiandentalacademy.com
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. 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. 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. 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
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. 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. 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. 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
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. 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. 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. 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. 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. 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. 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. 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. 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
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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
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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 #
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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)
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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.
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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
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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
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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
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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
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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
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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
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