Condylar fractures1 /certified fixed orthodontic courses by Indian dental academy

CONDYLAR FRACTURES
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com


Imaging/radiographs
P.A view of the skull
Lateral Oblique
OPG
C.T
M.R.I


Treatment of condylar #
Non Surgical/Conservative method

Surgical method


Conservative/Nonsurgical
Most of the cases can be treated by
this method.
1. Observation & softdiet
2. Immobilization with archbars&wires
3. Intense physiotherapy.

Anatomy of condyle in child
Upto 2 years of age condylar head is
highly vascular penetrated by
numerous blood vessels.
Cortical bone of condyle is thinner
than the adult condyle.
Condylar head is broader,fuller and
neck is thicker than adult

Glenoid fossa is shallower,concave with a
steeper morepronounced articular
eminence.
Bone quality is more softer and pliable.
The increased vascularity with thinner
cortical bone,makes childs condyle more
susceptible to burst type of #,leaving
multiple ,small,highly osteogenic fragments
in joint space.
This increases the risk of ankylosis

TREATMENT OF CONDYLAR#


Children under 10yrs of Age:
This group more likely develops
growth disturbance or limitation of
movement than others
If malocclusion is present becoz of
condylar #, it should be disregarded
becoz spontaneaous correction will
take place as the dentition develops


Displaced condylar neck # will undergo full
functional restitution in most cases.
Immobilzation by MMF is indicated for
control of pain and should be released in 710 days.
In case of intracapsular #careful followup
and monitoring of growth is required.
Treatment with myofunctional appliances
started if subsequent mandibular
development is reduced.

Adolescents 10-17 years
If malocclusion is present the
capacity for spontaneous correction is
less than the younger age group.
MMF is indicated for 2-3 weeks if
there is malocclusion.
The dentition is suitable for eyelet
application.


ADULTS
Unilateral intracapsular #:
-Occlusion is usually undisturbed
-Fracture should be treated conservatively
without MMF
-Occasionally slight malocclusion is
noted,in which case MMF for 2-3 weeks
is applied.

UNILATERAL CONDYALR NECK #
Undisplaced # where there is no
occlusal disturbance no active
treatment is done.
--A # dislocation will often cause
malocclusion due to shortening of
ramus.
--A low condylar neck # is probably best
treated by ORIF.

--High condylar # with extensive
displacement and malocclusion, MMF
is applied and maintained till bony union
has occurred i.e 3-4weeks
--BILATERAL CONDYLAR NECK #
There is considerable displacement on
one side or other
Although the application of MMF will
establish the occlusion,it will not reliably
reduce the fracture on both sides
So ORIF of atleast one side is indicated to
restore the ramus height

BILATERAL HIGH CONDYLAR NECK #
ORIF is likely to be difficult
MMF should be applied for 6 weeks
If arch bars or cap splints are applied
the use of intermittent elastics at night
for several weeks after the fixation is
removed is done.
When a bilateral # is associated with
major midfacial # then ORIF of both
sides is desirable.

INDICATIONS OF OPEN REDUCTION
ABSOLUTE INDICATIONS:
1. Displacement of condyle into the
middle cranial fossa.
2. Unable to obtain the good occlusion
by closed tech.
3. Lateral extracapsular dislocation of
the condyle

RELATIVE INDICATIONS:
1. Bilateral condylar #in an edentulous
patient when splints are unavailable
or not possible becoz of severe
ridge atrophy.
2. Unilateral/bilateral condylar #when
splinting is contraindicated becoz of
associated medical conditions.
3. Bilateral condylar # associated with
communited midfacial #

APPROACHES TO TMJ
1.
2.
3.
4.
5.

Submandibular(RISDON’S)
Postramal(HIND’S)
Postauricular
Endaural
Preauricular
-Dingmans
-Blair’s
-Thoma’s
-Al-Kayat and Bramley’s

6 Hemicoronal
7 Coronal/Bicoronal


FIXATION:
WIRE OSTEOSYNTHESIS
KIRSCHNER WIRE
LAG SCREW FIXATION
PLATE AND SCREW FIXATION


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