Condylar fractures are among the most common fractures of the mandible and typically result from indirect trauma, such as a blow to the chin, road traffic accidents, interpersonal violence, or falls. They may be classified based on anatomical location (condylar head, neck, or subcondylar region), degree of displacement, and presence of dislocation. Clinically, patients often present with preauricular pain, swelling, restricted mouth opening, deviation of the mandible on opening, malocclusion, and sometimes facial nerve dysfunction. Radiographic evaluation using panoramic radiographs and computed tomography is essential for accurate diagnosis and treatment planning. Management remains controversial and may be either conservative (closed reduction with functional therapy) or surgical (open reduction and internal fixation), depending on factors such as patient age, fracture type, degree of displacement, occlusal derangement, and associated injuries. Early mobilization and physiotherapy are crucial to restore mandibular function and prevent long-term complications such as ankylosis, malocclusion, and temporomandibular joint dysfunction.

1. Condylar fracture

3. 01/17/2026

4. Condylar fracture

5. Fractures involving the
mandibular condyle,
are the only facial
bone fractures which
involves a synovial
joint.

9. Mandible Anatomy

11. * Adults
 Represent 20-30% of
all mandibular
fractures (Ellis et al,
1985)
* Causes
 MVA
 Assault
 Sport relate injuries
 Falls
* Children
 Higher involvement
ranging from 40-
60% (Lehman &
Saddawi, 1976)
* Causes
 Falls
 MVA
 Sport related injuries
 Assault
Incidence & etiology

12.  Moving object striking a static individual
 Moving individual striking a static object
 Combination of forces
Forces resulting in trauma to the
TMJ

13. Classification (Lindhal, 1977)
 A) Fracture level
1) Condylar head( )
2) condylar neck
3) subcondylar (high or low)

22.  B) Relation of condyle to mandible
1) Non displaced
2) Diviated angulated
3) Displaced ( M or L/A or P overlap)
 C) Relation of condyle to glenoid fossa
1) Non dispalced
2) Displaced-still related to fossa
3) Dislocation-completely out of fossa (head
usually anteriomedial)

31.  Evidence of ST injury (Contusion, abrasions, chin
laceration)
 Facial asymmetry with chin deviation
 Noticeable or palpable swelling over affected TMJ
 Pain & tenderness over affected TMJ
 Malocclusion
 Deviation of mandibular dental midline
 Muscle splinting due to pain with limited
opening
 Bleeding from EOC
 Inability to palpate condylar movement
Clinical signs

32. Battle sign

38. Conventional Radiology
At least 2 views at right angle to each other.
Mandibular series: PA, Lateral oblique or
panoramic, & Towne’s view (projects condyle
below mastoid process).
CT
Significant displacement or dislocation,
mechanical obstruction, mult trauma pt, &
intracapsular fracture.
MRI
St injuries: effusion, visualization of disc.
Imaging

49.  1) Ankylosis:
Predisposing causes:
a) Age of the patient (<10 years).
c) Site & type of fracture:
 Intracapsular fracture.
 Close contact between the glenoid fossa &
condylar stamp.
c) Duration of immobilization.
(contributing factor in adults)
(causative factor in children)
d) Damage to meniscus.
Complications of condylar fracture

50.  2) Disturbance of mandibular growth
inchildren:
 Condylar growth center (Brosh 1930)
 Function matrix theory (Moss 1968)
 Damage to condylar cartilage in children lead
to hypoplasia

51.  Stable occlusion
 Restoration of interincisal opening
 Full range of mandibular excursive movements
 Minimize deviation
 Pain free
 Avoid growth disturbance
 Avoid ankylosis
Goals of treatment

52. TREATMENT
surgical conservative

53.  Unlike fractures of other bones, the exact
anatomic reapproximation of the fractured
segments may not be absolutely essential.
 There is no correlation between radiographic
findings & either preoperative symptoms or
postoperative function.
 Complications are uncommon with
conservative treatment.
Conservative treatment of condylar
fractuers

54. 1) Normal occlusion with minimal discomfort soft
diet and maintain as near normal function as
possible.
2) Malocclusion, deviation with function, pain
period of immobilization (7-21 days) in the
form of arch bars or ivy loops, followed by
active mobilization and physical therapy.
Period of immobilization depends on age of
pt, level of fx, and degree of displacement.

55.  Perceived benefits
(Muller 1976)
 Early mobilization of
the mandible ensures
normal joint function
& action.
 Restoration of normal
mouth & jaw activity.
 Possible complications
(Eckelt 1984)
 Potential visible
scarring.
 Damage to facial
nerve.
 Intraoperative
bleeding from the
maxillary artery.
 Loss of blood supply
with avascular
necrosis of the
condyle.
Open reduction

56.  Absolute indications:
1- Inability to obtain
adequate occlusin with
closed reduction.
2- Displacement of the
condyle into the middle
cranial fossa.
3- Lateral extra capsular
displacement.
4- Foreign body in the joint
capsule.
 Relative indications:
1- condylar fx asso
comminuted mid facial
fx.
2- B condylar fxin an
edentulous pt splints are
unavailable or impossible
because of sever ridge
atrophy.
3- Displaced condyle fx in a
medically compromised
pt (sz d/o, psych pt, or
alcoholism) where IMF is
contraindicated.
Indications for open reduction of condylar
fractures in adults (Zide & Kent, 1983)

57.  Periauricular
 Endaural
 Submandibular
 Retromandibular
 Intra oral
 Combination
*Depending on the level of fracture, degree of
displacement or dislocation, & the planned
method of fixation.
Approaches for open reduction

60. RETROMANDIBULAR APPROACH

63.  Mini plates
 Lag screws
 Pin fixation
 Inter osseous wire
Methods of fixation

68. Depends on:
1- Age of the patient:
a) Under 10 years
b) 10-17 years
c) Adult
2- Surgical anatomy:
a) Intracapsular fracture
b) Extracapsular fracture
c) Subcondylar fracture (high/ low)
3- Site:
a) Unilateral b) Bilateral
4- Occlusion:
a) Undisturbed b)Malocclusion
Treatment of condylar
fractures

69.  Unilateral / bilateral (either intracapsular or
extracapsular) : Conservative treatment.
• If there is pain IMF for 7-10 days only
Follow by active mobilization
Children under 10 years

70.  Unilateral / bilateral (intracapsular or extracapsular) :
Conservative treatment.
• If there is:
• Malocclusion: IMF for 2-3 weeks.
• Fracture dislocation: Open reduction + internal
fixation.
Adolescents aged 10-17 years

71.  Unilateral
- Conservative
treatment.
- IMF for 2-3 weeks if
there is
malocclusion.
 Bilateral
- IMF for 3-4 weeks
followed by
physiotherapy.
Adult
{A} Intracapsular

72.  Unilateral
- Conservative treatment
if the occlusion is
undisturbed.
- Low condylar fracture
with malocclusion
(open reduction).
- High condylar fracture
with extensive
malocclusion:
- IMF for 3-4 weeks.
- Some surgeons
favors ORIF.
 Bilateral
- Malocclusion is
present.
- At least ORIF for one
side.
- IMF for 4-6 weeks
followed by elastic
bands for several
weeks.
{B} Extracapsular

74. Thank you