This document discusses mandibular condylar fractures, including: 1. It provides an overview of the etiology, classification, clinical features, diagnosis, and management of mandibular condylar fractures. 2. Treatment protocols for geriatric and pediatric patients are also discussed. 3. The indications and contraindications of closed and open reduction and fixation techniques for condylar fractures are analyzed in detail.

1. MANDIBULAR CONDYLAR FRACTURES
Animation source: www.wikimedia.org
Presenter – Dr. Harjeet Yadav
PG III, Dept. of OMFS
Moderator – Dr. Ajay Das
Reader, Dept. of OMFS

2. Animation source: www.wikimedia.org
 This seminar deals with the etiology, classification, clinical
features, diagnosis, and contemporary management of
mandibular condylar fractures.
 Along with the regular management strategies, treatment
protocols for geriatric and pediatric patients have also been
discussed.
 The indications and contraindications of closed as well as
open reduction and fixation of condylar fractures are
analyzed in detail.
CONTENTS

3. • The topic of mandibular condylar fracture has generated more discussion and controversy than
any other in the field of maxillofacial trauma.
• Direct or indirect trauma can lead to fracture of the condyle. The degree of displacement of
fractured condyle depends on the direction and magnitude of force.
• In spite of a common occurrence, the management of condylar fractures has been
controversial as there is no established consensus. Traditionally closed reduction has been the
treatment of choice for condylar fractures and have been treated by various forms of
intermaxillary fixation. With the improvement in radiographic imaging and biomaterials used
in the fixation, surgical management has gradually found acceptance as it restores early
function.
INTRODUCTION

4. Image source: www.researchgate.net
Elliptical
Shape
• Condyle is a knuckle like structure. It is
a strong upward projection from the
postero-superior part of the ramus.
• The condyle has a backward angulation
of 15–33° to the frontal plane and is
elliptical in shape.
• The mesio-lateral width is 15–20 mm
and the antero-posterior width is 8–
10 mm.
• The condyle articulates with the
mandibular fossa in the temporal bone,
as part of the TMJ.
ANATOMY OF CONDYLE

5. • The main source of arterial supply to the
condyle is inferior alveolar artery. Other
sources include: superficial temporal artery,
posterior tympanic artery, posterior deep
temporal artery and transverse facial artery.
• Venous drainage is by the corresponding
tributaries.
• Nerve supply is from auriculotemporal,
masseteric and deep temporal nerves.
• Lateral pterygoid muscle is attached at the
pterygoid fovea which is helpful in
protrusive and lateral excursive
movements. Image source: www.aofoundation.org

6. Rounded
Bird-beak
Diamond
Crooked-finger
DIFFERENT SHAPES OF CONDYLAR HEADS ON OPG
Image source: www.banglajo.info

7. Image source: www.zipfslaw.org
ANATOMIC VARIATIONS AT DIFFERENT AGES
N Parameter Child Adult
1 Cortical bone Thin Thick
2 Condylar neck Broad Thin
3 Articular surface Thin Thick
4 Capsule Highly vascular Less vascular
5 Periosteum Highly active osteogenic phase
Less active in
latent stage
6
Intracapsular fracture &
hemarthrosis.
Very common Rare
7
Remodelling capacity following
trauma
Present Absent
8 Disturbance in growth Likely N.A

8. Image source: Ellis surgical approaches to the facial skeleton
SURGICALANATOMY

9. • The bifurcation of Facial nerve
lies 1.5–2 cm away from the
bony external auditory canal.
• The temporal branch of the facial
nerve lies 8–35 mm from the
bony external auditory canal.
• The marginal mandibular branch
of the facial nerve lies 1.2 cm
away from the inferior border.
Complication: Injury to extracranial branches of facial nerve may lead to
paralysis or severe weakness of muscles of facial expression.
Image source: Ellis surgical approaches to the facial skeleton

10. The Maxillary artery can be injured during procedures in the subcondylar portion
of the mandible. The mean distance of the branching point of the maxillary artery
to the tip of the condyle is 22.4 mm.
Maxillary artery
Maxillary artery: anatomical landmarks and relationship with the mandibular subcondyle, Hakan Orbay et al, PMID: 18090748 Image source: www.researchgate.net
Complication: Injury to the maxillary artery may lead to profuse bleeding.

11. The Auriculotemporal nerve passes posterior to the neck of the condyle. The
average vertical distance between the superior condyle and the auriculotemporal nerve
is 7.06 mm
Auriculotemporal nerve
The distribution of the auriculotemporal nerve around the temporomandibular joint, B L Schmidt et al, PMID: 9720090 Image source: www.springer.com
Complication: Injury to auriculotemporal nerve may lead to Frey’s syndrome.
Frey’s syndrome

12. There is a risk of damage to the Transverse facial artery during condylar surgeries. It
is located about 1.9 cm below the condylar process and runs about 1.25 mm lateral to
the head of mandibular condyle.
Transverse facial artery
The transverse facial artery and the mandibular condylar process: An anatomic and radiologic study, P Nicol et al, PMID: 30965155 Image source: www.wesnorman.com
Complication: Injury to the transverse facial artery may lead to impaired blood
supply to the TMJ.

13. The mean distance between the Middle meningeal artery and the apex of the
condyle is 18.8 mm.
Middle meningeal artery
Proximity of the middle meningeal artery and maxillary artery to the mandibular head and mandibular neck as
revealed by three-dimensional time-of-flight magnetic resonance angiography, Daphne Schönegg, PMID: 34024006 Image source: www.worldofmedicalsaviours.com
Complication: Injury to middle meningeal artery may lead to epidural hematoma.

14. The mean distance between medial margin of mandibular condyle to Internal carotid artery
is 11.2 mm ±0.6.
Surgical importance of distance from mandibular condyle to carotid canal and foramen spinosum: an anatomical study, November 2019, International Journal of Research in Medical
Sciences 7(12):4733, DOI:10.18203/2320-6012.ijrms20195547
Internal carotid artery
Complication: Injury to internal carotid artery may lead to thrombosis and
neurological deficit.

15. The Masseteric nerve is about 16 mm superior to the lowest point on the
mandibular notch.
Masseteric nerve
Topographical Landmarks for the Identification of Branches of Mandibular Nerve and Its Surgical Implications: A Cadaveric
Study, Ariyanachi Kaliappan et al, PMID: 34984156 Image source: www.pocketdentistry.com
Complication: Injury to masseteric nerve may lead to weakness in masseter
muscle and sensory deficit to the TMJ.

16. The location of Superficial temporal artery bifurcation is about 9.5 ± 5.3 mm
anterior to the posterior margin of the condyle.
Superficial temporal artery
The Anatomy of the Superficial Temporal Artery in Adult Koreans Using 3-Dimensional Computed Tomographic
Angiogram: Clinical Research, Byung Soo Kim et al, PMID: 24167792 Image source: www.musculoskeletalkey.com
Complication: Injury to superficial temporal artery may lead to profuse bleeding.

17. Road traffic accidents 45%
Fall injury 40%
Interpersonal violence 8%
Sports injury 3%
Crushing trauma 2%
Gun shot <1%
Pathological process <1%
ETIOLOGY

18. INCIDENCE
 About 30% of all mandibular fractures.
 Male predilection – About 80% cases. Image source: www.researchgate.net
28%

19. BLOW FALL RTA
Kinetic energy imported to the
static individual by a moving
object.
Lindahl (1977) proposed 3 mechanisms of injury to the condyle
MECHANISM OF INJURY
Kinetic energy derived from the
movement of individual and
extended upon a static object.
Kinetic energy which is
summation of forces derived
from a combination of 1. & 2
1 2 3

20. BONE BIOMECHANICS
Mandible functions as a class III lever system, where the
muscle force is between the TMJ & the occlusal load.
Sources: www.oralmaxsurgeryatlas.theclinics.com
www.springer.com

21. BIOMECHANICS OF INJURY
(HUNTING BOW CONCEPT)
• The Mandible resembles a Hunting bow
which is weak at the ends and strong in
the midline. Its ends (the condyles) are
enclosed by the glenoid fossa.
• So any blow to the midline (symphysis
region) of the mandible can cause
bilateral condylar fracture and any blow
to the parasymphysis region may cause a
contralateral condylar fracture.
• This is based on the impact of the force.
Condyle
Tension
Rotational movement
permitted
Tension
Condyle
Symphysis
Blow
Image source: www.researchgate.net
T
T T
C C
C

22. VARIATIONS IN STANDARD FRACTURE PATTERNS
Five general reasons:
 Magnitude oftheimpact
 Direction of the impact
 Position of the mandible
 Condition of the dentition
 Shape of the object delivering the impact
Image source: www.zerodonto.com

23. Unilateral subcondylar fractures 425 lbs / 193 kgs
Bilateral subcondylar fractures 550 lbs / 220 kgs
Symphyseal fractures 924 lbs / 419 kgs
Lateral impact for body fractures 300 to 700 lbs / 136 to 317 kgs
Biomechanics of cranio-maxillofacial trauma – Biju Pappachan & Mohan Alexander 2012 June PMID 23730074
FORCE REQUIRED TO FRACTURE A MANDIBLE

24. A. Facial nerve injuries
B. C-spine injuries
C. Displacement of the condyle into the middle cranial fossa
D. Injuries to the external auditory canal
E. Blunt internal carotid artery injury
F. Injury to inferior alveolar nerve
EARLY COMPLICATIONS ASSOCIATED WITH CONDYLAR FRACTURES
A. B. C. D. E. F.
The relationship between the carotid canal and mandibular condyle: an anatomical study with application to surgical
approaches to the skull base via the infratemporal fossa, Fernando Alonso et al, doi:10.2399/ana.16.03
GLENOID FOSSA
CAROTID CANAL

25. LATE COMPLICATIONS ASSOCIATED WITH CONDYLAR FRACTURES
A. Malocclusion
B. Growth disturbances
C. Temporomandibular joint dysfunction syndrome
D. Ankylosis
E. Condylar resorption
A. B. C. D. E.
Image source: www.zerodonto.com
www.mayoclinic.org
www.banglajol.info

26. COMPLICATION ASSOCIATED WITH CONDYLAR FRACTURES
Image source: Oral and maxillofacial surgery for clinicians – AOMSI

27. CLASSIFICATION OF CONDYLAR FRACTURES
 Unilateral or bilateral condylar fractures
 Wassmund's classification (1934)
 MacLennan’s Clinical classification (1952)
 Rowe and Killey's classification (1968)
 Spiessel and Schroll’s classification (1972)
 Lindahl’s classification (1977)
 Loukota’s classification (2005)

28. TYPE I
The angle between the head and the long axis of the ramus is 10 to 45
degrees.
TYPE
II
The angle between the head and the long axis of the ramus is 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 to traction of lateral pterygoid muscle, confined to within
the glenoid fossa.
TYPE
IV
The 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.
WASSMUND’S CLASSIFICATION (1934)
Image source: www.oralmaxsurgeryatlas.theclinics.com

29. TYPE I Non-displaced
TYPE II Deviation
TYPE III Displacement
TYPE IV Dislocation
MACLENNAN’S CLINICAL CLASSIFICATION (1952)
Image source: www.oralmaxsurgeryatlas.theclinics.com

30. A. Simple fractures of condyle
B. Compound fractures of condyle
C. Comminuted fracture associated with zygomatic arch fracture.

31. Type I Non-displaced fracture
Type II
Low neck fracture with
displacement
Type III
High neck fracture with
displacement
Type IV
Low neck fracture with
dislocation
Type V
High neck fracture with
dislocation
Type VI Head fracture
SPIESSELAND SCHROLL’S CLASSIFICATION (1972)
TYPE I TYPE II
TYPE III TYPE IV
TYPE V TYPE VI
Image source: www.oralmaxsurgeryatlas.theclinics.com

32. LINDAHL’S CLASSIFICATION (1977)
I. Anatomic location of the fracture:
Condylar head
Condylar neck
Subcondylar
II. Relationship of condylar fragment to mandible:
Non-displaced
Deviated
Displacement with medial or lateral overlap
Displacement with anterior or posterior overlap
III. Relationship of condylar head and fossa:
Non-displaced
Displacement
Dislocation
IV. Injury to meniscus:
It may be torn, ruptured or herniated in forward/backward direction. Image source: www.researchgate.net

33. LOUKOTA’S CLASSIFICATION
• Diacapitular fracture
• Condylar neck fracture
• Condylar basis fracture
Image source: www.researchgate.net

34. CLINICAL EXAMINATION
 Condylar fractures are diagnosed with the help of both clinical and radiological
assessment.
 These fractures are most commonly missed on clinical examination.
 Extracapsular condylar fractures are frequent and may be associated with
displacement of the condylar head.
 The condylar head may be in contact with the ramus or may be displaced laterally
or medially.

35. Unilateral condylar fractures:
• Facial asymmetry.
• Swelling and pain over the TMJ.
• Hemorrhage from the external ear (due to
laceration of external acoustic meatus by the
violent impact of condyle).
• Proper examination with an auriscope is
essential to differentiate bleeding from external
auditory canal and middle ear. Temporal bone
fracture may be accompanied by CSF leak
which is termed as otorrhea.
• Hematoma surrounding the fractured condyle.
• Hematoma in the mastoid region called the
Battle’s sign.
INSPECTION
Image source: www.tuyenlab.com
www.ihealthblogger.com
Auriscope

36. • If the condylar head is displaced medially, characteristic hollow in the region of condylar
head can be observed once the edema subsides.
• Ear bleed will persist if the head of the condyle is impacted in the glenoid fossa.
• Deviation of mandible towards the side of fracture.
• Decreased range of movements.
• Gagging of occlusion on the ipsilateral side.
• Locked mandible – due to entry into the middle cranial fossa.
Deviation of mandible and ipsilateral open bite Image source: www.sciencedirect.com

37. Bilateral condylar fractures:
• Overall mandibular movements are usually
more restricted.
• If the condyle is displaced bilaterally,
shortening of ramus occurs resulting in
derangement of occlusion.
• Overriding of the fractured segments result in
anterior open bite.
• Associated fracture of symphysis or para-
symphysis can also be present; thus careful
examination is mandatory (Contre-coupe
injury).
•Pseudo Class II appearance.
Anterior open bite
Image source: www.archwired.com
www.semanticscholar.org

38. PALPATION
• The condyles are palpated by standing behind the
patient. The little fingers are placed inside the
external auditory canal and the patient is asked to
open and close their mouth. By this method the
position and movement of the condyles are
determined.
• Tenderness over the condylar area with associated
crepitation.
• Displacement of the condylar head within the
external auditory meatus.
• Paresthesia of the lips.
Image source: www.pocketdentistry.com

39. RADIOGRAPHIC ASSESSMENT
 PA Skull View Or Reverse Towne’s View
 Lateral Oblique View
 Orthopantomography (OPG)
 Computed Tomography (CT Scan)
 Cone Beam Computed Tomography (CBCT)
 Multidetector Computed Tomography (MDCT)

40. PA Skull View or Reverse Towne’s
View
Image source: www.radiopaedia.org

41. Lateral Oblique View
Image source: www.sciencephoto.com

42. Orthopantomography (OPG)
Image source: www.radiopaedia.org

43. Computed Tomography Scan
Image source: www.radiopaedia.org
www.researchgate,net
Gold standard for the diagnosis of mandibular condylar fractures.
Coronal section of CT scan showing
a right condylar neck fracture with
medial dislocation of the condyle.
CT scan 3D reconstruction image
of skull showing a right condylar
neck fracture.
Axial section of CT scan showing a
left condylar neck fracture with
lateral dislocation of the condyle.

44. Cone Beam Computed Tomography
Image source: www.semanticscholar.org
Coronal section of CBCT scan showing a left
condylar neck fracture with medial dislocation
of the condyle.
 Multidetector Computed Tomograpy (MDCT) provides similar information as CBCT scan, but
additionally allows some visualization of the soft tissues.
 But the patients are exposed to higher radiation doses than CBCT scans.

45. MANAGEMENT OF CONDYLAR FRACTURES
This is achieved by proper repositioning and immobilization of the fractured fragments.
1. Restoration of form.
2. Obtain stable occlusion.
3. Restore interincisal opening.
4. Establish a full range of mandibular excursive movements.
5. Minimize deviation of the mandible.
6. Produce a pain-free articular apparatus at rest and during function.
7. Avoid internal derangement of the TMJ on the injured and the contralateral side.
8. Avoid the long-term complication of growth disturbances.
GOALS OF THERAPY

46. FACTORS TAKEN INTO CONSIDERATION FOR TREATMENT
• Location of the fracture.
• Amount of vertical reduction in height of the ramus.
• Degree of angulation.
• Relation of condylar head to the glenoid fossa.
• Fragmentation pattern (simple versus complex).
• Association with other mandibular injuries.
• Dental occlusion/status of dentition.
• Association with other facial bone injuries.
• Association with systemic injuries.
• Association with the condition of the patient (comorbidity factors).
• Foreign body in temporomandibular joint (TMJ).

47.  Conservative treatment
TREATMENT OPTIONS FOR MANDIBULAR
CONDYLAR FRACTURES
 Surgical treatment
Image source: www.aofoundation.org

48. CONSERVATIVE TREATMENT
In closed reduction, achievement of good occlusal relationship acts as the guidance
for proper reduction.
The upper and lower jaws are fixed together in occlusal relationship by means of
intermaxillary fixation or maxillomandibular fixation, done using wires or splints.
Various modalities of intermaxillary fixation used commonly for condylar
fracture are:
Wiring:
1. Ivy loop wiring
2. Continuous ivy loop wiring
3. Gilmer wiring
Image source: www.achievers.in
www.springer.com

49. Arch bars:
1. Erich’s arch bar
2. Bone supported arch bar
3. Custom made arch bar
1. 2.
Image source: www.joms.org
www.omfsfoam.com

50. Splints:
1. Cap splint in pediatric patients
2. Gunning splints in edentulous patients
Image source: www.jaypeedigital.com
www.ijds.in
1. 2.

51. 1. Minimally displaced fractures (Not more than 30°).
2. Pediatric fractures.
3. Presence of systemic comorbidities which may be an absolute contraindication for surgery.
4.
Condylar head fractures where there is an increased risk of injury to the joint and the
adjoining structures.
5.
Minimal pain complaints and no occlusal discrepancies with acceptable range of
movements.
INDICATIONS FOR CONSERVATIVE TREATMENT

52. ADVANTAGES DISADVANTAGES
Non-invasive, simple and easy.
Immobilization might not be adequate which
delays healing. Especially in subcondylar
fractures where control over proximal segments
is not established. Unfavorable muscle pull can
cause displacement of fragments.
Does not require exposure to general
anesthesia.
Increases patient morbidity.
Economical. Not safe in epileptic patients.
Less chances of infection. Not tolerated by alcoholic patients.
ADVANTAGES AND DISADVANTAGES OF
CONSERVATIVE TREATMENT

53. 1.
Severe displacement of the condyle.
2.
Mal-united fractures.
3.
Bilateral condylar fractures with severe displacement or dislocation affecting the
occlusion.
4.
Associated fractures of the mandible.
5.
Multi-fragmented fractures of the condylar head.
6. Inability to bring the teeth into occlusion for closed reduction.
INDICATIONS FOR SURGICAL TREATMENT

54. ABSOLUTE INDICATIONS RELATIVE INDICATIONS
Displacement of condyle into the middle cranial
fossa.
Bilateral condylar fractures in an edentulous
patient when a splint is unavailable or when
splinting is impossible because of alveolar ridge
atrophy.
Impossibility of restoring occlusion.
Unilateral or bilateral condylar fractures when
splinting is not recommended for medical
reasons.
Invasion of foreign body.
Bilateral condylar fractures associated with
comminuted midfacial fractures.
Lateral extracapsular displacement.
Bilateral condylar fractures and associated
gnathologic problems, such as retrognathia or
prognathism.
ZIDE AND KENT’S CRITERIA FOR OPEN REDUCTION

55. CLOSED REDUCTION OPEN REDUCTION
1. Undisplaced or displaced condylar or
comminuted fracture (in growing children) where
form and function can be restored.
1. Dislocated condyle and mechanical
interferences with the mandibular function.
2. No medical contraindications for MMF.
2. Loss of antero-posterior and vertical dimension
that cannot be managed by closed reduction
(example: panfacial and edentulous fractures).
3. Medical and anaesthetic contraindications for
open reduction.
3. Compound fractures.
4. Displacement of condyle into middle cranial
fossa.
5. Patient or surgeon preference for early or
immediate mobilization of function.
AAOMS 2017 INDICATIONS FOR CLOSED AND OPEN REDUCTION

56. ADVANTAGES AND DISADVANTAGES OF
SURGICAL TREATMENT
ADVANTAGES DISADVANTAGES
Direct visualization of the fragments for
correct reduction and fixation enabling
proper bone healing.
Potential visible scarring due to skin incisions.
Early mobilization of the mandible ensures
normal joint function and action.
Damage to the nerves, particularly facial nerve.
Restoration of normal oral and jaw activity.
Intra operative bleeding from the maxillary
artery injury.
Loss of blood supply with avascular necrosis of
the condyle.

57. SURGICALAPPROACHES TO CONDYLAR FRACTURES
1. Preauricular approach and its
modifications
2. Post-auricular approach and its
modifications
3. Endaural approach and its modifications
4. Submandibular approach (Risdon)
5. Retromandibular approach (Hind’s / Post-
ramal / Trans-parotid)
6. Rhytidectomy approach (Face-Lift)
7. Coronal approach
8. Intraoral approach
Image source: www.intechopen.com

58. APPROACH IS BASED ON THE LEVEL OF FRACTURE
The surgical approach to the condyle for open reduction and fixation is also dictated by the surgeon’s
experience and skill level, the degree of fracture displacement or dislocation, the patient’s desires, and
the complication risk, among other factors.
Image source: Oral and maxillofacial surgery for clinicians – AOMSI

59. SUBMANDIBULAR APPROACH
Image source: www.aofoundation.org
Oral and maxillofacial surgery for clinicians – AOMSI

60. RETROMANDIBULAR APPROACH
Image source: www.pocketdentistry.com
Oral and maxillofacial surgery for clinicians – AOMSI
Two main variations:
1. Transparotid approach
2. Retroparotid approach

61. POSTAURICULAR APPROACH
Image source: Ellis Surgical approaches to the facial skeleton

62. INTRAORAL ENDOSCOPIC APPROACH
Image source: Oral and maxillofacial surgery for clinicians – AOMSI

63. Image source: Oral and maxillofacial surgery for clinicians – AOMSI

64. PREAURICULAR APPROACH
Image source: Oral and maxillofacial surgery for clinicians – AOMSI

65. 2. Dissection
Locating temporalis fascia
Image source: www.aofoundation.org
1. Skin incision
3. Incising temporalis fascia 4. Dissection of the joint capsule

66. AL-KAYAT & BRAMLEY
(MODIFIED PRE-AURICULAR APPROACH)
Image source: www.wbidajournal.org
www.joms.org

67. CORONALAPPROACH
Image source: www.njms.in
www.aofoundation.org
Anterior branch of
Superficial temporal
artery
Superficial temporal
artery

68. Image source: Oral and maxillofacial surgery for clinicians – AOMSI
OTHER INCISIONS
DINGMAN BLAIR
AL-KAYAT & BRAMLEY POPWICH ENDAURAL
POSTAURICULAR RHYTIDECTOMY
RETROAURICULAR LIMB OF
RHYTIDECTOMY
THOMA

69. REDUCTION
• Reduction is the procedure done for restoring
the functional alignment of the fractured bone
fragments.
• Reduction is one of the most difficult steps in
mandibular condylar fracture surgery, and a
key factor governing the postoperative
outcome.
• It is done to bring the fractured fragments
together close to their previous anatomical
position so that healing is proper and rapid.
• Once access is gained to the surgical site,
reduction is done with the help of
repositioning forceps, repositioning pins,
screws, bone clamps, wires or towel clips.
Image source: Oral and maxillofacial surgery for clinicians – AOMSI

70. METHODS TO REDUCE OF CONDYLAR FRACTURES
ELEVATOR FORCEPS REDUCTION PINS SHARP RETRACTORS

71. FIXATION
Fixation is the surgical procedure that is done to stabilize and join the ends of
fractured bones by mechanical devices such as metal plates, pins, rods, wires,
or screws.
Wires
Screws
Plates
Image source: www.plasticsurgerykey.com
www.ijoms.com

72. IDEAL LINES OF OSTEOSYNTHESIS
Zone of tension: lies along the anterior
border of the condyle and the sigmoid
notch
Zone of compression: lies along the
posterior border of the ramus
Image source: www.sciencedirect.com
TENSION __________________________
COMPRESSION ---------------------------------------

73. FIXATION USING WIRES
 Perthes and Wassmund first mentioned the use of wires for fixing a TMJ fracture in
1924 and 1927 respectively.
 It provides non-rigid fixation.
 It requires other forms of fixation to maintain stability; like splints and IMF.
 It is low cost.

74. DIFFERENT FIXATION OPTIONS IN PLATING SYSTEM
Image source: www.joms.com
PLLA – Poly-L-Lactide (Biodegradable plates)
*
*
*

75. In a single miniplate the fracture must be stabilized using two screws on each side of the
fracture line. The drawback of this plating has showed the greatest peak displacement of
fracture.
SINGLE PLATE
Image source: www.springer.com
www.aofoundation.org

76. Application of two plates at the anterior and posterior aspects of the condylar neck helps
in resisting the torsional force that may not be opposed with a single plate.
TWO PLATE
Image source: www.aofoundation.org

77. These includes single L plate, Y plate, triangular plate, trapezoidal plate, and delta plate.
Among all plates geometric plates provide the better stability and outcome, because it
fulfills the criteria of functionally stable osteosynthesis in the fracture segments.
GEOMETRIC PLATE
Image source: www.e-asp.org
www.joms.org
www.orthopaper.com
Oral and maxillofacial surgery for clinicians – AOMSI

78. LAMBDA PLATE DELTA PLATE
Image source: Oral and maxillofacial surgery for clinicians – AOMSI

79. DISADVANTAGES OF PLATING SYSTEM
 The whole joint must be opened in most high fractures.
 If the osteosynthesis material is to be removed after the fracture has healed, then a
second operation on the joint region is required.
 The second operation can eventually be more dangerous for the facial nerve
because of the scarring from the first operation.

80. They prevents the need for re-operation
and has shown good results in the
treatment of condylar fractures. They are
not very stable when compared to titanium
plates in the treatment of condylar
fractures.
RESORBABLE PLATES
Image source: www.oooojournal.net
www.bjoms.com
Three-dimensional fixation of fracture
of the mandibular condyle with a
resorbable three-dimensional
osteosynthesis mesh.

81. Lag screw technique compresses the
fracture fragments together. Good
clinical results can be obtained
especially in diacapitular fractures.
LAG SCREW
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www.aofoundation.org
www.pocketdentistry.com

82. Kirschner wires or K-wires are sharpened, smooth stainless steel pins. Introduced in
1909 by Martin Kirschner, the wires are now widely used in orthopedics They come in
different sizes and are used to hold bone fragments together. The pins are often driven
into the bone through the skin (percutaneous pin fixation) using a power or hand drill.
KIRSCHNER WIRE / K WIRE AND BIORESORBABLE PINS
Image source: Indian Dental Academy
Rasse described an osteosynthesis method for fixing
intracapsular fractures using bioresorbable pins.
K WIRE BIORESORBABLE PINS

83. The condyle is explanted from the glenotemporal fossa, reduced and fixed in desired
position. The drawback of this type of fixation is that it will lead to avascular necrosis
related to detachment of soft tissue
EXTRA CORPOREAL REDUCTION AND FIXATION
Image source: www.researchgate.net

84. MANAGEMENT OF PEDIATRIC CONDYLAR FRACTURES
Cap splints for pediatric patients
Conservative-Functional treatment:
 No active fixation but early gentle mobilization if the patient, with or
without assistance, can obtain a normal occlusion.
 Intermaxillary fixation for 10 days, then gentle mobilization and function.
The increased vascularity, combined with thinner
cortical bone, makes the child's condyle more
susceptible to "burst" type fractures, leaving multiple
small highly osteogenic fragments within the joint
space, which may increase the risk for joint ankylosis.
The principle behind the treatment is the repositioning of large tooth-bearing
fragment and mobilization of the mandible at as early a stage as possible in
order to avoid arthrodesis. Bone awl

85. Current Concepts in the Mandibular Condyle / Fracture Management Part II: Open Reduction Versus Closed Reduction Kang-Young
Choi et al, Department of Plastic and Reconstructive Surgery, Kyungpook National University School of Medicine, Daegu, Korea

86. MANAGEMENT OF GERIATRIC CONDYLAR FRACTURES
Edentulous patients are treated with a Gunning splint or the
patient's own dentures to recreate the vertical height of the
mandible. If these splints are not firm enough, then circum-
mandibular wiring is used.
Intermediate splint is made
with self cure acrylic resin in
the articulator
A modified maxillary
Gunning splint using the
patient's preexisting dentures
Gunning Splint
Image source: www.researchgate.net
www.jaypeedigital.com

87. CIRCUM-MANDIBULAR WIRING
Image source: www.jaypeedigital.com

88. CONCLUSION
The most difficult problem arising after any condylar fracture is the risk of ankylosis.
These complications seldom arise today if the mandible is mobilized early and if the
patient fully cooperates. Long-term active patient co-operation is required for upto 6
months.
Perhaps the collective experience of many surgeons who treat these fractures can best be
characterized as follows:
Intracapsular fractures are best treated closed.
Fractures in children are best treated closed except when the fracture itself anatomically
prohibits jaw function.
Most fractures in adults can be treated closed.
When open reduction is indicated, the procedure must be performed well, with an
appreciation for the patient's occlusal relationships, and it must be supported by an
appropriate physical therapy and follow-up regimen.

89. REFERENCES
 Oral and maxillofacial trauma – Fonseca, vol.1
 Maxillofacial trauma & Esthetic facial reconstruction – Peterward Booth
 Maxillofacial Injuries – Rowe & Williams, vol 1
 Principles of oral maxillofacial and reconstructive surgery – Peterson’s, vol 1
 Oral and maxillofacial surgery for clinicians – AOMSI