Its a question on wich i made this presentation .need guideline to improve it further

2. Differentiate B/W displaced and dislocated condyle
fracture,and how will you manage bilateral condylar
fractures

5. Management of bilateral condylar
fractures
 History:
 ATLS protocol
 i. Primary survey
 A.airway and cervical spine
 B. breathing and ventilation
 C.circulation and haemorrhage control
 D. Disabilty due to neurological deficit
 E. Exposure and Environmental control

6. ii. Secondary survey
 Carried out after initial resuscitation
 Head to Toe examination
 Neurological assessment through GCS and pupil
response
 Maxillofacial region Examination
 Extraoral Examination
 Intraoral Examination

7. Extraoral Examination
On Inspection.
 Restricted and painful jaw movement
 Asymetry
 Open mouth(bilateral condylar fractures)
 Lengthening of face
 Swelling
 Bleeding from the ear
 Hematoma in external auditory meatus
 Facial nerve examination

8. Palpation
 Tenderness over both condylar regions
 Anterior and posterior palpation and check up for the
condyle movements
 Step deformity
 Crepitations

9. IntraoralAnterior open bite
Check for any hematoma and laceration
Symphysis and parasymphysis area should be examined
Gagging of the occlusion on the ipsilateral side in
unilateral fracture
Mandible deviated to the affected side in case of
unilateral condylar fracture
Limitaion of lateral excursion to the opposite side

11. Radiographic Examination
 OPG
 PA Face
 Reverse townes view
 CT Scan(for head and intracapsular #)
 MRI(for disc position)

 Diagnosis

14. Classification of condylar #
 Spiessl and schroll classification
 Type I: Fracture without displacement
 Type II: Low Fracture with displacement
• Type III: High Fracture with displacement
• Type IV: Low Fracture with dislocation
 Type V: high Fracture with dislocation
 Type VI: intracapsular fracture

15. Lindhal classification
 Level of condylar fracture
 Condylar head
 Condylar neck
 Subcondylar
Relationship of condylar segment to mandibular ramus
 Nondisplaced
 Deviated
 Displaced with medial or lateral overlap
 Displaced with anterior or posterior overlap
 No contact B/W fracture segments

16. Relationship B/W condylar head
and glenoid fossa
 Non displaced
 Displaced
 Dislocated

17. On the basis of age and Occlusion
Age
 A) under 10 years
 B) 10-17 years
 C) Adult
Occlusion
 Disturbed
 Undisturbed

18. Dislocated condylar fractures
 A dislocted condylar fracture is one in wich condyle is
driven out of the glenoid fossa but still in capsule.
Displaced Fractures
 A fracture in wich the fracture in wich the fracture
segments are pull apart from each other or
override each other . It is measured in degrees and
mm
Displaced dislocated fracture

19. Treatment of bilateral condyle
fracture
 Closed treatment
 ORIF
Closed treatment
 Intracapsular fractues:
 If occlusion is undisturbed
 Conservative treatment without immobiliztion
 If occlusion is slightly disturbed
 2-3 wks immobiliztion
 Can lead to chronic limitation of movements
 Post reduction physiotherapy with simple jaw excerciser

20. In case of children under 10 year of
age
Strict followup is necessary to monitor the growth of
mandible 6month to 1 year
If growth reduced it should be treated with
myofunctional appliances

21. Extracapsular fracture
 In fracture without displacement
IMF 3-4 wks
Functional treatment if lateral deviation or anterior
open bite is present
In case of fracture with displacement
Same treatment as above

22. For children under 10 year of age
 IMF is indicated to control pain for 7-10 days
 In children 10-17 year of age
 IMF for 2-3 wks
Adults
 3-4 wks
In edentulous patients
 Gunning splints
 Patient own denture
 Zygomaticomaxillary suspension
 Cirumferential wiring

23. Gunnings splints

24. ORIF
Absolute indications
a) Displacement of the condyle into middle cranial
fossa
b) Impossibility of restoring occlusion
c) Lateral extracapsular displacement
d) Invasion by foreign body
e) Displacement more than 5 mm and 30degree
deviation

25. Relative indications
a) When IMF is contraindicated for medical reasons
b) Bilateral fractures with associated midface fractures
c) Bilateral fractures with severe open bite
d) Bilateral fracture with preinjury malocclusion.

26. Various surgical approaches to
Condyle fracture
Submandibular approach
Retromandibular approach
Pre auricular and auricular approach
Coronal

28. Reduction
 For reduction of condylar head fracture the ramus is
needed to be pull down
Fixation
a) Miniplates
b) Lag screw
c) Transosseous wiring
d) K wire

30. Complications
I. Ankylosis(less than 12 year)
II. Growth restriction
III. Disturbance in mandibular movements

31. THANK YOU