CONDYLAR FRACTURES

CONTENTS

• SURGICAL ANATOMY
• ETIOLOGY
• BIOMECHANICS
• CLASSIFICATION OF CONDYLAR FRACTURES
• RADIOGRAPHIC EVALUATION
• CLINICAL FEATURES
• MANAGEMENT
• COMPLICATIONS
• CONCLUSION
• REFERENCES
2

CONDYLAR FRACTURES
INTRODUCTION- SURGICAL ANATOMY

CONDYLAR FRACTURES
 ETIOLOGY
• Direct or indirect trauma
• Interpersonal violence- frequent
cause,
• Sports injury,
• Falls and road traffic accident

CONDYLAR FRACTURES
• ROWE AND WILLIAM MAXILLOFACIAL INJURIES, 2ND EDITION
BIOMECHANISM OF CONDYLE
FRACTRUE

CONDYLAR FRACTURES Treatment of Mandibular Condylar Process Fractures: Biological Considerations

Edward Ellis III, DDS, MS* and Gaylord S. Throckmorton, PhD†
MECHANISM OFINJURY

CONDYLAR FRACTURES • ROWE AND WILLIAM MAXILLOFACIAL INJURIES, 2ND EDITION

 • WASSMUND CLASSIFICATION(1934)
• MAC LENNAN CLASSIFICATION (1952)
• ROWE AND KILLEYS CLASSIFICATION(1968)
• SPIESSEL AND SCHROLL CLASSIFICATION(1972)
• COMPREHENSIVE CLASSIFICATION-
CLASSIFICATION OF LINDHAL(1977)
CONDYLAR FRACTURES • ELLIS AND COWORKERS (1999)
• LOUKOTA ET AL- ADOPTED BY STRASBOURG
OSTEOSYNTHESIS RESEARCH GROUP (2005)
• AO CLASSIFICATION (2010)

CONDYLAR FRACTURES
 Wassumund 1927
• DIFFERENTIATED BETWEEN THE HEAD
AND NECK FRACTURES OF THE
CONDYLE. 8

EARLY CLASSIFCATION ONLY

DESCRIBED ANATOMICAL POSITION
BUT HAD NO RELEVANCE IN
TREATMENT

CONDYLAR FRACTURES WERE

CLASSIFED AS: Base fracture
Neck fracture
Head fracture

CONDYLAR FRACTURES
 MAC LENNAN (1952)

• More simple and practical the

classification.
• Class I: no deviation (bending)
• Class II: deviation (bending) at the
fracture level
• Class III: displacement (condylar
head remains within
• fossa)
• Class IV: dislocation (condylar head
outside of fossa)

CONDYLAR FRACTURES
 LINDAHL (1977) CLASSIFICATION

RELATIONSHIP OF CONDYLAR FRAGMENT TO MANDIBLE

FRACTURE LEVEL

RELATIONSHIP OF CONDYLAR HEAD TO

GLENOID FOSSA 10

CONDYLAR FRACTURES
 Rowe & Killey 's classification(1968)

a. Intracapsular Fractures or High Condylar Fractures

i. Fractures involving the articular surface
ii. Fractures above or through the anatomical neck, which do not
involve the articular surface

b. Extracapsular or Low Condylar or Sub condylar Fractures---

Fracture line runs obliquly from the lowest point of curvature of
the sigmoid notch downward and backward below the neck to the upper
posterior limit of the ramus.

c. Fractures associated with injury to the capsule, ligament and meniscus

d. Fractures involving adjacent bone– Roof of the glenoid fossa or tympanic 11

plate of the external auditory meatus.

CONDYLAR FRACTURES
 CLINICAL FEATURES
1. Localised pain & swelling in the Preauricular
Unilateral fracture
region.
1. Deviation, upon opening to theinvolved
2. Limitation in mouthopening.
side.
3. Blood in the external auditorycanal.
2. Posterior open bite on the contralateral
4. Ecchymosis of skin over the mastoid process. side
5. Painful and restricted jaw protrusive, retrusive and 3. Ipsilateral side with posterior crossbite.
lateral jaw movements.
Bilateral fracture
1. Anterior open bite
2. Elongation of face
3. Frequently assocated with symphysis
and parasymphysis#

• ROWE AND WILLIAM MAXILLOFACIAL

INJURIES, 2ND EDITION
 MANAGEMENT OF CONDYLAR
FRACTURES

CONSERVATIVE SURGICAL

FUNCTIONAL

13

CONDYLAR FRACTURES
CONSERVATIVE MANAGEMENT
• Exercise
• Increasing mouth opening
• Push the jaws laterally
• Diet: Soft diet
• Analgesics
• Anti-inflammatory
• Soft diet and mouth exercises-
• Teeth into normal occlusion
• Adequate ROM
• Elastic MMF for 2-3 weeks
• When occlusion is found to be altered
• Patient was unable to bring their teeth into normal occlusion
presence of pain or swelling
 CLOSED REDUCTION
• Advantages
• Relatively safe procedure
• No injuries to vital structures
• Hospitalization may not be required
• Disadvantage
• Long period of intermaxillary fixation
• Growth disturbances can occur in children
• Success depends on patients cooperation
• Long-term follow
• Contraindicated in medically compromised
• Challenge in partially or totally edentulous patients

15

CONDYLAR FRACTURES
 INDICATIAONS FOR OPEN REDUCTION AND INTERNAL FIXATION

ZIDE AND KENT – 1983

VS
ABSOLUTE RELATIVE
• Bilateral fractures in edentulous jaws
• Displacement into middle cranial fossa or
• Gross condylar displacement > 45 degrees
external auditory meatus
• Anatomic reduction of ramus height > 2mm
• Inability to obtain adequate occlusion by
non surgical treatment • Unstable occlusion
• condylar fractures with an unstable base
• Invasion of foreign body
(associated with midface fractures)
• Lateral extracapsular displacement • IMF contraindicated for medical reasons
• Condylar fractures in which active
16
physiotherapy is impossible

CONDYLAR FRACTURES
 BENEFITS OF ORIF COMPLICATIONS OF ORIF

• Direct visualization of fracture • Poor esthetic result from skin incision

fragments for accurate fixation and • Neural damage , especially to facial
reduction nerve
• Early mobilization of mandible • Intraoperative bleeding from maxillary
• Early restoration of normal jaw activity artery

• loss of blood supply to condylar head,

leading to necrosis

17

CONDYLAR FRACTURES
 SURGICAL
APPROACHES
• Retromandibular
• Submandibular
• Rhytidectomy
• Preauricular
• Intraoral
• endoscopic

18

CONDYLAR FRACTURES
Transparotid Incision
Retroparotid Incision
Submandibular Incision
Rhytidectomy Incision
 Intraoral Incision
e
 METHODS OF REDUCTION

• MANUAL DIGITAL TRACTION

• BITE BLOCK
• TRANSOSSEOUS WIRE
• TOWEL CLIP

24

CONDYLAR FRACTURES
 METHODS OF IMMOBILIZATION

CURRENT METHODS

Miniplate osteosynthesis
Specially designed condylar plates
Lag screw osteosynthesis
Pin fixation
Bioresorbable plates and pins

25

CONDYLAR FRACTURES
 MINIPLATE OSTEOSYNTHESIS

26

CONDYLAR FRACTURES
 Complications
COMMON RARE SURGICAL

• Joint mobility disorders • Articular head necrosis • Transient or permanent

• Occlusal discrepancies
• Ipsilateral asymmetry
on the side of trauma
• Ankylosis [0.2% -0.4%]
• Alteration of facial
growth
• Infection
• Fixation failure
• Malunion
which is related with facial palsy
surgical method • Marginal mandibular
nerve palsy
• Ear lobe hypoesthesia
• Post surgical scarring
• EAC stenosis
• Auriculotemporal
nerve syndrome or
Frey’s syndrome
• Formation of sialocele
or salivary fistulas
• Masseter myotonia
27

CONDYLAR FRACTURES
RECENT STUDY IN MANAGEMENT OF CONDYLAR FRCATURE

28

CONDYLAR FRACTURES
 REFERENCES
• ORAL AND MAXILLOFACIAL TRAUMA, RAYMOND J. FONSECA, 4TH EDITION
• MAXILLOFACIAL SURGERY, PETER WARD BOOTH, 2ND EDITION, VOLUME 2
• ROWE AND WILLIAM MAXILLOFACIAL INJURIES, 2ND EDITION
• KILLEYS FRACTURE OF MANDIBLE , 4TH EDITION
• A MODIFIED PRE-AURICULAR APPROACH TO THE TEMPOROMANDIBULAR JOINT AND MALAR ARCH ADIL AL-KAYAT, B.D.S.,
M.MED.SCI., F.D.S.R.C.S., 1 and PAUL BRAMLEY, M.B., CH.B., B.D.S., F.D.S.R.C.S.
• MANAGEMENT OF PEDIATRIC MANDIBLE FRACTURES ERIK M. WOLFSWINKEL, BS, WILLIAM M. WEATHERS, MD, JOHN O. WIRTHLIN, DDS, MSD, LAURA
A. MONSON, MD, LARRY H. HOLLIER JR, MD*, DAVID Y. KHECHOYAN, MD
• TREATMENT OF MANDIBULAR CONDYLAR PROCESS FRACTURES: BIOLOGICAL CONSIDERATIONS EDWARD ELLIS III, DDS,
MS* AND GAYLORD S. THROCKMORTON, PHD†

29

CONDYLAR FRACTURES