2. ETIOLOGY - MECHANISM OF INJURY
LINDAHL (1977) PROPOSED 3 MECHANISMS OF INJURY TO THE CONDYLE.
1. Kinetic energy imported to the static individual by a moving
object.
2. Kinetic energy derived from the movement of the individual and
expended upon a static object.
3. Kinetic energy which is a summation of forces derived from a
combination of 1 & 2.
3. CLINICAL CLASSIFICATION
Spiessl & Schroll 1972
Type I - No displacement
Type II - Fracture deviation
Type III - Fracture displacement
Type IV - Fracture dislocation
5. RELATIONSHIP OF CONDYLAR
FRAGMENT TO MANDIBLE
Undispladed fracture
Deviated – simple angulation
Displaced: - medial or lateral
overlap.
- anterior or
posterior overlap
No contact between fragments
7. CLINICAL FEATURES OF SUBCONDYLAR
FRACTURES
* Contusion, abrations, laceration of chin, ecchymosis and
hematoma in the temperomandibular joint region
* Laceration or bleeding of external auditory canal.
* Swelling over TMJ - secondary to hematoma, edema, in
indicating laterally dislocated condylar head.
* Facial asymmetry - secondary to foreshortening of
mandibular ranus.
* Pain and tenderness spontaneously or in response to
pressure.
* Deviation of mandibular midline towards the fracture side.
.
9. DIAGNOSTIC AIDS AND ITS
ROLED IN TREATMENT PLAN
* CONVENTIONAL RADIOGRAPHY (in common use)
- Orthopantomogram
- Lateral oblique view mandible
- Reverse towens view mandible
- P.A. view skull
- Trans cranial views of TMJ
10. *CONVENTIONAL TOMOGRAPHY
- Coronal or saggital plane may provides useful
information
- Three dimensional CT scans indicates shift of the
condyle either anteriorly or medially deciding the
treatment plan.
* ARTHROGRAPHY
- Evaluates soft tissue components especially disk
position, function and shape during capsular
damage
11. ABSOLUTE AND RELATIVE INDICATION OF
OPEN REDUCTION(ZIDE AND KENT)
ABSOLUTE INDICATIONS:
* To restore vertical and anterioposterior facial dimention
* When stability of occlusion is limited (less than 3 teeth per
quadrant, gross, periodontal diseases, skeletal abnormality)
* When rigid internal fixation is used to address other facial fractures
affecting the occlusion
* when manipulation and closed treatment cannot re-establish the
pre tramatic occlusion
* Invation of the foreign body
* Post pubertal patients
* Dislocation of condyle into middle cranial fossa
12. RELATIVE INDICATIONS
(ZIDE AND KENT)
* Edentulous jaws
* Uncontrolled seizure disorders
* Status asthmaticus.
* Psycologic compromise
14. OPEN REDUCTION
APPROACHES AND ADVANTAGES
PRE AURICULAR APPROACH
* An incision of the Alkayat & Bramley type for high condylar
and neck fractures.
* Condyle can be exposed for almost half of its depth in
addition to lateral aspects
* Branches of facial nerve are avoided
* Postoperative scar hidden
15. OPEN REDUCTION
APPROACHES AND ADVANTAGES
RETROMANDIBULAR APPROACH
* A Risdon type submandibular incision gives good access of
low sub condylar fractures. (Basal # dislocation)
* Osteosynthesis with wire ligature or mini plates may be
accomplished
22. CLOSED REDUCTION & MAXILLO
MANDIBULAR FIXATION
DISADVANTAGES
- FAILURE OF INDIRECT REDUCTION.
* When Condyle has incompletely penetrated the capsule
assumes a cuff-life position around the neck of the condyle
interfering with repositioning.
* Connection between the peripheral mandibular fragment and
dislocated small fragment is torn so that force is not
transmitted to the fragment.
* The rate of dyfunction like malocclusion, reduced mouth
opening, deviation, impaired masticatory function, pain over
affected joint.
23. CLOSED REDUCTION & MAXILLO
MANDIBULAR FIXATION
ADVANTAGES
- The Risks associated with surgical intervention are
compensated.
- Economic point of view hospitalization can be dispensed with,
were two periods of hospitalization are necessary for surgical
treatment.
24. RETROSPECTIVE STUDY 6
YEARS (1996 - 2002)
- Total number of # in 6 years - 435 cases
- Condylar fractures 72
Types of Condylar fractures - undisplaced = 34
- displaced = 24
- deviated = 8
- dislocated = 6
Type of treatment - Conservative = 59
- Functional = 7
- Surgical = 6
