Mandibular Condylar Fractures, Lecture notes of Dental surgery

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CONDYLAR FRACTURES

ANATOMY

CLASSIFICATIONS

LINDAHL CLASSIFICATION

AO CLASSIFICATION

IMAGING

CT SCAN

CLINICAL FEATURES

BILATERAL

• INTRACAPSULAR

• (^) Occlusion slightly deranged
• (^) CONDYLAR NECK
• (^) Considerable displacement to either side
• (^) Anterior open bite
• (^) Premature occlusal contact

INDICATIONS FOR REDUCTION

Absolute Indications:

• Condylar displacement into middle cranial fossa
• Invasion by foreign body
• Lateral extracapsular displacement of condyle
• When occlusion cannot be achieved by closed reduction

INDICATIONS FOR REDUCTION

Closed Reduction

• Nondisplaced or incomplete fractures
• Isolated intracapsular fractures
• Condylar fractures in children (except for absolute indications)
• Medical illness or injury that inhibits ability to receive extended general anesthesia

TREATMENT

YOUNG PATIENTS AT RISK FROM ANKYLOSIS OR DEFECTIVE DEVELOPMENT

• (^) close proximity of the fractured condyle neck to glenoid fossa (intracapsular fractures and dislocations with gross telescoping)
• (^) compound fractures (coronoid and zygomatic involvement)
• (^) patients aged below 10 years
• Conservative non immobilisation regime used, in case of severe pain IMF indicated but for not more than 14 days.

COMPOUND FRACTURES

• (^) Antibiotics and early operation indicated.
• (^) Removal of nonviable fragments indicated at the time of exploration.
• (^) Early movement encouraged. Use of elastic exerciser or increasing wedges of wooden spoons help postoperatively.
• (^) IMF minimised.
• (^) Review to check for ankylosis and retarded development.