a method for treating the fracture of the neck of the condyle

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A RIETHOD FOR TREATIXG THE FRACTIIRE OF TIIE NECK OF THE COND‘S'L,K C ASE (E. G. B.) NO. 508, W. M. Age 29. _4ccitlcnt 1\Z:rrch 27, 1925. Bislo~g.-The pat,ictnt fell forward &liking his chin on :I piece of sheet iron which was being pushed by him. He suffered from severe pain in his head, hemorrhage and pain, and was unable to hear in the right ear. He was x-rayed by a physician for the Fig. l.--SntermaxiIla~J- splints with stilts in place. Fig. 2.-Fracture of the condyloid neck with displacement. obtainable alignment. Approximation, and best Fig. i.-X-r33.v, Interal after’ treatment. insurance company, with negative report as to fracture. The case was referred to the hospital, and the patient was under observation for three days. He was x-rayed again, with negative report as to fracture. Patient was discharged from hospital. He reported 84

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A RIETHOD FOR TREATIXG THE FRACTIIRE OF TIIE NECK OF THE COND‘S'L,K

C ASE (E. G. B.) NO. 508, W. M. Age 29. _4ccitlcnt 1\Z:rrch 27, 1925.

Bislo~g.-The pat,ictnt fell forward &liking his chin on :I piece of sheet iron which

was being pushed by him. He suffered from severe pain in his head, hemorrhage and pain, and was unable to hear in the right ear. He was x-rayed by a physician for the

Fig. l.--SntermaxiIla~J- splints with stilts in place.

Fig. 2.-Fracture of the condyloid neck with displacement. obtainable alignment.

Approximation, and best Fig. i.-X-r33.v, Interal after’ treatment.

insurance company, with negative report as to fracture. The case was referred to the hospital, and the patient was under observation for three days. He was x-rayed again, with negative report as to fracture. Patient was discharged from hospital. He reported

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Fig. 4. Fig. 5. Fig. 6. Fig. 4.-Illustration of fracture of condyloid neck with displawmmt of the htnd Jag. 5.-With stilts in place to afford :~ppr’oxinlation and stability. Fig 6.---Closed, after union, to carry ht~+rl bxck into thr- ~lmoi~l cw\,ity.

Fig. 8.-X-ray, anterior posterior, of left side, Fig. R.-X-ray, anterior posterior, of left sirl?. before treatment. after treatment.

86 A. L’. Russell

to his dentist to have fractured teeth restored. Because of lack of occlusion from dis- placed mandible, the patient was referred to me for diagnosis.

Exarnina.tion.-April 3, 1925. Condyloid head on right side was located by palpation in right ear. Crepitation was present upon movement. Ro condylnr head movement on left could be demonstrated. There was some swelling and soreness. The mandible was displaced to the right with little or no occlusion of the teeth.

Radiographic exnminntion revealed fracture of the left eondyle neck with upward and inward displacement of head. Fracture of tympanic plate could not be well dem- l

onstrated by x-ray, but was present.

Recoltlntetldutir,t(.-Reduction of fracture by intermaxillary splints with stilts. (The st,ilts were to be used to stabilize the mandible aud to produce better alignment of fracture and to move the condyloid head forward out of the fractured tympanic plate.)

The patient, was referred by the physician to be x-rayed again, and fracture of condylc neck on left side and fracture of tympanic plate right side \vere reported. Dental con- sultation was called, no treatment recommended becausr the opinion was given that “treat- ment will not be beneficial, and if treated l’aticnt will have a stiff jaw due to the fractured tympanic plate. ’ ’

The patient came back to me. My above recommendation was carried out. (Fig. 1.) Intermaxillary splints were constructed and cemented to place. (Fig. 3.) X-ray showed fractured ends approximatiug but not in perfect alignment. (Fig. 3.) Three weeks later stilts were removed and rubber bands applied to assist the teeth and jaws to assume former relatiou. Usual st,ifYness due to disuse, occlusion good. Fig. 4 illustrates fracture of the condyloid ueck nith displaced head. Fig. 5 shows stilt in place allowing enough approxima- t,ion for union. Fig. G shows stilt removed, mouth closed which carries head into the glenoid cavity. Use assists the head to assume its normal position and good alignment. (Fig. 7.) After treatment good alignment. (Fig. 8.) Anterior posterior x-ray shows frac-

ture and displacement. (Fig. 9.) After treatment. The x-rays were mntlc as nearly as possible at right angles to show the alignment

from two positions.