1. GOODMORNING

2. SEMINARCONDYLAR FRACTURESSUBMITTED BYYASMIN MOIDIN2008 BatchAl Azhar Dental College 3. CONTENTSINTRODUCTIONCLASSIFICATIONINVESTIGATIONSETIOLOGYCLINICAL EXAMINATIONPRINCIPLES OF TREATMENTTREATMENTTREATMENT PROTOCOLCOMPLICATIONS 4. ClassificationUnilateral and bilateral fracturesIntracapsular fracture and extra capsular fractures.Simple, compound or comminuted fractures of thecondyle. 5. Lindhals classificationo Based on anatomic location of the fracture(level ofcondylar fracture)Condylar headCondylar neckSubcondylar.,o Based on the relationship of the condylar segment tothe mandibular fragmentNon displacedDeviatedDisplaced with medial or lateral overlapDisplacement with anterior or posterior overlapNo contact between the fracture segments 6. o Based on the relationship between the condylar headand glenoid fossa.Non displacedDisplacementDislocationMacLennan systemNon displacedFracture deviationFracture displacementFracture dislocation 7. AetiologyInjury caused by a moving object as in caes of firstinjury, violence, sports etcInjury caused when an individual falls or hits a surfacewhile in motion as in cases of parade ground fracturewhere the soldier falls on the ground from an uprightposition due to syncope without making any effort toprotect the face.Injury resulting due to the combined forces of theabove mentioned causes. 8. Signs and SymptomsUnilateral condylar fractureSwelling and tenderness over the TMJ area.Haemorrhage from ear on that side ( results from lacerationof the anterior wall of the external auditory meatus. 9. Bleeding originating in the external auditory canalfrom the middle ear haemorrhage.Ecchymosis of the skin just below the mastoid processon the same side. This particular physical sign alsooccur with fractures of the base of the skull when it isknown as Battles sign. 10. If the condylar head is dislocated medially and all oedemahas subsided due to passage of time, a chacteristic hollowover the region of the condylar head is observed.Deviation of the mandible on opening towards the side ofthe fracture.unilateral posterior crossbite and retrognathic occlusionParaesthesia of the lower lip in the absence of fracture ofthe body or angle of mandible on that side. 11. Gagging of the occlusion on the ipsilateral molarteeth.Painful limitation of protrusion and lateral excursionto the opposite side.Mandible will be locked and middle ear bleeding maypresent externally .Tenderness over the condylar area on palpitation 12. Bilateral condylar fractureThe signs and symptoms for unilateral fracture may bepresent on both sides.Swelling over fracture sitesOverall mandibular movement is usually morerestricted than in unilateral fracture. 13. Pain and limitation of opening and restrictedprotrusion and lateral excrusions.Appearance of an elongated face may be the result ofbilateral subcondylar fracture.Bilateral condylar fractures are frequently associatedwith fracture of the symphisis or parasymphisis. 14. Principle of treatment of condylar fractureConservativeFunctionalSurgical 15. TREATMENT OF CONDYLARPROCESS FRACTUREClosed Technique(conservative treatment) Unilateral or bilateral fractures Active jaw movement Excessive pain or gross malocclusion is present,intermaxillary fixation is recommended 16. INDICATIONS Condylar fracture with minimum displacement andminimum occlusal disturbance and in case of themandible opening the mouth. 17. Open Reduction The objective of surgical treatment is achieved byexposure of the condylar fragment, reduction to thenormal relationship and fixation in that position. 18. ABSOLUTE INDICATION Dislocation of the condyle into the middle cranialfossa. Inability to achieve occlusion by closed reduction. Lateral fracture dislocation of the condyle Compound fracture of the condyle like that due to gunshot wounds or invasion by other foreign objects 19. Surgical approachesPreauricular approachAlkayat- BramleyRowes extensionObwegesers modificationHockey stickRetromandibular approachSubmandibular approachBicoronal 20. Methods of immobilization ofcondyleINTRA MAXILLARY FIXATIONTransosseous wiringKirschner wireIntramedullary screwBone pinsBone plating 21. Treatment protocol for differenttypes of condylar fracture.For children under 10 years of age.This age group is more likely to develop ankylosis due tothe condylar fracture. The treatment is completelyfunctional for both unilateral and bilateral condylarfractures. IMF may be required for a period of 7 to 10days in case of extreme pain. 22. Adolescents between 10 and17years of ageThe treatment protocol is same for this group.However, malocclusion interferes with the treatment,and therefore IMF is indicated for a period of 2 to 3weeks in such cases. 23. Unilateral intracapsular fractures inadultThis kind of fracture deosnot cause much of adeformity. Therefore, conservative treatment isconsidered appropriate and IMF for a period of 2 to 3weeks in case of malocclusion. 24. Bilateral intracapsular fractures inadultAn intermaxillary fixation for a period of 3 to 4 weeksis recommended as the amount of displacement ofboth the condyles may be different. Physiotherapyafter IMF prevents any restricted of mouth opening 25. Unilateral extracapsular in adultA low condylar neck fracture is treated by openreducion method in case of severe malocclusioncaused by the fracture or dislocation . No effectivetreatment is undertaken, if the fractured segment arenot displaced, and there is no disturbance to toocclusion. 26. Bilateral extracapsular in adultUsually this fracture results in instabilty and grossdisplacement of the mandible. IMF is not reliable forthe proper reduction of the fractured site though itmay establish the normal height is recommended andthen the treatment protocol is same that for unilateralextracapsular fracture. When bilateral extracapsularfracture is associated with other gross midfacialfracture, open reduction of the both the sides shouldbe considered. 27. COMPLICATIONSANKYLOSIS OF THE TMJ-Ageof the patientGreater in younger patients(10 yrs)Intra capsular fracturesProlonged immobilisation-Ankylosis 28. Damage to meniscus2.interferance with growth