Condylar fractures1 /certified fixed orthodontic courses by Indian dental academy

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CONDYLAR FRACTURES

INDIAN DENTAL ACADEMY

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www.indiandentalacademy.com

Imaging/radiographs

P.A view of the skull

Lateral Oblique

OPG

C.T

M.R.I


Treatment of condylar #

Non Surgical/Conservative method

Surgical method


Conservative/Nonsurgical

Most of the cases can be treated by this method.

1. Observation & softdiet

2. Immobilization with archbars&wires

3. Intense physiotherapy.


Anatomy of condyle in child

Upto 2 years of age condylar head is highly vascular penetrated by numerous blood vessels.

Cortical bone of condyle is thinner than the adult condyle.

Condylar head is broader,fuller and neck is thicker than adult


Glenoid fossa is shallower,concave with a steeper morepronounced articular eminence.

Bone quality is more softer and pliable.

The increased vascularity with thinner cortical bone,makes childs condyle more susceptible to burst type of #,leaving multiple ,small,highly osteogenic fragments

in joint space. This increases the risk of ankylosis


TREATMENT OF CONDYLAR#


Children under 10yrs of Age:

This group more likely develops growth disturbance or limitation of movement than others

If malocclusion is present becoz of condylar #, it should be disregarded

becoz spontaneaous correction will take place as the dentition develops


Displaced condylar neck # will undergo full functional restitution in most cases.

Immobilzation by MMF is indicated for control of pain and should be released in 7-10 days.In case of intracapsular #careful followup and monitoring of growth is required.

Treatment with myofunctional appliances started if subsequent mandibular development is reduced.


Adolescents 10-17 years

If malocclusion is present the capacity for spontaneous correction is less than the younger age group.

MMF is indicated for 2-3 weeks if there is malocclusion.

The dentition is suitable for eyelet application.


ADULTS

Unilateral intracapsular #:

-Occlusion is usually undisturbed

-Fracture should be treated conservatively without MMF

-Occasionally slight malocclusion is noted,in which case MMF for 2-3 weeks is applied.


UNILATERAL CONDYALR NECK #

Undisplaced # where there is no occlusal disturbance no active treatment is done.

--A # dislocation will often cause malocclusion due to shortening of ramus.

--A low condylar neck # is probably best treated by ORIF.


--High condylar # with extensive displacement and malocclusion, MMF

is applied and maintained till bony union has occurred i.e 3-4weeks

--BILATERAL CONDYLAR NECK #There is considerable displacement on one side or otherAlthough the application of MMF will establish the occlusion,it will not reliably reduce the fracture on both sides

So ORIF of atleast one side is indicated to restore the ramus height


BILATERAL HIGH CONDYLAR NECK #

ORIF is likely to be difficult MMF should be applied for 6 weeksIf arch bars or cap splints are applied the use of intermittent elastics at night for several weeks after the fixation is removed is done.When a bilateral # is associated with major midfacial # then ORIF of both sides is desirable.


INDICATIONS OF OPEN REDUCTION

ABSOLUTE INDICATIONS:

1. Displacement of condyle into the middle cranial fossa.

2. Unable to obtain the good occlusion by closed tech.

3. Lateral extracapsular dislocation of the condyle


RELATIVE INDICATIONS:1. Bilateral condylar #in an edentulous

patient when splints are unavailable or not possible becoz of severe ridge atrophy.

2. Unilateral/bilateral condylar #when splinting is contraindicated becoz of associated medical conditions.

3. Bilateral condylar # associated with communited midfacial #


APPROACHES TO TMJ

1. Submandibular(RISDON’S)2. Postramal(HIND’S)3. Postauricular4. Endaural5. Preauricular -Dingmans -Blair’s -Thoma’s -Al-Kayat and Bramley’s


6 Hemicoronal

7 Coronal/Bicoronal








FIXATION:

WIRE OSTEOSYNTHESIS

KIRSCHNER WIRE

LAG SCREW FIXATION

PLATE AND SCREW FIXATION






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Condylar fractures1 /certified fixed orthodontic courses by Indian dental academy