Download condylar injury

condylar injury
Mandibular fossa
Articular
emminence
condyle
Coronoid
process of
mandible
neck
Mandibular
notch
Mental foramen for
V3 sensory branch
Categories of condylar injuries:
1- Contusion: Injuries to the soft tissues
around the joint or an effusion within the
joint.
2- Dislocation: Mean displacement of the
condylar head from glenoid fossa but still
within the capsule.
3- Fracture: Intracapsular( head or neck) and
extra capsular (neck or subcondylar)
Classification of condylar fracture
1-unilateral or bilateral fracture.
2- intra capsular or extra capsular.
3- Lindahls classification:
1- Level of condylar fracture into :
a- Condylar head fracture ( intra capsular) . They are
further classified into vertical fracture, compression
fracture, and comminuted fracture.
b- Condylar neck fracture : Which is the thin
constricted area located immediately below the
condylar head .
c- Sub condylar fracture : the region below
the neck .
2- relationship of the condylar segment to the
mandible into :
a- un displaced ( hair line fracture).
b- deviated .
c- displaced with medial or lateral overlap.
d- displaced with anterior or posterior overlap.
e- no contact between the fracture segments.
Signs and symptoms of condylar fracture.
1 -Signs of trauma like wounds over the chin
or ecchymosis or hematoma over the TMJ.
2- Swelling over the TMJ due to hematoma,
edema, or dislocated condyle which is
visible and palpable.
3- Bleeding from the external auditory
canal (superior dislocation).
• 4- Battles sign which
is ecchymosis of the
skin below the
mastoid process .
This also occur with
fracture of the base
of the skull.
5- Deviation of the
mandible towards the
fractured side on
opening the mouth.
6 - When there is medial
dislocation of the joint,
there will be a
characteristic hollow is
seen in the
preauricular region.
7- Gagging of the occlusion( posterior pre
mature contact) in the ipsilateral side with
ipsilateral midline shift.
8- Pain and tenderness over the TMJ region .
9- Pain during lateral excursion to the opposite
side and during protrusion.
10- Facial asymmetry.
11- Crepitation over the TMJ.
12- In bilateral fracture there is anterior open
bite.
• Investigations:
OPG
transcranial view of the TMJ
revers Townes view.
CT scan.
MRI.
Treatment of condylar fracture
• It may be conservative or surgical :
1- Conservative treatment : It may simple
observation and soft diet or may include
IMF for a short period of time.
2- Surgical treatment or open reduction:
the joint space is surgically exposed and
the condyle fixed in its original position by
wire or plate.
Conservative
1- Minimal displacement: No active treatment . A normal
occlusion is maintained which allows bony union to
occur. In fracture-dislocation a functional
psuedoarthrosis may be produced.
2- Persistent malocclusion or severe pain indicated for a
short period of IMF(7-10 days).until edema and muscle
spasm disappear.
3- Bilateral fracture: a longer period of IMF (3-4) weeks
with posterior distraction block.
Elastic traction may be necessary to close anterior open
bite.
Indications for open reduction of condylar
fracture
• Absolute indication
1-Fracture dislocation of the condyle to the
middle cranial fossa.
2- Lateral fracture dislocation of the condyle.
3- Impossibility to achieve adequate occlusion
by closed reduction .
4- Invasion by foreign bodies.(compound
fracture as in gun shoot)
Relative indications:
1- Patient in whom IMF is not recommended
like mentally retarded patient , epileptic
patient, or those having severe respiratory
disorders.
2- Bilateral fracture condyle with comminuted
midface fracture.
3- Bilateral fracture condyle of edentulous
patient with atrophic ridges in whom
splinting is not recommended.
Surgical approach to the TMJ
• 1- Pre auricular approach.
• 2- Sub mandibular approach .
• 3- Intra oral approach.
• 4- Bicoronal flap in bilateral condylar fracture.
Methods of surgical treatment include;
1- bone plating
2- transosseous wiring
3-K wire
4- external pin fixation.
Complications of condylar injuries
1- TMJ pain /dysfunction syndrome.
2- Disturbance of mandibular growth.
3- TMJ ankylosis.
Condylar fractures
 Intraoral approach
 Ramus incision
 Extraoral approach
 Preauricular approach
 Retromandibular approach