Condyle ppt
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Condylar fractures can occur in different locations and with varying degrees of displacement. Treatment depends on factors like the patient's age, whether other fractures are present, and the level and displacement of the condylar fracture. Classification systems aim to describe the anatomic location and relationship of condylar fragments to help determine appropriate treatment, whether closed or open reduction is necessary. The goals of treatment are to relieve pain, achieve stable occlusion, restore jaw function, and avoid long-term complications.
Condyle ppt
- 2. The topic of Mandibular Condylar fracture has generated more discussion and controversy than any other in the field of maxillofacial trauma. Condylar and Subcondylar fractures accounting for approx 30% (DENTATE)to 37% (EDENTATE)of all mandibular fractures. Condyle is the major growth centre for the mandible.
- 4. Condylar fractures can be extracapsular or intracapsular, undisplaced, deviated, displaced, or dislocated.Treatment depends on the age of the patient, the co-existence of other mandibular or maxillary fractures, whether the condylar fracture is unilateral or bilateral,the level and displacement of fracture,the state of dentition and dental occlusion.
- 6. As mandibular condyle fracture may cause long-term complications such as malocclusion, particularly open bite, reduced posterior facial height, and facial asymmetry in addition to chronic pain and mobility limitation, great caution should be taken…
- 7. 1-K.E imparted by moving object 2-K.E derived from movement of the individual 3-K.E as a summation of both forces
- 11. 5Types Wassmunds Classification – 1934 • Type I – Fracture of condyle with slight displacement of head with angle of 10-45 degree between head and ramus – reduces spontaneously •Type II – Angle of 45 – 90 degree between head and ramus, tearing of medial portion of capsule •Type III – Fragments not in contact, head displaced medially and forward due to lat. Pterygoid pull/spasm, fragments is within glenoid fossa, capsule is torn and head is out side the capsule – open reduction advocated •Type IV –Fractured head articulates on/forward to articular eminence •TypeV –Vertical/oblique fracture through head of condyle – rare
- 12. Lindhal’s classification:- Comprehensive classification (1977) Lindahl proposed a classification based on several factors namely 1. The anatomic location of the fracture 2. The relation of the condylar segment to the mandibular segment 3. The relation of the condylar head to the articular fossa
- 13. 1-BASED ON ANATOMICAL LOCATION Depending on fracture level i. ii. iii. Condylar head # Condylar neck # Subcondylar #(below neck)RESPECTIVELY. 2-BASED ON RELATIONSHIP OF CONDYLAR FRAGMENTTO MANDIBLE: i. Undisplaced (fissure fracture) (B) ii. Deviated – simple angulation of the condylar process in i.r.t distal mandibular segment without overlap.(C) iii. Displaced with medial overlap (D) iv. Displaced with lateral overlap (E) v. Antero-posterior overlap – possible but are seldom seen. (F) vi.Without contact between fragments
- 14. RELATIONSHIP OF CONDYLAR HEADTO FOSSA: i. No displacement- condylar head appears in normal prelation with fossa ii. Displacement – condylar head is in fossa but there is alteration of joint space. Joint space is increased iii. Dislocation –The condylar process is completely out of the fossa.
- 15. INJURYTO MENISCUS: It may be torn, ruptured or herniated in forward or backward direction.
- 16. MacLennan Classification: 1952 –Clinical Classification Type I: No displacement Type II: Fracture deviation – simple angulation of the fracture segments without overlap or separation. Ex. Green stick fracture in children Type III: Fracture displacement –when there is overlap of fracture fragments.This overlap may be in an anterior, posterior, lateral or medial. Medial is commonest. Type IV: Fracture dislocation – here the condylar head is completely dislocated out of the articular fossa and out of the capsular confines. Again dislocation can be medial or lateral and rarely anterior or posterior. TypeV : High condylar fracture with luxation TypeVI : Head fracture or intracapsular fracture
- 17. Evidence of soft tissue injury ex chin lacerations. Facial asymmetry with chin deviation. Noticeable swelling over the affectedTMJ. Pain and swelling over affectedTMJ. Malocclusion Deviation of mandible to same side during opening. Bleeding from ExternalAuditory canal. Inability to palpate condylar movement. Limited Mouth Opening and pain due to muscle splinting.
- 18. CONVENTIONAL RADIOGRAPHY P.A view LateralOblique Panoramic ReverseTownes TMJ views CT MRI
- 19. Concerning the treatment for Condylar Fracture,”it seems that the battle will rage forever between the extremists who urge non-operative treatment in particularly every case and the other extremists who advocate open reduction in almost every case ! “ Malkin
- 20. Open Reduction is a must if: BilateralCondylar fracture Gunshot injury/compound fracture Lateral displacement of condyle Open bite Condyle displaced in middle cranial fossa Interlocked condyle In case of any medical concern,i-e COPD,Asthma,seizures,mental/neurological/ learning problem.
- 21. Whether going for Open or Closed Reduction, the goals of Rx should always be : Relief from pain Stable occlusion Restoration of inter-incisal opening Full range of mandibular movement To minimize deviation Avoid growth disturbances Avoid Ankylosis
Editor's Notes
- #3: Arch Plast Surg. 2012 Jul;39(4):291-300. English. Published online 2012 July 13.
- #4: When the mouth is closed the meniscus is bordered medially and superiorly by the glenoid fossa of the petrous portion of the temporal bone. When the mouth is opened maximally, the meniscus is distracted anteriorly and inferiorly along the slope of the inferior portion of the temporal bone towards the tubercle, or articular eminence, in order to remain interposed between the condyle and the temoporal bone in all jaw positions.When the mouth is closed the meniscus is bordered medially and superiorly by the glenoid fossa of the petrous portion of the temporal bone. When the mouth is opened maximally, the meniscus is distracted anteriorly and inferiorly along the slope of the inferior portion of the temporal bone towards the tubercle, or articular eminence, in order to remain interposed between the condyle and the temoporal bone in all jaw positions. http://en.wikipedia.org/wiki/Mandibular_condyle
- #5: Arch Plast Surg. 2012 Jul;39(4):291-300. English. Published online 2012 July 13.
- #7: Arch Plast Surg. 2012 Jul;39(4):291-300. English. Published online 2012 July 13.
- #10: the AO classification is presented along with a simplified version. The AO classification allows for better communication between radiologists and surgeons. On the other hand, the simplified version better reflects the clinical treatment implications.
- #11: xowe & Killey’s classification (1968) 1.Intracapsular fracture - high condylar fracture Involving the articular surface AND Fracture through the neck 2.Extracapsular fracture - low condylar fracture , injury to the capsule, ligament and meniscus AND Involving the ADJACENT BONE.