Presentation kcd
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This document discusses condylar fractures, which are the most common type of mandibular fractures. It provides detailed classifications of condylar fractures including location, degree of displacement, and relationship to surrounding structures. Treatment options are also summarized, including functional treatment for non-displaced fractures, maxillomandibular fixation for some displaced fractures, and open reduction with internal fixation for more severely displaced fractures. Surgical approaches and fixation methods for open reduction are also outlined.
Presentation kcd
- 1. Condylar fractures and their management most common fractures of the mandible. Involve TMJ either directly or indirectly Represent 20-30% of all mandibular fractures
- 4. CLASSIFICATION • 1.Unilateral or Bilateral condylar fractures • 2.Rowe and Killeys classification(1968) • a)Intracapsular or high condylar # • b)Extracapsular or low condylar#or subcondylar # • c)fractures associated with injury to capsule,ligaments and meniscus • d)fractures involving the adjacent bone e.g # of roof of glenoid fossa or the tympanic plate of external auditory meatus
- 6. • 3.Clinical classification by MacLennan(1952 • a)No displacement • b)Displacement • c)Deviation • d)Dislocation
- 8. WASSMUNDS CLASSIFICATION A. TYPE I • Fracture of neck of the condyle with slight displacement of head. • 10-45 degree variation between head and axis of ramus. • Tend to reduce spontaneously. B.TYPE II • 45-90 degree angulation between head and ramus. • Tearing of medial portion of joint capsule.
- 9. C. TYPE III • Fragments not in contact. • Condylar head displaced medially and forward. • Fragments confined within glenoid fossa. • Capsule torn and head is outside the capsule.
- 10. D. TYPE IV • Fractured head articulates on or forward to articular eminence. E. TYPE V • Vertical or oblique fracture through head of condyle.
- 11. • COMPREHENSIVE CLASSIFICATION • Lindhal (1977) • A) Fracture level • i)condylar head • Intracapsular • Vertical ,compression, comminuted
- 12. ii) Condylar neck iii) Subcondylar b) Relationship of condylar fragment to mandible i) Undisplaced ii) deviated iii) displaced with medial overlap of condylar fragment iv) displaced with lateral ovelap of the condylar fragment v) Anteroposterior override vi) no contact
- 13. • Relationship of condylar head to fossa • i)No displacement • Joint space appears normal • ii)Displacement • Joint space increased • D)injury to meniscus • Torn,ruptured or herniated in forward or backward direction
- 15. • 7.Thoma classification (1945) • Spiessl and schroll classification • 5 types
- 16. • AETIOLOGY 1) Assault • Interpersonal violence or fist fight 2)Road Traffic Accident 3)Sports injuries 4)Falls on the chin 5)war injuries
- 18. • MECHANISM • i)Degree of force • K=1/2 mvv • ii)Direction of impact • Above,below,front ,side • iii)The precise point of application of force • chin • Lateral side of face • iv)open or closed mouth • v)partially or fully edentulous patients
- 19. • DIAGNOSIS 1) Examination • Inspection • Palpation • Auscultation
- 21. OPG
- 22. • Clinical features • Unilateral condylar fracture • Limitation in mouth opening • Swelling over TMJ area • Bleeding from the ear • i)laceration of anterior wall of EAM ii)fractur of petrous temporal bone Battles sign Gagging of occlusion on Ipsilateral side(ramus shortening
- 25. Deviation on opening towards the side of fracture Painful limitation of protrusion and lateral excursion to the opposite side Bilateral condylar fractures Anterior open bite(bilateral displaced fractures of condylar necks) Pain an d L.M.O With restricted protrusion and lateral excursion fracture of symphasis and parasymphasis frequent.
- 27. TREATMENT OF CONDYLAR FRACTURES • No clear guidelines exist. • Three treatment options • 1)functional • 2)indirect immobilization • 3)osteosynthesis • CONSERVATIVE-FUNCTIONAL TREATMENT • Condylar neck fracture with little or no dislocation • ALL intracapsular # and all # in growing children. • CHILDREN • UNDER 10 YEARS • DISREGARD MALOCCLUSION
- 28. Treatment • ADOLESCENTS AGED 10-17 YEARS • If occlusion undisturbed= FUNCTIONAL TREATMENT • If malocclusion present=MMF for 2-3 weeks. • ARGUMENT FOR ORIF?Whether indicated for major displacement of condyle. • FUNCTIONALTREATMENT • SEMI SOLID DIET • ANALGESICS • MUSCLE TRAINING JAW EXERCISES
- 29. MMF
- 30. ADULTS INTRACAPSULAR Unilateral Occlusion undisturbed=conservative treatment(dietary advice,appropriate analgesics) Slight malocclusion with effusion in tmj=MMF for 2-3 weeks. Bilateral If there is slightly deranged occlusion=MMF for 3-4 weeks.
- 31. CONDYLAR NECK # UNILATERAL Undisplaced # and occlusion undisturbed=no active treatment necessary SUBCONDYLAR # ORIF HIGH CONDYLAR FRACTURE Extensive displacementand malocclusion=MMF FOR 3-4 WEEKS. BILATERAL FUNCTIONALTREATMENT C/I OPERATIVE REDUCATION OF ATLEAST ONE OF THE # IS DESIRABLE TO RESTORE RAMUS HEIGHT. BILATERAL HIGH CONDYLARNECK # OPEN REDUCTION DIFFICULT=MMF FOR 6 WEEKS.
- 32. METHODS OF FIXATION OF CONDYLAR # • 1)TRANSOSSEOUS WIRING • 2)BONE PLATING WITH MINIPLATING SYSTEM • TWO STANDARD MINIPLATES SHOULD ALWAYS BE INSERTED • 3)LAG SCREW OSTEOSYNTHESIS
- 34. • SUBMANDIBULARAPPR OACH • Ramus # • Low fractures of condylar neck • Retromandibularapproa ch/postramal incision • Subcondylar/low condylar # • PREAURICULAR APPROACH • High condylar #
- 37. • THANK YOU • Dr. Qiam-ud-din • Dr. Umer Khitab • Dr. Muslim khan • Dr. Attaurahman • Dr. Murad • TMOS Oral Surgery