Contents

Introduction

Incidence

Anatomy

Etiology

Classification of Fracture

Clinical Examination

Treatment of the Fracture

Complications of the Fracture

Conclusion

Reference

Introduction

Condylar fractures are the most common overall fractures of the mandible. Condylar

fractures account for 25% to 35% of all mandibular fractures. Fracture of the neck of

the condyle can be regarded as a safety mechanism which protects the patient from

the serious consequence of middle fossa fracture. Fractures involving the mandibular

condyle are the only facial bone fractures which involve a synovial joint.

Fracture of condyle may be consequence of an indirect blow and direct blow. Indirect

blow as when the external force, being applied in an anteroposterior direction and

from below upwards upon the chin, the head of the condyle is forced against the

prominent margins of the glenoid cavity. From a direct blow as when moving object

strikes the region of the joint forcibly and impinges upon this part of the bone.

Incidence

The relative weakness of the mandible in the region of the neck would appear to make

it the most vulnerable part of the whole jaw.

Incidence of condylar fractures may be as high as 35.6%. (Rowe & Killey, 1968)

Tasanen et. al. 1975 -> 32.4%

Ekholm 1961 -> 27.7%

Schuchardt et.al. 1966 -> 25%.

Children under 15 years of age :

Hall et.al. (1983) reviewed 2194 maxillofacial injuries treated at the royal children's

hospital, Melbourne, Australia from 1970-1979.

982 fractures of the facial bones were sustained, of which 242 (24.6%) occurred in the

mandible.

98 of the mandibular fractures affected the condyle.

22 (22.4%) of which were located in the condylar head

76 (77.6%) were subcondylar fracture.

64 of the 98 fractures exhibited a displacement of 45 or less; 11 (11.2%) were

displaced between 45 and 90, 1(1.02%) was laterally displaced and 22 (22.4%) of

cases sustained trauma to the articular head without displacement.

Lindane (1977) found that all types of condylar fracture occurred irrespective of

occlusion and that the location of the most distal occlusal contact did not influence the

type or magnitude of dislocation of the condylar fragment. In patient with unilateral

fractures, injuries to the teeth were more often seen with intracapsular fractures than

with subcondylar fractures.

Fonseca (1974) pointed out a relatively high incidence of condylar fractures in road

traffic accidents, speculating that the mouth is likely to be open, either to scream or in

fright at the moment of impact, and contrasted this with the low incidence in boxing

where the boxer uses a mouth protector and has a tendency to keep the teeth clenched

into the soft mouthpiece.

Anatomy

Anatomy of condyle is important to predict and manage the effect of trauma.

Muscles Several muscles act upon the mandibular condyle, ramus and boyd.

Lateral pterygoid muscle act upon the condyle. Lateral pterygoid muscle is often

described as having a superior and inferior portion. The superior lateral pterygoid

muscle originates from the inflatemporal surface of the greater wing of the sphenoid

and inserts on the temporomandibular joint capsule and disk and the neck ofthe

mandibular condyle. The insertion is primarily on the medial aspect of these

structures. The superior portion of the lateral pterygoid muscle functions when the

mandible is elevated against resistance. The inferior portion of the lateral pterygoid

muscles originates from the lateral surface of the lateral pterygoid plate and inserts on

the condylar neck. These muscles function during protrusion and lateral excursive

movements of the mandible.

Blood Vessels The temporomandibular joint itself is relatively a vascular the soft

tissue surrounding the mandibular condyle and subcondylar region is highly vascular.

End branches of the external carotid artery travel on both the medial (maxillary

artery) and lateral (superficial temporal artery) aspects of the condylar head and neck.

The external carotid artery bifurcates in the parotid gland region, developing into the

maxillary and superficial temporal arteries.

Superficial Temporal Artery This artery in the pre-auricular region runs in the

temporoparietal fascia just beneath the subcutaneous fat layer. This artery crosses

lateral to the zygomatic arch and forms a single branch, the transverse facial artery.

After crossing over the zygomatic arch the superficial temporal artery divides into the

frontal and parietal branches.

Maxillary Artery The maxillary artery is the largest terminal branch of the external

carotid artery. It originates from the external carotid medial to the condylar neck at

the level of the sigmoid notch. It first travels through the parotid gland posterior and

medial to the condylar neck and then runs along the inferior portion of the lateral

pterygoid muscle. The first portion of the maxillary artery, termed the mandibular

portion, travels through the infratemporal fossa in close proximity to the medial

aspect of the mandibular condyle and neck. In this region the maxillary artery divided

into several branches, including the deep auricular, anterior tympanic, middle

meningeal, accessory meningeal and inferior alveolar arteries. The second portion of

the maxillary artery also partitions into several branches. The masseteric artery

detaches from the maxillary artery and travels through the sigmoid notch before

entering the medial surface of the masseter muscle.

Retromandibular Vein The superficial temporal vein and the maxillary vein unite,

forming the retromandibular vein, within the body of the parotid gland medial to the

mandibular condyle neck. This vein descends through the parotid gland superficial to

the external carotid artery and deep to the facial nerve. It travels just posterior to the

ramus of the mandible and divides into an anterior and a posterior portion. The

anterior portion joins the facial vein and then empties into the internal jugular. The

posterior portion joints the posterior auricular vein and then empties into the external

jugular vein.

Nerves

Facial Nerve The facial nerve emerges from the brain-stem and enters the internal

auditory meatus. It travels through the petrous portion of the temporal bone in the

facial canal and exits the skull base at the stylomastoid foramen. The main trunk of

the facial nerve is 2 cm deep to the skin surface at the middle of the anterior border of

the mastoid process. The posterior auricular nerve and branches to the posterior

digastric and stylohyoid muscle arise from the facial nerve as it exits the skull base.

The nerve then courses forward toward the parotid gland. It crosses over the styloid

process, retromandibular vein and external carotid artery before entering the parotid

gland and dividing into the temporal facial and cervical facial branches. The mean

distance from the lowest portion of the bony external auditory canal to the bifurcation

of the facial nerve was 2.3 cm and that from the post glenoid tubercle was 3 cm. At

kayat and branmley also found that distances from the most anterior portion of the

bony external auditory canal to where the upper trunk crossed the zygomatic arch

ranged from 0.8 cm 3.5 cm. This defined the 8 mm 'safe zone' for preauricular

incisions. In the body of the parotid gland the temporal facial and cervical facial

branches further divide into the nerve's terminal branches (temporal, zygomatic,

buccal, mandibular and cervical). The temporal branch travels in, or just deep to, the

temporal parietal fascia. It innervates the frontalis, corrugator and orbicularis oculi

muscles.

Trigeminal Nerve The third division of the trigeminal nerve exists the skull base

through the foramen ovale. At this point the nerve is 4 cm from the skin surface and

just anterior and deep to the condyle neck. The motor root of the third division of

trigeminal nerve supplies motor innervation of the muscle of mastication. The

auricular temporal nerve (branch of the third division of trigeminal nerve) courses

laterally behind the condyle neck and supplies sensation to skin in the temporal and

pre-auricular region, the external auditory meatus and the tympanic membrane. The

lingual nerve (next branch) travels in an anterior direction deep to the lateral

pterygoid muscle. The nerve continues laterally, emerges from under the lateral

pterygoid and runs between the mandibular ramus and medial pterygoid muscle. The

inferior alveolar nerve is initially deep to the lateral pterygoid muscle. It emerges

below the inferior surface of the muscle, crosses the spheno-mandibular ligament and

enters the mandibular foramen.

Etiology

A etiological factors leading to condylar fractures may be grouped as

1) Intentional Trauma Interpersonal violence/fish fight, etc.

2) Unintentional Trauma Motor vehicular accidents, fall on the chin, sports

injuries, industrial mishaps etc.

Mechanism of Injury

Lindanl (1977) divided trauma causing condylar injury into three groups.

1) Kinetic energy imparted by a moving object through the tissues of static

individual. This commonly results from trauma sustained from a fist during

sporting activities, or in the course of some industrial accidents.

2) Kinetic energy derived from the movement of the individual and expended

upon a static object. This type of injury is more often seen in an epileptic

patients or soldiers who fall on the face during parade.

3) Kinetic energy which is a summation of forces derived from a combination of

1 and 2 and, therefore, generally produces a more severe type of injury such as

typically occurs in a road traffic accident.

The position of the fractured condyle in relation to the other fractured segment

will depend on certain factors :

1) The direction and degree of the forces resulting from impact.

2) The precise point of application of force.

3) Whether the teeth were in occlusion or not at the time of injury.

4) Whether the patient is partially or fully edentulous.

In case of patient is wearing a denture or is having the posterior teeth in occlusion at

the time of injury, the contact between the upper and lower teeth would minimize the

consequences of the impact, but if such protection is not possible, then the patient

may sustain a severe fracture dislocation of one or both the condyles.

If the patient receives a blow on the chin, the force of the impact is transmitted

upwards and backwards direction along the length of the mandible. If the blow is

delivered with great force, it would force the condylar head through the glenoid fossa,

into the middle cranial fossa.

The vector force to the symphysis can determine where condylar injury will occur.

The most common cause of condylar fracture is blunt trauma delivered directly to

symphysis, parallel to the inferior border. For example in most case of vehicular

trauma, the mouth is open at the point of impach, which allow majority of the force to

be delivered to the weakest part of the mandible. A force directed perpendicular to

the inferior border is likely to result in dental trauma and less likely to cause condylar

fracture or intracapsular trauma.

When the blow is received in the centre of the chin, the distribution of force is equal

to both the condyles, resulting in a bilateral indirect fracture of the condylar neck

along with the direct fracture of the symphysis.

This type of injury is more often seen in an epileptic patients or soldiers who fall on

the face during parade. If the force is received from the lateral direction or if the teeth

are out of occlusion, then the fracture of the condyle will be with little or without

displacement.

Classification of Condylar Fractures

1) Unilateral or bilateral condylar fractures

2) Rowe and Killey's classification

a) Simple fractures of condyle

b) Compound fractures of condyle

c) Comminuted fracture associated with zygomatic arch fractures

3) Rowe and Killey's Classification (1968)

a) Intracapsular fractures or high condylar fractures

i) fractures involving the articular surface

ii) fractures above or through the anatomical neck, which do not involve

the articular surfaces.

b) Extra capsular or low condylar or subcondylar fractures. Here the fracture

runs from the lowest point of cunature of the sigmoid notch, obliquely

downward and backward below the surgical neck of the condyle to the

posterior aspect of the upper part of the ramus.

c) Fractures associated with injury to the capsule, ligaments and meniscus.

d) Fractures involving the adjacent bone eg. fracture of the roof of the glenoid

fossa or the tympanic plate of the external auditory meatus.

4) Clinical classification by Maclennan (1952)

a) No displacement : A crack fracture is seen without alteration of the normal

relationship of the condylar head to the glenoid fossa or of the neck of the

condyle to the ramus.

b) Deviation : Simple angulation exists between the condylar neck and the ramus.

c) Displacement : Overlap occurs between the condylar process and the ramus.

The obliquely fractured condylar fragment lies lateral to the ramus.

d) Dislocation : Disruption takes place between the condylar head and the

glenoid fossa. The condylar fragment gets pulled anteriorly and medially by

the lateral pterygoid muscle.

5) Wassmund's Classification (1934)

a) Type I : Fracture of the neck of the condyle with slight displacement of the

head. The angle between the head and axis of the ramus varies from 10-45.

These type of fractures tend to reduce spontaneously.

b) Type II : An angle of 45-90 is seen between the head and the ramus. There is

tearing of the medial portion of the joint capsule.

c) Type III : The fragments are not in contact. Head is displaced medially and

forward due to the pull of lateral pterygoid muscle and spasm. The fragment

is generally confined within the area of the glenoid fossa. The capsule is turn

and head is outside the capsule open reduction is advocated.

d) Type IV Fractured head articulates on or forward to the articular eminence.

e) Type V Vertical or oblique fracture through the head of the condyle (rare).

6) Comprehensive Classification

Proposed by Lindhal (1977), which required radiographs in two planes at right

angles to each other.

a) Fracture level : This may be as follows :

i) Condylar head fracture, intracapsular : They are divided into :

- vertical (anterioposterior sagittal split)

- compression (producing a mushroom type of expansion)

- comminuted

ii) Condylar neck The radiographic constriction representing the condylar neck

corresponds anatomically to the region of the inferior attachment of joint

capsule.

iii) Sub condylar

b) Relationship of condylar fragment to mandible This may be as follows :

i) Undisplaced (or fissure fracture)

ii) Deviated This is a simple angulation of the condylar process in relation to

main mandibular fragment without overlap.

iii) Displaced with medial overlap of the condylar fragment.

iv) Displaced with lateral overlap of the condylar fragment.

v) Anteroposterior overlap is possible, but intraquent.

vi) Without contact between the fragments.

c) Relationship of condylar head to fossa

The following relationship may be observed :

i) No displacement : joint space appears normal.

ii) Displacement : joint space is increased, but condyle is still related to the

glenoid fossa. Lindhal subdivided this into slight displacement and moderate

displacement but quantification is difficult.

iii) Dislocation : Condylar fragment is completely out of the fossa. The actual

location of the fragment to the fossa is usually antero-medial.

d) Injury to meniscus It may be turn, ruptured/herniated in forward/backward

direction.

7) Thoma (1945) classified fractures in a simple way taking into consideration

the direction of displacement.

A) Condylar fracture

1. Without displacement of condyle

Greenstick fracture

Intracapsular

Extra capsular

2. With displacement of condyle

Lateral

Medial

Forward

Backward

3. With overriding of fragments

4. With dislocation in lateral or medial direction

Intracapsular

Complete fracture dislocation

Complete dislodgement of the condyle

Dislocation of the fractured part of the head of the condyle.

5. With dislocation in forward direction

Anteriorly from the articular eminence

Posteriorly from the articular eminence

With dislocation and displacement of the meniscus

With comminution

Old fracture with

o Pseudoarthrosis

o Ankylosis

B) Sub condylar fracture

1. Without displacement of fragment

2. With displacement of fragment

C) Spiessel and Schroll classification (1972)

1. Non displaced fracture

2. Low neck fracture with displacement

3. High neck fracture with displacement

4. Low neck fracture with dislocation

5. High neck fracture with dislocation.

6. Head fracture

Clinical Examination

Condylar fracture are the most common overall fractures of the mandible and are the

ones most commonly missed on clinical examination.

They may be unilateral or bilateral and they may be intra capsular or extra capsular.

The most common displacement is anteromedial owing to the direction of pull of the

lateral pterygoid muscle, which is attached to the anteromedial aspect of the condylar

head and to the meniscus of the tempromandibular joint.

Unilateral Condylar Fractures

Sign and Symptoms

There is often swelling and tenderness over the temporomandibular area.

There may be haemorrhage from the ear on that side results from laceration of

the anterior wall of the external auditory meatus.

Ecchymosis of the skin just below the mastoid process on the same side. This

particular physical sign also occurs with fractures of the base of the skull when

it is known as 'Battle's sign'.

If the condylar head is dislocated medially and all oedema has subsided due to

passage of time, a characteristic hollow over the region of the condylar head is

observed.

Deviation of the mandible on opening toward the involved side.

Unilateral posterior crossbite and retrognathic occlusion also be associated.

Paraesthesia of the lower lip in the absence of a fracture of the body or angle

of mandible on that side.

Displacement of the condyle from the fossa or overriding of the fractured

condylar neck shortens the ramus on that side and produces gagging of the

occlusion on the ipsilateral molar teeth.

Painful limitation of protrusion and lateral excursion to the opposite side.

Tenderness over the condylar area on palpation.

Bilateral Condylar fractures

The signs and symptoms for unilateral fracture may be present on both sides.

Overall mandibular movement is usually more restricted than in unilateral

fracture.

Swelling over both fracture sites.

If both fractures have resulted in displacement of the condyles from the

glenoid fossa or overriding of the fractured bone ends, an anterior open bite is

present.

There is pain and limitation of opening and restricted protrusion and lateral

excursions.

They are frequently associated with fracture of the symphysis or

parasymphysis.

Principles of treatment of condylar fracture

Condylar fracture depends upon the patient's age, can be treated either conservatively

or radically by open reduction.

In recent years, open treatment of condylar fractures has become more common,

probably because of the introduction of plate and screw fixation devices that allow

stabilization of such injuries.

There are three main treatments advocated for condylar fractures:-

1. Conservative :- This involves immobilization by intermaxillary fixation. The

time duration for this treatment may range from 7-10 days as in case of

unilateral fracture to 4 weeks or more as in bilateral fracture with anterior

open bite.

2. Functional :- The emphasis here is given on active movement. The principle

is that the risk of ankylosis can be prevented by active movement.

3. Surgical :- A variety of surgical approaches have been devised using

miniature bone plates to provide from fixation.

The first two are forms of closed treatment and the third one is an open

method.

Treatment of Condylar Fractures

Closed Technique (Conservative Treatment)

This term is utilized for all kind of the fractures other then surgical intervention. The

closed technique is applied to all kinds of unilateral of bilateral fractures other than

those with gross displacement. Primary goal of conservative and functional treatment

is to facilitate active jaw movement as early as possible and as long as the patient can

bring his/her teeth into occlusion. When excessive pain or gross malocclusion is

present, intermaxillary fixation is recommended which would not exceed a period of

two weeks.

Indications

Condylar fracture with minimum displacement and minimum occlusal

disturbance.

In cases of slight deviation of the mandible on opening the mouth.

Open reduction

The objective of surgical treatment is achieved by exposure of the condylar fragment,

reduction to the normal relationship and fiaxation in that position.

Zide and Kent (1983) have outlined the indications for open reduction.

Zide and Kent's indication of open reduction

1. Absolute Indications

Displacement of condyle into middle cranial fossa.

Impossibility of restoring occlusion by closed reduction.

Lateral extra capsular displacement.

Invasion by foreign body.

2. Relative indications

Unilateral or bilateral condylar fractures where in intermaxillary fixation is not

recommended for medical reasons.

Bilateral condylar fractures in case of edentulous patients where splinting is

not recommended for reason like atrophic residual alveolar ridge.

Bilateral condylar fractures with comminuted mid face fractures.

Bilateral condylar fractures in patients with orthognathic problems such as

retrognathia or prognathia, lack of teeth in the posterior segment, mandible

requiring reconstruction and open bite with periodontal support.

Surgical Approaches

There are three principal approaches to a fractured condyle.

1. Preauricular approach

2. Submandibular approach

3. Intraoral approach

1. Preauricular approach This is the most direct approach in high

subcondylar and neck fractures and also in fracture dislocations where medial

exploration is facilitated.

2. Submandibular approach This gives good access in cases of low

subcondylar fractures.

3. Intra oral approach An incision is made from high on the anterior border

of the ramus downwards to the retromolar region. The tendinous attachment

of the temporalis is exposed. Medial dissection is carried out to identify the

inferior alveolar nerve at the mandibular foramen. With intra and extra oral

digital manipulation the medially dislocated condylar fragment is repositioned

in the glenoid fossa.

Methods of fixation of Condyler Fractures

There are a variety of methods of fixation of condylar fractures.

1. Transosseous wiring This is occasionally used in low subcondylar

fractures, particularly those extending through the sigmoid notch, access being

obtained through the submandibular incision. It may be possible to drill and

wire across the fracture at one or even two sites in a conventional manner. It

is best to pass the wire through the hole in the major fragment first so that this

may be used for downward traction to improve access to the condylar

fragment. A pull through wire will be needed for passing the wire through a

hole drilled in the minor fragment.

For higher level fracture approaches through a preauricular incision Thoma

(1954) advocates a special sequence. The fragments are drilled obliquely from

the external surface to the fracture surface. This facilitates insertion of the

wire and decreases the danger of injuring the blood vessels on the medial

aspect, particularly the maxillary artery. If there is lateral overlap of the

condylar fragment, this fragment is drilled first. Since this is more accessible.

When this has been done an instrument, such as a small bone elevator, is

inserted between the bone ends and is used to reverse the overlap so that the

mandibular fragment becomes accessible for drilling. A pull through wire is

again needed for the second insertion. Where there is medial overlap the

sequence is reversed.

2. Bone pins Archer (1975) describes the insertion of pins into the condylar

head and neck which are connected with an external bar and universal joints.

3. Plating A small monocortical non-compression bone plate may be used for

rigid fixation, which usually requires contouring to compensate for the

outward flaring of the condyle.

4. Gut Suture Wassmund (1934) describes drilling a small hole through the

lateral edge of the glenoid fossa and the related edge of the condylar

articulating surface. A chronic catgut suture can be looped through and tied.

It may, however, resorb or loosen prematurely with unpredictable results, as

reported by Herfert (1961).

5. Kirschner wire A Kirschner wire may be drilled vertically through the main

mandibular fragment from the angle, avoiding the inferior alveolar bundle, so

that it enters the fracture interface and can be further inserted into the condyle

which has previously been reduced. Petzel (1982) describes a technique using

self tapping intramedullary screw pins inserted from a submandibular incision.

The lower end is secured to a countersunk nut which, when tightened, exerts a

degree of compression at the fracture site.

Surgical Technique (Endoural modification of preauricular approach)

Scalp is shaved and head prepared and draped for sterile surgery.

General anaesthesia is administrated through nasoendotracheal intubation.

Injection of local anaesthetic solution containing vaso-constrictor beneath the

line of incision not only reduces bleeding but can be useful in defining tissue

planes.

Once the preauricular incision is made, it is carefully deepened in layers

following the plane superficial to the perichondrium of the external auditory

meatus.

Care should be not to inure the temporal branch of facial nerve.

Now carefully blunt dissection is done to locate the proximal fractured

segment, which is likely to be displaced in forward and medial direction. Here

care should be taken not to injure the parotid gland, facial nerve and its

branches.

After identifying the proximal segment. It should be reduced to its anatomical

position. For this purpose we can use a bone pin near the neck of the condyle

to manipulate it more conveniently into the correct anatomical position.

To get a correct relationship between the fractured segments one must do IMF

prior to the surgery.

Once the fractured segments are reduced four miniature holes are made using

a drill to stabilize the attained result.

Care is taken to preserve the insertion of the pterygoid muscles.

Intermaxillary fixation is removed to verify the opening, closing, protrusive,

retrusive and excursive movements of the mandible.

Finally, haematosis is secured before closing the wound in layers.

No drains are used.

Patients should be informed not to perform any physical jaw exercise in the

immediate postoperative period.

Mouth opening, overbite, overjet, mandibular mobility and

Temporomandibular joint function are evaluated.

Treatment protocol for different types of condylar fracture

1. For children under 10 years of age

This age group is more likely to develop ankylosis and growth disturbance due

to the condylar fracture. The treatment is completely functional for both

unilateral and bilateral condylar fractures. Intermaxillary fixation may be

required for a period of 9-10 days in case of extreme pain.

2. Adolescents 10-17 years of age

The treatment protocol is same for this group. If malocclusion is present the

capacity for spontaneous correction is less than in the younger group.

Therefore intermaxillary fixation is indicated for a period of 2-3 weeks in such

cases.

3. Unilateral intracapsular fractures in adults

The occlusion is usually undisturbed and the fracture should be treated

conservatively without immobilization of the mandible.

In one of malocclusion, intermaxillary fixation is indicated for a period of 2-3

weeks.

4. Unilateral extracapsular fractures is adults

A low condylar neck fracture is treated by open reduction method in case of

severe malocclusion caused by the fracture or dislocation.

No effective treatment is necessary if the fractured segments are not displaced,

and there is no disturbance to the occlusion.

5. Bilateral intracapsular fractures in adults

These fractures represent the slightly deranged occlusion. The degree of

displacement of the two condyles may be different therefore an intermaxillary

fixation required for a period of 3-4 weeks for stable union. Physiotherapy

after intermaxillary fixation prevents any restriction of the mouth opening.

6. Bilateral extracapsular fracture in adults

These fractures present the major problem in treatment. Usually this fracture

results in instability and gross displacement of the mandible.

Although the intermaxillary fixation will establish the occlusion, it will not

reliably reduce the fracture on both sides. Open reduction of at least one side

to establish the normal height is recommended and then the treatment protocol

is same that for unilateral extra capsular fracture. If bilateral extra capsular

fracture is associated with other gross mid facial fracture, open reduction of

the both the sides should be considered.

In case of bilateral high condylar neck fractures where open reduction is likely

to be difficult, intermaxillary fixation should be applied for upto 6 weeks.

Complications of Condylar Fracture

In considering any treatment the two most important complications of condylar injury

must be considered which are ankylosis and disturbance of mandibular growth in

children.

A) Ankylosis Ankylosis is the development of significant or complete

limitation of movement of the temporomandibular joint by bone or fibrous

tissue.

According to Laskin, the factors predisposing to ankylosis are:

1. Age of the patient The predisposition is greater in younger patients (below

10 years) than the older patients.

2. Site and type of fracture Intracapsular fractures are associated with high risk

of ankylosis. Laskin considers that the most important feature in a fracture

encouraging ankylosis is close contact between the glenoid fossa and the

condylar stump and that this is more likely to occur with intracapsular

fractures than with extra capsular fractures.

3. Duration of immobilization According to some authors, prolonged

immobilization may be a contributory cause for ankylosis.

4. Damage to meniscus Laskin has suggested that the position and state of the

meniscus may be the key factor in determining whether post traumatic

ankylosis will develop. The meniscus acts as a barrier between the glenoid

fossa and the condylar head. Therefore bony union does not occur in a

condylar fracture wherein the meniscus is intact, but If meniscus is damaged

or misplaced then ankylosis may occur.

Disturbance of mandibulr growth in children

Disturbance of growth is seen in small proportion of children in whom the fracture

involves condylar cartilage and the articular surface. In some cases fibrous or bony

ankylosis of the tempromandibular joint in an additional complication. This reduces

the normal functional movement of the jaw which further inhibits growth. The effect

of damage to this area will cause failure of development of condylar process as well

as retarded growth of the mandible on the affected side.

Conclusion

Condylar fractures are most common fractures of the mandible. Because of relative

weakness of mandible in this region, neck of mandible is the most vulnerable part of

the whole jaw.

It is unfortunate that there are still no clear guide lines for the treatment of mandibular

condylar fracture. Fractures can be treated by conservative treatment using closed

reduction and by surgical treatment using open reduction. Treatment type should be

selected considering patient's age, fracture type. Patient's systemic status, other

fracture and existence of foreign materials.

If these fractured are not recognized and treated appropriately, these fractures can

result in marked pain, dysfunction and deformity.

References

Textbook of Oral and Maxillofacial Surgery

Neelima Anil Malik (2nd Edition)

Textbook of Oral and Maxillofacial Injuries

N.L. Rowe and J.L.L. Williams

(Volume One)

Textbook of Oral and Maxillofacial Surgery

Fonseca (Volume One)

Textbook of Oral and Maxillofacial Surgery

S.M. Balaji

Killey's Fractures of the Manidble