Perhaps no area of facial trauma has inspired more controversy than the management of mandibular subcondylar fractures. Fractures of the condylar region. Clinically, this equates to open treatment of condylar neck fractures or subcondylar (caudal) fractures (A). The surgeon may elect to place one or two plates. Background and objective: Mandibular fractures are the most frequent and sub condylar region is a common site of fracture. Proper.
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Immediate surgery is not necessarily required. The force is transmitted from the body of the mandible to the condyle. People will also be very sensitive to touching the area of the jaw that is broken, or in the case of condylar fracture the area just in front of the tragus of the ear. Cysts and tumours can limit effective bone to bone contact and osteomyelitis or osteonecrosis compromise blood supply to the bone.
One of the reasons that cause condylar fractures to be of paramount importance in maxillofacial surgery, is that many ensuing complications are connected to a condylar fracture, whether it is treated or not. Computed tomography is the most sensitive and specific of the imaging techniques. Avoiding the complications related to the traditional open technique such as the facial nerve damage, scarring and those related to the close technique such as the lengthened MMF, non-anatomical reduction and difficulties associated with mandibular movements, have deemed the endoscopic method a favorite among surgeons.
A Preoperative design of a mini-retromandibular incision. A systematic review was unable to find sufficient evidence of the superiority of one method over another in the management of condylar fractures. This research received no specific grant from the government or any other funding agency in the public, commercial, or not-for-profit sectors.
Endoscopy-assisted open treatment of condylar fractures of the mandible: The periosteum at the posterior border of the ramus is then incised, and subperiosteal dissection is continued to the condylar area until the fracture line and the displaced or dislocated proximal fragment are identified. First, the lack of teeth makes reduction and fixation using MMF difficult.
However the superior anatomic reduction and better functional results, induce ORIF as the treatment of choice in patients with complex conditions. While it is against surgical dicta to consider treatment of traumatic injuries through small incisions and limited access, the application of minimally invasive surgery to facial fracture repair has become widespread. Coronal view of the above patient shows angulation and luxation of the condylar process fracture.
Mandibular fractures are typically the result of trauma. Find articles by Dong Hee Kang.
Surgical Management of a Mandible Subcondylar Fracture
Panoramic radiograph of a simple mandible fracture of the right mandibular body, minimally displaced. Mini-retromandibular approach to low subcondylar fractures The retromandibular incision was first proposed by Hinds and Girotti [ 6 ] in Vertical shortening of the left mandible is noted along with the right anterior body fracture.
Temporomandibular joint morphology following post-traumatic ankylosis in 26 patients. Journal of Oral and Maxillofacial Surgery. As soon as the globular parotid tissue appears from the fascial incision, blunt dissection with a mosquito is used. Lee W, Kang DH.
Mandibular Subcondylar Fractures: A Review on Treatment Strategies
As there are controversies around management of condylar fractures, different treatment modalities are suggested in literature, so this paper reviews different treatment strategies of the following types of fractures in adults: Views Read Edit View history.
Application of modified retromandibular approach indirectly from subdondylar anterior edge of the parotid gland in the surgical treatment of condylar fracture. Symphyseal fractures are a linear fractures that run in the midline of the mandible the symphysis.
Mandibular fractures that involve the tooth-bearing portion of the jaw are by definition compound fractures,  because there is at least a communication via the periodontal ligament with the oral cavity and with more displaced fractures there may be frank tearing of the gingival and alveolar mucosa.
Miniaturized osteosynthesis devices are essential for stabilization of subcondylar fractures because of the small size of the subcondylar fragments [ 4 ]. The delta plate from Medartis is triangular in shape, oriented towards the angle of the mandible, and the lines of tensile and compressive stress run parallel to both sides of the triangle.
The review found insufficient evidence to recommend the effectiveness of any single intervention. Support Center Support Center.
The surgeon decides to treat condylar process fractures in an open or closed method. In other projects Wikimedia Commons.
F Load displacement curve in the MTS chart recorder. The occlusion shows premature contact on the right with the deviation of the jaw to the affected side that is commonly seen with a right mandibular condyle frcature. It would thus be wise to assume that TMJ ankylosis is a result of a direct trauma to the joint capsule or condylar head therefore the risk of ankylosis is minor in subcondylar fractures: