Definition
By mandibular condyle, we mean that part of
the mandible, which forms the condyle, reaching from the
semilunar notch to the caput.
We differentiate between low, middle and high condyle fractures,
as well as the capitulum fracture as intra-articular condyle
fracture.
Picture
6: Diagram. During a fall, this patient broke the
mandible in the middle as well as both condyles.
Therapy Goals
Discussion about adequate therapy for condyle
fractures has been newly invigorated by the improved methods
of osteosynthesis with mini-plates and lag-screw and the
development of absorbable materials. In connection with
the unsatisfying results of conservative therapy in luxation
fractures, a trend in favor of surgical therapy, especially
for luxation fractures, has appeared. This was accompanied
by a better understanding of the growth processes of the
mandible. These are no longer seen as being controlled by
the condyle, but by a growth cartilage. The increased attention
given to functional disorders of the joint, like disc dislocation
and its surgical therapy, is directing interest towards
associated soft tissue injuries and the restoration of intra-articular
fractures (M. Rasse, Neuere
Entwicklungen der Therapie der Gelenkfortsatzbrüche der
Mandibula in Mund-, Kiefer- und Gesichtschirurgie, Volume
4 Issue 2 (2000) pp 69-87).
Generally, the therapeutic goal is to restore the function
of the mandible with correct occlusion, articulation and
joint function. During the acute phase of the disease pain
intervention is also paramount.
Restoration
of form and function of the mandibule
Prevention of growth disturbances in adolescents
and children
Prevention of acute and/ or chronic temporomandibular joint
diseases (osteoarthritis, disc dislocation)
Infection prevention
Prevention of ankylosis
Therapy Indications
Clinical and/ or radiological evidence of a fracture
Malocclusion
Picture 7: Diagram. A dislocated unilateral mandible fracture
(e.g. collum) leads to a malocclusion
in the opposite side of the mandible.
Picture 8: Diagram. A dislocated bilateral condylar fractures
leads to a malocclusion
in the front area of the teeth.
Complications
Dysfunction
Disturbance of the relation between the jaws
External ear canal injury
Liquorrhoea from the external ear canal
Pain
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Examinations
Inspection
Palpation
X-rays on 2 levels
Asthesiometry
Functional test
Special x-ray examinations
Computer tomography in case of multiple fractures or heavily
dislocated caput
If indicated, magnetic resonance tomography in the case of
suspected destruction of the temporomandibular joint soft
tissue (e.g. capsule, disc)
Inspection of the external ear canal in the case of suspected
anterior wall lesion in the ear canal
Casting and modeling of maxilla and mandible which serve
as setups for repositioning, occlusion control and for the
possibility to make individually designed splints
Therapy
Conservative Therapy
A conservative therapy is indicated in case of:
-fractures that are not dislocated where form and function
can be restored without surgery
-children (whether the fracture is dislocated or not)
-medical and/ or aesthetic contraindications to a surgical
treatment of the fracture
A conservative fracture treatment can include:
Repositioning
Immobilization through maxilla-mandible-fixation
Early mobilization
Insertion of a functional orthodontic apparatus
Diet (soft food)
Surgical Therapy
A surgical therapy is indicated in case of:
-dislocated condyle fractures
-mechanical impairment of oral opening due to the fracture
or to a traumatogenic xenolith
-condyle fractures with loss of anterior/ posterior and vertical
relation of the mandible, where experience has shown that
a conservative fracture treatment will not lead to a restutio
ad integrum (multiple craniofacial fractures)
-dislocation of the approximal fragment from the socket
-contraindications for a maxilla-mandible-fixation/ splinting
An operative fracture treatment can include:
Open repositioning
Osteosynthesis
Additional Measures
Analgesic treatment
If indicated, antibiotic therapy
Drainage of contaminated wounds
Recommendation
The decision whether an in hospital or outpatient treatment
is indicated has to be made individually for each patient.
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