**8. Conservative treatment of condylar fractures**

Conservative therapy remained the primary mode of treatment of mandibular condyle fracture for many years. This is now overshadowed by surgical therapy due to increase in surgical expertise and the advent of new technological advances in both instrumentation and radiological diagnosis. But there exist certain scenarios where conservative treatment is preferred.

In closed reduction achievement of good occlusal relationship acts as the guidance for proper reduction. The upper and lower jaws are fixed together in occlusal relationship by means of intermaxillary fixation or maxillomandibular fixation done using wires or splints. The wires that pass through the embrasure space of the adjacent teeth of the same arch are called interdental wires. These are later engaged during intermaxillary wiring.

Various modalities of intermaxillary fixation used commonly for condylar fracture are:

1.Wiring:

*Oral and Maxillofacial Surgery*

• TMJ tomography

*Computed tomography.*

**Figure 9.**

• Nasal projection [9]

(**Figure 9**) [10].

comes [11].

• Waters projection or Para nasal sinus view

CT in all three planes, i.e., coronal, axial, and sagittal remains a gold standard for the diagnosis of mandibular condyle fractures. 3D CT provides better orientation of the fractured fragments in relation to the normal anatomic structures

Determining the degree of dislocation, relationship between the fractured fragments and the direction of dislocation remains a challenge in the diagnosis of mandibular condyle fractures. It may be difficult to ascertain position and rotation of the articular head of the condyle with the use of conventional imaging techniques. MRI may provide a better outlook in assessing both the hard tissue and soft tissue part of the condylar head. One must remember that re-establishing only the bony component of the joint is not sufficient and the soft tissue anatomy (Articular disc) must also be restored to achieve satisfactory functional out-

This is achieved by proper repositioning and immobilization of the fractured

• Clementschitsch view or occipital

**7. Management of condylar fractures**

Aims of treatment includes

1.Restoration of form

2.Restoration of function

**128**

fragments.


Indications for conservative treatment:


Conservative treatment consists of maxillo-mandibular fixation by means of arch bars, IMF screws or dental splints (cap splint or gunning splint) and intermaxillary traction using elastics or wires. Immobilization of the joints are done for a period of 4–6 weeks in case of adults whereas 7–10 days for children. Antegrade physiotherapy is mandatory until full adhesion of the fractured fragments [9]. The treatment span is shortened in the pediatric population as they have an increased growth potential and prolonged immobilization may lead to ankylosis of the joint [12].
