**Abstract**

In the maxillofacial region, mandibular condyle fracture accounts for about 10–40% of the trauma spectrum. This chapter deals with the etiology, classification, clinical features, diagnosis, and contemporary management of mandibular condyle fractures. Along with the regular management strategies, treatment protocols for geriatric and pediatric patients have also been discussed. The indications and contraindications of closed as well as open reduction and fixation of condyle fractures are analyzed in detail.

**Keywords:** mandible, condyle, trauma, clinical features, diagnosis, management, ORIF, closed reduction, edentulous, pediatric, complications

#### **1. Introduction**

Mandible is the second most commonly fractured after nasal bone, though it is the largest and strongest bone. Mandibular condyle fractures accounts for about 10–40% when compared to other anatomical sites of mandible [1]. The proportion of condylar fractures is higher in children than adults, and has been reported to account for 40–67% of mandibular fractures [2]. According to Widmark and Santler, condylar fracture is the most common fracture in the maxillofacial region [1]. Direct or indirect trauma can lead to fracture of the condyle; the degree of displacement depends on the direction and magnitude of the force. Falls, road traffic accident, sports injuries, work-related injuries and assault are frequently related to condylar fracture [3].

#### **2. Anatomy**

Condyle develops from Meckel's cartilage and it is intramembranous in ossification. The secretion of bone matrix directly within the connective tissue without any intermediate cartilage leads to bone formation. The condensation of mesenchyme just lateral to the Meckel's cartilage forms the primitive condyle.

Condyle is a knuckle like structure. It is a strong upward projection from the postero-superior part of the ramus. The condyle has a backward angulation of 15–33° to the frontal plane and is elliptical in shape. The condyle has an angulation of 145–160° at the region where it meets at the anterior ligament of foramen magnum on basion. The medio-lateral width is 15–20 mm and the antero-posterior width is 8–10 mm. The condyle has a roughened, bluntly pointed lateral pole and a rounded medial pole which extends from the plane of ramus. Superficial temporal artery, posterior tympanic artery, posterior deep temporal artery and transverse facial artery provides the arterial

#### *Oral and Maxillofacial Surgery*

supply to the condyle. Venous drainage is by the corresponding tributaries. Nerve supply is from facial and auriculotemporal nerves. Lateral pterygoid muscle is attached at the pterygoid fovea which is helpful in protrusive and lateral excursive movements [4].

The bifurcation of facial nerve lies 1.5–2 cm away from the bony external auditory canal. The Temporal branch of the facial nerve lies 8–35 mm from the bony external auditory canal. The marginal mandibular branch of the facial nerve lies 1.2 cm away from the inferior border.

The anatomical variations between an adult and a pediatric condyle are given in **Table 1** (**Figures 1** and **2**).


#### **Table 1.**

*Differences between pediatric and adult condyle.*

**121**

**Figure 3.**

*Hunting bow concept.*

**Figure 2.**

*Anatomy of adult condyle.*

*Diagnosis and Management of Mandibular Condyle Fractures*

**3. Biomechanics of injury (Hunting bow concept)**

The Mandible resembles a Hunting bow which is weak at the ends and strong in the midline and the condyles are enclosed by the glenoid fossa. So any blow to the midline of the mandible can cause bilateral condylar fracture and any blow to the parasymphysis may cause a contralateral fracture. This is based on the impact of the force (**Figure 3**) [5].

*DOI: http://dx.doi.org/10.5772/intechopen.93795*

**Figure 1.** *Anatomy of Paediatric condyle.*

*Diagnosis and Management of Mandibular Condyle Fractures DOI: http://dx.doi.org/10.5772/intechopen.93795*

*Oral and Maxillofacial Surgery*

**Table 1** (**Figures 1** and **2**).

**Table 1.**

1.2 cm away from the inferior border.

*Differences between pediatric and adult condyle.*

supply to the condyle. Venous drainage is by the corresponding tributaries. Nerve supply is from facial and auriculotemporal nerves. Lateral pterygoid muscle is attached at the pterygoid fovea which is helpful in protrusive and lateral excursive movements [4]. The bifurcation of facial nerve lies 1.5–2 cm away from the bony external auditory canal. The Temporal branch of the facial nerve lies 8–35 mm from the bony external auditory canal. The marginal mandibular branch of the facial nerve lies

The anatomical variations between an adult and a pediatric condyle are given in

**Anatomical structure Child Adult** Cortical bone Thin Thick Condylar neck Broad Thin Articular surface Thin Thick Capsule Highly vascular Less vascular

**120**

**Figure 1.**

*Anatomy of Paediatric condyle.*

**Figure 2.** *Anatomy of adult condyle.*
