**13. Different fixation options**

Fixation is done after ensuring anatomic reduction and normal occlusion.


**135**

tissue [22].

**Figure 14.**

complications like:

1.Ankylosis

affected side

3.Gross facial asymmetry

**14. Pediatric condylar fractures**

*Treatment algorithm for adult condylar fracture.*

*Diagnosis and Management of Mandibular Condyle Fractures*

this type of fixation will lead to avascular necrosis related to detachment of soft

The treatment plan is summarized and depicted in a flow chart (**Figure 14**) [13].

In children displacement of the fractured condyle is uncommon and it is mostly a greenstick fracture. This is due to the fact that the facial bone in children is enclosed by thick soft tissues; the bone is elastic in nature, presence of a large amount of immature trabecular bone and thin cortical bone. Fractures in the pediatric population can easily be overlooked and if untreated may lead to delayed

2.Poor development of the body and ramus of the mandible on the

4.Bird face and microgenia in case of bilateral condylar fractures [12]

tory. Surgical treatment is indicated under the following conditions:

Treatment in children differs from adults taking the growth and development into consideration. There are certain conditions where surgical treatment is manda-

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

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

**Figure 14.**

*Oral and Maxillofacial Surgery*

**12.1 Ideal lines of osteosynthesis**

**13. Different fixation options**

as follows:

**Figure 13.**

*Ideal line of osteosynthesis.*

notch

The condyles are subjected to major stress during mastication. Meyers gave the ideal lines of osteosynthesis for the mandibular condyle through his research works

1.Zone of tension: lies along the anterior border of the condyle and the sigmoid

The long axis of the condylar neck acts as a beam which is subjected to flexion in the sagittal plane. All these biomechanical properties must be taken into consideration

Fixation is done after ensuring anatomic reduction and normal occlusion.

b.**Two plates**—application of these two plates at the anterior and posterior aspects of the condylar neck which helps in resisting the torsional force that

c.**Geometric plate**—a single L, Y plate, triangular plate, trapezoidal plate, delta plate or 3 D plates are used. Among all plates geometric plates provide the better stability and outcome, because it fulfills the criteria of functionally stable

d.**Resorbable plate**—prevents the need for re-operation and has shown good results in the treatment of condylar fractures. They are not very stable when compared to titanium plates in the treatment of condylar fractures [19].

e.**Lag screw**—good clinical results can be obtained especially in diacapitular/

f. **Extra corporeal reduction and fixation**—the condyle is explanted from the glenotemporal fossa, reduced and fixed in desired position. The drawback of

a.**Single plate**—**i**n a single miniplate the fracture must be stabilized using two screws on each side of the fracture line. The drawback of this plating has

2.Zone of compression: lies along the posterior border of the ramus

while fixation of the fracture pertained to the region (**Figures 12** and **13**) [18].

showed the greatest peak displacement of fracture.

may not be opposed with a single plate [19].

osteosynthesis in the fracture segments [20].

sagittal head fractures [21].

**134**

*Treatment algorithm for adult condylar fracture.*

this type of fixation will lead to avascular necrosis related to detachment of soft tissue [22].

The treatment plan is summarized and depicted in a flow chart (**Figure 14**) [13].

## **14. Pediatric condylar fractures**

In children displacement of the fractured condyle is uncommon and it is mostly a greenstick fracture. This is due to the fact that the facial bone in children is enclosed by thick soft tissues; the bone is elastic in nature, presence of a large amount of immature trabecular bone and thin cortical bone. Fractures in the pediatric population can easily be overlooked and if untreated may lead to delayed complications like:


Treatment in children differs from adults taking the growth and development into consideration. There are certain conditions where surgical treatment is mandatory. Surgical treatment is indicated under the following conditions:

#### **Figure 15.**

*Treatment algorithm for pediatric condylar fracture.*


Surgical treatment may affect the normal growth of the mandible due to the surgical trauma to the soft tissue and the rigidly fixed bony fragments. Moreover, due to the risk of damage to the facial nerve and the invasiveness of surgery conservative treatment is mostly preferred. Maxillomandibular fixation is preferred for a period of 7–10 days followed by physiotherapy (**Figure 15**) [23].

### **15. Management of geriatric condylar fracture**

The cross-sectional area of an atrophic mandible is usually decreased when compared to a mandible with dentition. The vascularity of the bone is decreased and the bone is sclerotic in nature which will hinder or delay the normal healing of the mandible following open reduction. Due to the lack of dentition the fractured fragments are easily displaced. The poor quality of the bone is not suitable for plating the fracture. Conservative treatment with a Gunning splint is advantageous as it provides a stable maxillomandibular fixation and also preserves the periosteal vascularity. Thomas brain gunning designed the "Gunning splint" for maxillomandibular fixation of edentulous or partially edentulous jaw. It consists of two dentures held together in a mono-block. It holds the fracture fragments together and immobilizes the jaw. There is no means of retention or stabilization in an edentulous patient therefore the maxillary denture is secured to the maxilla through per alveolar wiring and the mandibular denture is secured to the mandible with circum-mandibular wiring. The two splints are connected with wire loops or elastics and intermaxillary fixation is achieved [24].

**137**

*Diagnosis and Management of Mandibular Condyle Fractures*

Rehabilitation can be begun just on the first day of operation in patients who are treated surgically. It mainly consists of exercises which adduces and dissuades the mandible. The exercise is done in front of the mirror so that the mandible is adduced in the correct position. The exercise is done for about 3 to 5 times a day for a timing of 5–10 minutes. In patients who are treated nonsurgically rehabilitation starts at the end of removal of maxillomandibular fixation. Majority of the authors recommend shortening the period of immobilization for 1o to 14 days to prevent the risk of ankylosis. Zaccharides recommends removal of the maxillomandibular fixation once a week during the treatment, the patient should practice opening and closing for half an hour to 1 hour before re-installation of MMF [12]. After conservative treatment physiotherapy is recommended for 3–4 weeks. Rehabilitation is finished when the

Complications in the management of mandibular condyle fractures depends on the severeness of trauma, fracture type, degree of fracture displacement, presence of associated fractures, the type of management (open/closed) and the timing of

patient is able to open and close the mouth similar to pre-trauma [9].

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

**16. Rehabilitation**

**17. Complications**

a.Common complications [12]

• Ipsilateral asymmetry on the side of trauma

• Articular head necrosis which is related with surgical method

• Joint motility disorders

• Occlusal discrepancies

• Ankylosis (0.2–0.4%)

c.Surgical complications

• Ear lobe hypoesthesia

• Post-surgical scarring

• Masseter myotonia

• EAC stenosis

• Transient or permanent facial palsy

• Formation of sialocele and salivary fistulas

• Auriculotemporal nerve syndrome or Frey's syndrome

• Marginal mandibular nerve palsy

b.Rare complications

intervention.
