**16. Rehabilitation**

*Oral and Maxillofacial Surgery*

1.Complex or open fractures

*Treatment algorithm for pediatric condylar fracture.*

4.Multiple fractures of the condyle

3.Sub condylar fractures with associated facial or calvarial fractures

period of 7–10 days followed by physiotherapy (**Figure 15**) [23].

**15. Management of geriatric condylar fracture**

elastics and intermaxillary fixation is achieved [24].

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

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

2.Severe displacement

**Figure 15.**

**136**

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