**9. Surgical treatment of condylar fractures**

Conservative treatment using maxillo-mandibular fixation does not always provide satisfactory outcomes. Persistent malocclusion may be present where the necessity for open reduction and internal fixation.

Open reduction and internal fixation helps in faster restoration of both form and function unlike conservative treatment. The patient is rehabilitated in a shorter period of time unlike conservative treatment. Some of the indications for open reduction and internal fixation of mandibular condyle fracture includes.


**131**

*Diagnosis and Management of Mandibular Condyle Fractures*

**Closed reduction Open reduction**

1. Dislocated condyle and where there is mechanical interferences with the mandibular

2. Loss of anterior-posterior and vertical dimension that cannot be managed by closed reduction (ex-panfacial and in edentulous

4. Displacement of condyle into middle cranial

5. Patient and surgeon preference for early or immediate mobilization of function

function

fracture) 3. Compound fracture

fossa

• Displacement of condyle into the middle cranial fossa

• When intermaxillary fixation is contraindicated for medical reasons

*Indications for open and closed reduction of mandibular condyle fracture AAOMS 2017 guidelines [12].*

• Bilateral fracture with associated comminuted mid face fracture

According to AAOMS 2017 the indications for closed and open reduction of

A variety of incisions to approach the TMJ have evolved over the years with each

one having their own advantages and disadvantages. These incisions have been

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

1. Undisplaced or displaced condylar or comminuted fracture (in growing children) where form and function can be restored 2. No medical contraindications for MMF 3. Medical and anesthetic contraindications for

**Absolute indications**:

**Table 2.**

open reduction

• Invasion of foreign body

**Relative indications**:

• Impossibility of restoring occlusion

• Lateral extracapsular displacement

• Bilateral fracture with open bite deformity

• Periodontal problems and loss of teeth

condylar fractures are tabulated in **Table 2** [15].

1.Preauricular and its modification (**Figure 10**)

2.Post-auricular and modification (**Figure 10**)

**10. Surgical approaches to TMJ**

categorized into [16]

• Unilateral condylar fracture with unstable base [14]


Zide and Kent's criteria for open reduction are as follows.


#### **Table 2.**

*Oral and Maxillofacial Surgery*

joint [12].

Advantages:

• Economical

Disadvantages:

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

• Immobilization might not be adequate which delays healing. Especially in

Conservative treatment using maxillo-mandibular fixation does not always provide satisfactory outcomes. Persistent malocclusion may be present where the

Open reduction and internal fixation helps in faster restoration of both form and function unlike conservative treatment. The patient is rehabilitated in a shorter period of time unlike conservative treatment. Some of the indications for open reduction and internal fixation of mandibular condyle fracture includes.

c.Bilateral condylar fractures with severe displacement or dislocation affecting

unfavorable muscle pull can cause displacement of fragments.

subcondylar fractures where control over proximal segments is not established,

**8.1 Advantages and disadvantages of closed treatment**

• Does not require exposure to general anesthesia

• Noninvasive, simple, easy to master

• Less chance of infection [13]

• Increases patient morbidity

• Not safe in epileptic patients [13]

**9. Surgical treatment of condylar fractures**

necessity for open reduction and internal fixation.

a.Severe displacement of the condyle

d.Associated fractures of the mandible

e.Multifragmented fracture of the condylar head

Zide and Kent's criteria for open reduction are as follows.

b.Mal-united fracture

the occlusion

**130**

*Indications for open and closed reduction of mandibular condyle fracture AAOMS 2017 guidelines [12].*
