CONDYLAR AND CONDYLAR AND CORONOID CORONOID

FRACTURESFRACTURESDr V.RAMKUMAR

CONSULTANT DENTAL& FACIOMAXILLARY SURGEON

REG NO : 4118- TAMILNADU –INDIA(ASIA)

ANATOMICAL DIFFERENCEANATOMICAL DIFFERENCE

Healing potential (good)Healing potential (good) Condyle & coronoidCondyle & coronoid proximal endproximal end Muscle attachmentMuscle attachment

(Temporalis & (Temporalis & medial pterygoid)medial pterygoid)

WHAT MAKES IT COMPLEXWHAT MAKES IT COMPLEX Muscular attachment (Lateral Pterygoid)Muscular attachment (Lateral Pterygoid)

Size & Shape of condyleSize & Shape of condyle

Deviation & DisplacementDeviation & Displacement

WHAT SORT OF FORCE MAY WHAT SORT OF FORCE MAY CAUSE DAMAGE TO THE JOINTCAUSE DAMAGE TO THE JOINT

LINDAHL (1977)LINDAHL (1977)KE I : Moving object on a static individualKE I : Moving object on a static individualKE 2: Moving individual on static objectKE 2: Moving individual on static objectKE 3: Moving object on moving individual KE 3: Moving object on moving individual

CLASSIFICATIONCLASSIFICATION

Based on Based on Site of #Site of # Relationship of the # fragment to Relationship of the # fragment to

remaining mandibleremaining mandible LateralityLaterality

BASED ON SITEBASED ON SITE

Intra capsularIntra capsular Extra capsularExtra capsular

– NeckNeck– Sub condylarSub condylar

BASED ON THE RELATIONSHIP BASED ON THE RELATIONSHIP OF THE # FRAGMENTOF THE # FRAGMENT

Pneumonic “4 D”Pneumonic “4 D” No displacementNo displacement Deviation (Green stick)Deviation (Green stick) Displacement (Overlap)Displacement (Overlap) Dislocation (Out of the fossa)Dislocation (Out of the fossa)

CLINICAL FEATURESCLINICAL FEATURES HaemarthrosisHaemarthrosis Posterior open bite on same sidePosterior open bite on same side Deviation of midline to opposite sideDeviation of midline to opposite side Bilateral condyle #’s – Anterior open biteBilateral condyle #’s – Anterior open bite Unilateral dislocation without #Unilateral dislocation without #

– Midline deviat ion to opposite sideMidline deviat ion to opposite side– Occlusal derrangementOcclusal derrangement

Bilateral dislocation without #Bilateral dislocation without #– Prognathism +vePrognathism +ve– Total loss of occlusionTotal loss of occlusion

PARADE GROUND FRACTUREPARADE GROUND FRACTURE

RARE COMPLICATIONRARE COMPLICATION Central dislocation through glenoid fossa Central dislocation through glenoid fossa

without # of condylar neckwithout # of condylar neck– Deviation of midline to ipsilateral sideDeviation of midline to ipsilateral side– Gagging of ipsilateral posterior TeethGagging of ipsilateral posterior Teeth– Contralateral posterior open biteContralateral posterior open bite– Absolute immobility of the lower jawAbsolute immobility of the lower jaw

RADIOGRAPHS & OTHER RADIOGRAPHS & OTHER INVESTIGATIONSINVESTIGATIONS

OPG (View of both condyle)OPG (View of both condyle) TMJ ViewTMJ View

– Trans OrbitalTrans Orbital– Trans PharyngealTrans Pharyngeal

CT Scan: If displaced (or) DeviatedCT Scan: If displaced (or) Deviated

SCHOOL OF THOUGHTSSCHOOL OF THOUGHTS(KRUGER & SCHILLI)(KRUGER & SCHILLI)

ConventionalConventional

Functional Functional

Surgical Surgical

INDICATION FOR OPEN REDUCTION & INDICATION FOR OPEN REDUCTION & FIXATIONFIXATION

(ZIDE & KENT- 1963)(ZIDE & KENT- 1963)

Absolute Indication:Absolute Indication: Dislocation into cranial fossa Dislocation into cranial fossa Impossibility to obtain adequate occlusionImpossibility to obtain adequate occlusion Lateral dislocation of condyleLateral dislocation of condyle Invasion of foreign body (Gun shot)Invasion of foreign body (Gun shot) Compound #Compound #

Relative IndicationsRelative Indications Bilateral in edentulous where splinting is Bilateral in edentulous where splinting is

impossibleimpossible– Alveolar ridge atrophyAlveolar ridge atrophy– No denture & No co-operationNo denture & No co-operation

Unilateral or Bilateral where wiring is Unilateral or Bilateral where wiring is contraindicatedcontraindicated– EpilepticEpileptic– Psychiatric Psychiatric

Bilateral with Communited MidfaceBilateral with Communited Midface– To reconstitute mandibular platform as starting To reconstitute mandibular platform as starting

pointpoint

REDUCTIONREDUCTION Moule pins (To manipulate the # condylar Moule pins (To manipulate the # condylar

fragment)fragment)

FIXATIONFIXATION Intra osseous wiringIntra osseous wiring

– Figure of ‘8’Figure of ‘8’ Gleno-condylar sutures with catgut (Not-used)Gleno-condylar sutures with catgut (Not-used) ‘‘K’ wiresK’ wires Bone platingBone plating

– Miniplate Miniplate – MicroplatesMicroplates

Bone pinsBone pins Bone staplesBone staples Intra medullary screwsIntra medullary screws

– Steinmans (Sp. for condyle)Steinmans (Sp. for condyle)– Kitayamma (Intra oral) Kitayamma (Intra oral)

POST OPERATIVEPOST OPERATIVE Good healing immaterial of any treatmentGood healing immaterial of any treatment

Remodeling Remodeling

Pseudo joint (Ebernation)Pseudo joint (Ebernation)

COMPLICATIONS OF CONDYLAR COMPLICATIONS OF CONDYLAR INJURYINJURY

AnkylosisAnkylosis Disturbance of mandibular growth Disturbance of mandibular growth

(Micrognathia)(Micrognathia)Predisposing factors in complicationsPredisposing factors in complications Age Age Site & Type of #Site & Type of # Duration of immobilizationDuration of immobilization Damage to meniscusDamage to meniscus

COMPLICATIONCOMPLICATION

Ankylosis of coronoid to Ankylosis of coronoid to zygomatic archzygomatic arch– (extra articular ankylosis)(extra articular ankylosis)

Communited # of zygoma Communited # of zygoma associatedassociated

SUMMARYSUMMARY

Child = Take careChild = Take care

Active mouth openingActive mouth opening

Prevent ankylosisPrevent ankylosis

Adult = Take careAdult = Take care

Max. Closed Reduction & ImmobilizationMax. Closed Reduction & Immobilization

Avoid damage to facial nerve in Open Avoid damage to facial nerve in Open Reduction & FixationReduction & Fixation

CORONOID FRACTURECORONOID FRACTURE RareRare

No direct injury (Because of Zygomatic No direct injury (Because of Zygomatic arch)arch)

Hardly needs any TreatmentHardly needs any Treatment

CLINICAL FEATURESCLINICAL FEATURES Superficial lacerationSuperficial laceration Depressed # ZygomaDepressed # Zygoma Trismus Trismus Decreased mandibular movementsDecreased mandibular movements Intraoral swelling over the # siteIntraoral swelling over the # site Bruising posterior Bruising posterior the zygomatic buttressthe zygomatic buttress Lateral crossbite on ipsilateral sideLateral crossbite on ipsilateral side

TREATMENTTREATMENT If SymptomaticIf Symptomatic

– Intra oral exposure & fixationIntra oral exposure & fixation

If ComplicatedIf Complicated– Coronoidectomy Coronoidectomy