Classification of Condylar Fractures

The topic of Mandibular Condylar fracture has generated more discussion and controversy than any other in the field of maxillofacial trauma.

Condylar and Subcondylar fractures accounting for approx 30% (DENTATE)to 37% (EDENTATE)of all mandibular fractures.

Condyle is the major growth centre for the mandible.

Condylar fractures can be extracapsular or intracapsular, undisplaced, deviated, displaced, or dislocated. Treatment depends on the age of the patient, the co-existence of other mandibular or maxillary fractures, whether the condylar fracture is unilateral or bilateral,the level and displacement of fracture,the state of dentition and dental occlusion.

As mandibular condyle fracture may cause long-term complications such as malocclusion, particularly open bite, reduced posterior facial height, and facial asymmetry in addition to chronic pain and mobility limitation, great caution should be taken…

1-K.E imparted by moving

object

2-K.E derived from

movement of the individual

3-K.E as a summation of

both forces

(ROW and KILLEYS’ CLASSIFICATION)

5 Types

Wassmunds Classification – 1934

• Type I – Fracture of condyle with slight displacement of head with angle of 10-45 degree between head and ramus– reduces spontaneously

• Type II – Angle of 45 – 90 degree between head and ramus, tearing of medial portion of capsule

• Type III – Fragments not in contact, head displaced medially and forward due to lat. Pterygoid pull/spasm, fragments is within glenoid fossa, capsule is torn and head is out side the capsule – open reduction advocated

• Type IV –Fractured head articulates on/forward to articular eminence

• Type V – Vertical/oblique fracture through head of condyle – rare

Lindhal’s classification:- Comprehensive classification (1977) Lindahl proposed a

classification based on several factors namely 1. The anatomic location of the fracture 2. The relation of the condylar segment to the

mandibular segment 3. The relation of the condylar head to the

articular fossa

1-BASED ON ANATOMICAL LOCATION Depending on fracture level i. ii. iii. Condylar head # Condylar neck # Subcondylar #(below neck)RESPECTIVELY.

2-BASED ON RELATIONSHIP OF CONDYLAR FRAGMENT TO MANDIBLE:

i. Undisplaced (fissure fracture) (B) ii. Deviated –simple angulation of the condylar process in i.r.t distal mandibular segment without overlap.(C) iii. Displacedwith medial overlap (D) iv. Displaced with lateral overlap (E) v. Antero-posterior overlap – possible but are seldom seen. (F) vi. Without contact between fragments

RELATIONSHIP OF CONDYLAR HEAD TO FOSSA:

i. No displacement- condylar head appears in normal prelation with fossa ii. Displacement – condylar head is in fossa but there is alteration of joint space. Joint space is increased iii. Dislocation – The condylar process is completely out of the fossa.

INJURY TO MENISCUS:

It may be torn, ruptured or herniated in forward or backward direction.

MacLennan Classification: 1952 –Clinical Classification Type I: No displacement Type II: Fracture deviation –simple angulation of the fracture segments without overlap or separation. Ex. Green stick fracture in children Type III: Fracture displacement –when there is overlap of fracture fragments. This overlap may be in an anterior, posterior, lateral or medial. Medial is commonest. Type IV: Fracture dislocation – here the condylar head is completely dislocated out of the articular fossa and out of the capsular confines. Again dislocation can be medial or lateral and rarely anterior or posterior. Type V : High condylar fracture with luxation Type VI : Head fracture or intracapsular fracture

Evidence of soft tissue injury ex chin lacerations.

Facial asymmetry with chin deviation. Noticeable swelling over the affected TMJ. Pain and swelling over affected TMJ. Malocclusion Deviation of mandible to same side during

opening. Bleeding from External Auditory canal. Inability to palpate condylar movement. Limited Mouth Opening and pain due to

muscle splinting.

CONVENTIONAL RADIOGRAPHY P.A view Lateral Oblique Panoramic Reverse Townes TMJ viewsCTMRI

Concerning the treatment for Condylar Fracture,”it seems that the battle will rage forever between the extremists who urge

non-operative treatment in particularly every case and the other extremists who advocate open reduction in almost every case ! “ Malkin

Open Reduction is a must if: Bilateral Condylar fracture Gunshot injury/compound fracture Lateral displacement of condyle Open bite Condyle displaced in middle cranial fossa Interlocked condyle In case of any medical concern,i-e COPD,Asthma,seizures,mental/neurological/learning problem.

Whether going for Open or Closed Reduction, the goals of Rx should always be :

Relief from pain Stable occlusion Restoration of inter-incisal opening Full range of mandibular movement To minimize deviation Avoid growth disturbances Avoid Ankylosis