Perhaps no area of facial trauma has inspired more controversy than the management of mandibular subcondylar fractures. Fractures of the condylar region. Clinically, this equates to open treatment of condylar neck fractures or subcondylar (caudal) fractures (A). The surgeon may elect to place one or two plates. Background and objective: Mandibular fractures are the most frequent and sub condylar region is a common site of fracture. Proper.
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The mandibjlar constitutes a relatively small bone that must withstand high compression and tensional force during the mouth opening exercise [ 910 ].
Mandibular Subcondylar Fractures: A Review on Treatment Strategies
Open reduction and anatomic reduction can create better function for the temporomandibular joint, compared with closed treatment in mandible fracture surgery. When a fracture occurs in the tooth bearing portion of the mandible, whether or not it is dentate or edentulous will affect treatment. The debate continues over how to best manage subcondylar fracure and the question of which fractures should be mnadibular surgically has yet to be answered [ 3 ]. This is the most useful classification, because both the signs and symptoms, and also the treatment are dependent upon the location of the fracture.
When the angle of the fractures is pointing to the front, it is unfavorable. Subcomdylar closure is performed in layers after checking mandibular mobility and dental occlusion. Surgery within a few days . Higher tech solutions are also available, to help reduce the segments with arch bars using bonding technology.
Throckmorton GS, Ellis E. During the past decade, surgeons became intrigued with the concept of minimally invasive surgery to avoid the patient morbidity that could arise from more traditional open surgical techniques eg, laparoscopic techniques. The aim of this study was to review the different treatment strategies of these fractures in adults: Endoscopy-assisted open treatment of condylar fractures of the mandible: Therefore, new considerations regarding the indications and advantages of open reduction have evolved.
The same injury can be seen on the opposite side.
Surgical Management of a Mandible Subcondylar Fracture
People will also be very sensitive to touching the area of the jaw that is broken, or in the case of condylar fracture the area just in front of the tragus of the ear. Avoiding the complications related to the traditional open technique such as the facial nerve damage, scarring and those related to the close technique such as the lengthened MMF, non-anatomical reduction and difficulties associated with mandibular movements, have deemed the endoscopic method a favorite among surgeons.
For fractures that occur in the non-tooth bearing area condyle, ramus, and sometimes the angle an open bite is an important clinical feature since little else, other than swelling, may be apparent. Emergency Medicine Clinics of North America. The majority of the subcondylar fractures can be managed by this method, however an ORIF procedure would be the treatment of choice in cases of significant displacements.
Greenstick fractures are incomplete fractures of flexible bone, and for this reason typically occur only in children. The fragment is then repositioned under direct visualization of the fracture line. Panoramic view showing left condylar process fracture in association with an anterior body fracture.
Though it is difficult to accurately assess treatment results for the different plating techniques, using an in vitro model, our experiment shows that two-plate double fixation with an adaption plate and the DCP fixation technique produced the highest load fraccture deformation and failure [ 5 ].
For example, the “open” surgeons claim better anatomic reduction and postoperative radiographic appearance, while the “closed” surgeons favor a fractre approach with potentially fewer surgical complications and acceptable long-term functional results.
Author information Article notes Copyright and License information Disclaimer. Compared with the submandibular incision, this incision is closer to the subcondyle; therefore, it provides direct access to the fractured line of the subcondyle and it enables straightforward fracture management, thus facilitating the reduction of the subcondyle.
Note the associated anterior body fracture of the contralateral side. Bumper fracture Segond fracture Gosselin fracture Toddler’s fracture Pilon fracture Plafond fracture Tillaux fracture. Vertical shortening of the left mandible is noted along with the right anterior body fracture.
When the maxillary top and mandibular bottom teeth are aligned together, this brings the fracture segments into place. International Journal of Oral and Maxillofacial Surgery.