Condylar injuries


Classification

Contusion—Injuries to the soft tissues around the joint or an effusion within the joint

Dislocation—Displacement of the condylar head from the glenoid fossa but still within the capsule

Fracture:

  • Intra-capsular—Condylar head or neck
  • Extracapsular—Condylar neck or subcondylar

 

Clinical Features

  • Tempromandibular joint effusion/haemarthrosis
  • Ipsilateral posterior open bite
  • Midline shift to contra-lateral side

 

Unilateral Fracture

  • Ipsilateral premature contact posteriorly
  • Ipsilateral midline shift

 

Bilateral fracture dislocations

  • Anterior open-bite as both mandibular rami are shortened

 

Bilateral Dislocation of condylar heads

  • Pseudoprognathism
  • Unable to bring teeth into occlusion
  • Elongated face
  • Condyles able to be palpated

 

Treatment


1. Conservative treatment

No active treatment if minimal displacement and lack of symptoms

Persistent malocclusion or severe pain may require intermaxillary fixation

 

2. Surgical indications

Compound and comminuted fractures

Condylar displacements with gross occlusal disruption/telescoping

Multiple facial fractures


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