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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It would thus be wise to assume that TMJ ankylosis is a result of a direct trauma to the joint capsule or condylar head therefore the risk of ankylosis is minor in subcondylar fractures: Patient benefit from endoscopically assisted fixation of condylar neck fractures-a randomized controlled trial. Therefore, several kinds of plates have been specifically designed for the stabilization of subcondylar fractures, and they were subjected to rigorous experimental testing before clinical use [ 4 ].
Treatment implications — simplified classification Mandibulsr contrast to the descriptive, previously defined anatomical classification, a more simplified one is outlined and used in the Surgery Reference. Traditionally, plain films of the mandible would be exposed but had lower sensitivity and specificity owing to overlap of structures.
Management of mandible fractures has been mentioned as early as B. This will mandibulqr in an ipsilateral premature contact of the teeth. Tests of two-plate fixation technique It remains uncertain whether plate fixation in condylar neck fractures is rigid enough to dispense with MMF and whether fixation techniques are strong enough to withstand functional loads encountered during the period of bone healing [ 1011 ]. Surgical versus conservative treatment of unilateral condylar process fractures: The best treatment for condylar fractures is subcondylat.
Since the introduction of internal fixation appliances, open reduction of condylar fractures is becoming more popular. If the bones fracture and overlie each other there may mandubular shortening of the height of the ramus. Higher tech solutions are also available, to help reduce the segments with arch bars using bonding technology.
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 for deformation and mandibullar [ 5 ].
Mandibular Subcondylar Fractures: A Review on Treatment Strategies
More commonly, open reduction and rigid internal fixation is placed. This protocol is also applicable subcoondylar bilateral fractures in which the fractured segments are not displaced. In a few patients who had malocclusion, elastic traction with a rubber band was used for several days. The osteotomized tibia bone was fixed using one of the four different mndibular groups A-D. Other fractures of the body, are classified as open or closed.
Considerations in Subcondylar Fracture Management.
Panoramic radiographs are tomograms where the mandible is in the focal trough and show a flat image of the mandible. Mandibular fracturealso known as fracture of the jawis a break through the mandibular bone.
Closed reduction with maxillomandibular fixation Closed reduction was historically considered the standard treatment for subcondylar fractures With a condylar fracture, there is very often shortening of the ramus on the affected side. High velocity injuries e. Panoramic view showing left condylar process fracture in association with an anterior body fracture. During the application of surgical approaches, it is important to ensure that the surgeon is able to conduct anatomic reduction under direct vision of the completely exposed fractured end [ 4 ].
Simple fractures are usually treated with closed reduction and indirect skeletal fixation, more commonly referred to as maxillo-mandibular fixation MMF. Fractures such as a symphyseal or bilateral parasymphyseal may lead to mobility of the central portion of the mandible where genioglossus attaches, and allow the tongue to fall backwards and block the airway. To access the fractured area, different approaches are available and surgeons would decide upon a suitable approach, based on experience and personal taste.
The aim of this study was to review the different treatment strategies of these fractures in adults:. Scaphoid Rolando Bennett’s Boxer’s Busch’s.
Considerations in Subcondylar Fracture Management
Clinical findings Direct trauma to the TMJ area is unusual but may be associated with fractures of the zygomatic complex. A Repeated tensile and compression forces are exerted on the subcondyle during mouth opening exercises. When the fracture is intracapsular there is a higher rate of late-term osteoarthritis and the potential for subcondylxr although the later is a rare complication as long as mobilization is early.
A periosteal elevator is used in order to strip the masseter muscle from the ramus and dissect superiorly to expose the fractured end along the posterior border of the condylar process.
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