This document discusses condylar fractures, which are the most common type of mandibular fractures. It provides detailed classifications of condylar fractures including location, degree of displacement, and relationship to surrounding structures. Treatment options are also summarized, including functional treatment for non-displaced fractures, maxillomandibular fixation for some displaced fractures, and open reduction with internal fixation for more severely displaced fractures. Surgical approaches and fixation methods for open reduction are also outlined.

1. Condylar fractures and their
management
most common fractures of the
mandible.
Involve TMJ either
directly or indirectly
Represent 20-30% of all
mandibular fractures

4. CLASSIFICATION
• 1.Unilateral or Bilateral condylar
fractures
• 2.Rowe and Killeys classification(1968)
• a)Intracapsular or high condylar #
• b)Extracapsular or low condylar#or
subcondylar #
• c)fractures associated with injury to
capsule,ligaments and meniscus
• d)fractures involving the adjacent bone
e.g # of roof of glenoid fossa or the
tympanic plate of external auditory
meatus

6. • 3.Clinical classification by
MacLennan(1952
• a)No displacement
• b)Displacement
• c)Deviation
• d)Dislocation

8. WASSMUNDS CLASSIFICATION
A. TYPE I
• Fracture of neck of the condyle with slight
displacement of head.
• 10-45 degree variation between head and
axis of ramus.
• Tend to reduce spontaneously.
B.TYPE II
• 45-90 degree angulation between head and
ramus.
• Tearing of medial portion of joint capsule.

9. C. TYPE III
• Fragments not in contact.
• Condylar head displaced
medially and forward.
• Fragments confined within
glenoid fossa.
• Capsule torn and head is
outside the capsule.

10. D. TYPE IV
• Fractured head articulates on or
forward to articular eminence.
E. TYPE V
• Vertical or oblique fracture
through head of condyle.

11. • COMPREHENSIVE
CLASSIFICATION
• Lindhal (1977)
• A) Fracture level
• i)condylar head
• Intracapsular
• Vertical ,compression,
comminuted

12. ii) Condylar neck
iii) Subcondylar
b) Relationship of condylar fragment to mandible
i) Undisplaced
ii) deviated
iii) displaced with medial overlap of condylar fragment
iv) displaced with lateral ovelap of the condylar
fragment
v) Anteroposterior override
vi) no contact

13. • Relationship of condylar head to
fossa
• i)No displacement
• Joint space appears normal
• ii)Displacement
• Joint space increased
• D)injury to meniscus
• Torn,ruptured or herniated in forward
or backward direction

15. • 7.Thoma
classification
(1945)
• Spiessl and
schroll
classification
• 5 types

16. • AETIOLOGY
1) Assault
• Interpersonal violence or fist
fight
2)Road Traffic Accident
3)Sports injuries
4)Falls on the chin
5)war injuries

18. • MECHANISM
• i)Degree of force
• K=1/2 mvv
• ii)Direction of impact
• Above,below,front ,side
• iii)The precise point of application of force
• chin
• Lateral side of face
• iv)open or closed mouth
• v)partially or fully edentulous patients

19. • DIAGNOSIS
1) Examination
• Inspection
• Palpation
• Auscultation

20. 2)Radiographs
OPG
PA VIEW

21. OPG

22. • Clinical features
• Unilateral condylar fracture
• Limitation in mouth opening
• Swelling over TMJ area
• Bleeding from the ear
• i)laceration of anterior wall of EAM
ii)fractur of petrous temporal bone
Battles sign
Gagging of occlusion on Ipsilateral
side(ramus shortening

25. Deviation on opening towards the side of fracture
Painful limitation of protrusion and lateral excursion to
the opposite side
Bilateral condylar fractures
Anterior open bite(bilateral displaced fractures of
condylar necks)
Pain an d L.M.O With restricted protrusion and
lateral excursion
fracture of symphasis and parasymphasis frequent.

27. TREATMENT OF
CONDYLAR
FRACTURES
• No clear guidelines exist.
• Three treatment options
• 1)functional
• 2)indirect immobilization
• 3)osteosynthesis
• CONSERVATIVE-FUNCTIONAL TREATMENT
• Condylar neck fracture with little or no
dislocation
• ALL intracapsular # and all # in growing
children.
• CHILDREN
• UNDER 10 YEARS
• DISREGARD MALOCCLUSION

28. Treatment
• ADOLESCENTS AGED 10-17 YEARS
• If occlusion undisturbed=
FUNCTIONAL TREATMENT
• If malocclusion present=MMF for 2-3
weeks.
• ARGUMENT FOR ORIF?Whether
indicated for major displacement of
condyle.
• FUNCTIONALTREATMENT
• SEMI SOLID DIET
• ANALGESICS
• MUSCLE TRAINING JAW EXERCISES

29. MMF

30. ADULTS
INTRACAPSULAR
Unilateral
Occlusion
undisturbed=conservative
treatment(dietary
advice,appropriate analgesics)
Slight malocclusion with effusion
in tmj=MMF for 2-3 weeks.
Bilateral
If there is slightly deranged
occlusion=MMF for 3-4 weeks.

31. CONDYLAR NECK #
UNILATERAL
Undisplaced # and occlusion
undisturbed=no active treatment necessary
SUBCONDYLAR #
ORIF
HIGH CONDYLAR FRACTURE
Extensive displacementand
malocclusion=MMF FOR 3-4 WEEKS.
BILATERAL
FUNCTIONALTREATMENT C/I
OPERATIVE REDUCATION OF
ATLEAST ONE OF THE # IS
DESIRABLE TO RESTORE RAMUS
HEIGHT.
BILATERAL HIGH CONDYLARNECK
#
OPEN REDUCTION DIFFICULT=MMF
FOR 6 WEEKS.

32. METHODS OF FIXATION
OF CONDYLAR #
• 1)TRANSOSSEOUS WIRING
• 2)BONE PLATING WITH
MINIPLATING SYSTEM
• TWO STANDARD MINIPLATES
SHOULD ALWAYS BE INSERTED
• 3)LAG SCREW
OSTEOSYNTHESIS

34. • SUBMANDIBULARAPPR
OACH
• Ramus #
• Low fractures of
condylar neck
• Retromandibularapproa
ch/postramal incision
• Subcondylar/low
condylar #
• PREAURICULAR
APPROACH
• High condylar #

37. • THANK YOU
• Dr. Qiam-ud-din
• Dr. Umer Khitab
• Dr. Muslim khan
• Dr. Attaurahman
• Dr. Murad
• TMOS Oral Surgery