Condylar Fracture

Question 1

Indications for ORIF

Answer 1

Lat extracapsular displacement
Bony overlap >5mm 
Shortened ramus height 
Edentulous mandible
Dislocation (into middle cranial fossa or EAC)

Relative indications:
Bilat displaced condylar fractures
Assoc mobile midface fractures

Question 2

Indications of closed tx in condylar fracture

Answer 2

Peds displaced fractures
Minimally displaced causing mild malocclusion
Malocclusion in which orif is contraindicated

Question 3

Imaging to assess condylar fracture

Answer 3

OPG
PA allows view of condylar displacement in medial or lateral
Reverse townes - focuses and elongates the condyle and ramus becos of the AP view of the head faving downwards when beam shone
SMV - zygomatic arch and condylez

Question 4

Conservative tx of Condyle fracture includes

Answer 4

Soft diet
Close follow up
Early mobilization for intracapsular to prevent ankylosis

Question 5

Closed reduction of condyles involves?

Answer 5

Archbars and elastic traction for unilateral condylar fracture
IMF for bilateral

Question 6

Indications of conservative tx includes

Answer 6

Peds
Intracapsular
Undisplaced
Edentulous
No maloclussion

Question 7

What are surgical access for orif condyles

Answer 7

Retromandibular with transparotid approach
Preauricular with temporal extension
Intraoral
Endoscopic

Question 8

Enumerate how to do retromandibular with transparotid approach

Answer 8

Skin incision below ear 2-3cm
Subcut
Incise open the parotid capsule
Blunt dissection through parotid be careful not to injure the nerves
Dissect until find mandible
Periosteum incision to expose posterior mandible all the way superiorly to the condyles
Anatomical and functional reduction while maintaining proximal segment in glenoid fossa
Fixation:
1. 2 plates (2-miniholes on each side) one to be placed at posterior border and another at the sigmoid notch - to prevent rotational movement of head condyle
2. Special design condylar plate - 4 minihole in square shape
3. Bicortical lag screws with a lag screw technique with a gliding hole to allow compression of segment

Question 9

What is Guardmans fracture

Answer 9

Type of fracture that causes

1. Chin laceration
2. Bilateral condylar fracture
3. symphyseal fracture

Presents as

• retrognathia, or
• AOB
• increased mandibular width