presentation kcd
TRANSCRIPT
![Page 1: Presentation kcd](https://reader036.vdocumento.com/reader036/viewer/2022062316/58837dc61a28ab22688b6c41/html5/thumbnails/1.jpg)
Condylar fractures and their management
most common fractures of the mandible.
Involve TMJ eitherdirectly or indirectly
Represent 20-30% of all mandibular fractures
![Page 2: Presentation kcd](https://reader036.vdocumento.com/reader036/viewer/2022062316/58837dc61a28ab22688b6c41/html5/thumbnails/2.jpg)
![Page 3: Presentation kcd](https://reader036.vdocumento.com/reader036/viewer/2022062316/58837dc61a28ab22688b6c41/html5/thumbnails/3.jpg)
![Page 4: Presentation kcd](https://reader036.vdocumento.com/reader036/viewer/2022062316/58837dc61a28ab22688b6c41/html5/thumbnails/4.jpg)
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
![Page 5: Presentation kcd](https://reader036.vdocumento.com/reader036/viewer/2022062316/58837dc61a28ab22688b6c41/html5/thumbnails/5.jpg)
![Page 6: Presentation kcd](https://reader036.vdocumento.com/reader036/viewer/2022062316/58837dc61a28ab22688b6c41/html5/thumbnails/6.jpg)
• 3.Clinical classification by MacLennan(1952
• a)No displacement• b)Displacement• c)Deviation• d)Dislocation
![Page 7: Presentation kcd](https://reader036.vdocumento.com/reader036/viewer/2022062316/58837dc61a28ab22688b6c41/html5/thumbnails/7.jpg)
![Page 8: Presentation kcd](https://reader036.vdocumento.com/reader036/viewer/2022062316/58837dc61a28ab22688b6c41/html5/thumbnails/8.jpg)
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.
![Page 9: Presentation kcd](https://reader036.vdocumento.com/reader036/viewer/2022062316/58837dc61a28ab22688b6c41/html5/thumbnails/9.jpg)
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.
![Page 10: Presentation kcd](https://reader036.vdocumento.com/reader036/viewer/2022062316/58837dc61a28ab22688b6c41/html5/thumbnails/10.jpg)
D. TYPE IV• Fractured head articulates on or
forward to articular eminence.E. TYPE V• Vertical or oblique fracture through
head of condyle.
![Page 11: Presentation kcd](https://reader036.vdocumento.com/reader036/viewer/2022062316/58837dc61a28ab22688b6c41/html5/thumbnails/11.jpg)
• COMPREHENSIVE CLASSIFICATION• Lindhal (1977)• A) Fracture level• i)condylar head• Intracapsular • Vertical ,compression, comminuted
![Page 12: Presentation kcd](https://reader036.vdocumento.com/reader036/viewer/2022062316/58837dc61a28ab22688b6c41/html5/thumbnails/12.jpg)
ii) Condylar neckiii) Subcondylarb) Relationship of condylar fragment to mandiblei) Undisplacedii) deviatediii) displaced with medial overlap of condylar fragmentiv) displaced with lateral ovelap of the condylar fragmentv) Anteroposterior overridevi) no contact
![Page 13: Presentation kcd](https://reader036.vdocumento.com/reader036/viewer/2022062316/58837dc61a28ab22688b6c41/html5/thumbnails/13.jpg)
• 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
![Page 14: Presentation kcd](https://reader036.vdocumento.com/reader036/viewer/2022062316/58837dc61a28ab22688b6c41/html5/thumbnails/14.jpg)
![Page 15: Presentation kcd](https://reader036.vdocumento.com/reader036/viewer/2022062316/58837dc61a28ab22688b6c41/html5/thumbnails/15.jpg)
• 7.Thoma classification (1945)
• Spiessl and schroll classification
• 5 types
![Page 16: Presentation kcd](https://reader036.vdocumento.com/reader036/viewer/2022062316/58837dc61a28ab22688b6c41/html5/thumbnails/16.jpg)
• AETIOLOGY1) Assault• Interpersonal violence or fist fight2)Road Traffic Accident3)Sports injuries4)Falls on the chin5)war injuries
![Page 17: Presentation kcd](https://reader036.vdocumento.com/reader036/viewer/2022062316/58837dc61a28ab22688b6c41/html5/thumbnails/17.jpg)
![Page 18: Presentation kcd](https://reader036.vdocumento.com/reader036/viewer/2022062316/58837dc61a28ab22688b6c41/html5/thumbnails/18.jpg)
• 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
![Page 19: Presentation kcd](https://reader036.vdocumento.com/reader036/viewer/2022062316/58837dc61a28ab22688b6c41/html5/thumbnails/19.jpg)
• DIAGNOSIS1) Examination• Inspection• Palpation• Auscultation
![Page 20: Presentation kcd](https://reader036.vdocumento.com/reader036/viewer/2022062316/58837dc61a28ab22688b6c41/html5/thumbnails/20.jpg)
2)Radiographs OPG PA VIEW
![Page 21: Presentation kcd](https://reader036.vdocumento.com/reader036/viewer/2022062316/58837dc61a28ab22688b6c41/html5/thumbnails/21.jpg)
OPG
![Page 22: Presentation kcd](https://reader036.vdocumento.com/reader036/viewer/2022062316/58837dc61a28ab22688b6c41/html5/thumbnails/22.jpg)
• 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 boneBattles signGagging of occlusion on Ipsilateral side(ramus
shortening
![Page 23: Presentation kcd](https://reader036.vdocumento.com/reader036/viewer/2022062316/58837dc61a28ab22688b6c41/html5/thumbnails/23.jpg)
![Page 24: Presentation kcd](https://reader036.vdocumento.com/reader036/viewer/2022062316/58837dc61a28ab22688b6c41/html5/thumbnails/24.jpg)
![Page 25: Presentation kcd](https://reader036.vdocumento.com/reader036/viewer/2022062316/58837dc61a28ab22688b6c41/html5/thumbnails/25.jpg)
Deviation on opening towards the side of fracturePainful limitation of protrusion and lateral excursion to the opposite sideBilateral condylar fracturesAnterior 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.
![Page 26: Presentation kcd](https://reader036.vdocumento.com/reader036/viewer/2022062316/58837dc61a28ab22688b6c41/html5/thumbnails/26.jpg)
![Page 27: Presentation kcd](https://reader036.vdocumento.com/reader036/viewer/2022062316/58837dc61a28ab22688b6c41/html5/thumbnails/27.jpg)
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• DO FUNCTIONAL TREATMENT• MMF INDICATED FOR 7-10 DAYS for pain control only.
![Page 28: Presentation kcd](https://reader036.vdocumento.com/reader036/viewer/2022062316/58837dc61a28ab22688b6c41/html5/thumbnails/28.jpg)
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• ELASTIC TRACTIONS
![Page 29: Presentation kcd](https://reader036.vdocumento.com/reader036/viewer/2022062316/58837dc61a28ab22688b6c41/html5/thumbnails/29.jpg)
MMF
![Page 30: Presentation kcd](https://reader036.vdocumento.com/reader036/viewer/2022062316/58837dc61a28ab22688b6c41/html5/thumbnails/30.jpg)
ADULTSINTRACAPSULAR UnilateralOcclusion undisturbed=conservative treatment(dietary advice,appropriate analgesics)Slight malocclusion with effusion in tmj=MMF for 2-3 weeks.BilateralIf there is slightly deranged occlusion=MMF for 3-4 weeks.
![Page 31: Presentation kcd](https://reader036.vdocumento.com/reader036/viewer/2022062316/58837dc61a28ab22688b6c41/html5/thumbnails/31.jpg)
CONDYLAR NECK #UNILATERALUndisplaced # and occlusion undisturbed=no active treatment necessarySUBCONDYLAR #ORIFHIGH CONDYLAR FRACTUREExtensive displacementand malocclusion=MMF FOR 3-4 WEEKS.BILATERALFUNCTIONALTREATMENT C/IOPERATIVE REDUCATION OF ATLEAST ONE OF THE # IS DESIRABLE TO RESTORE RAMUS HEIGHT.BILATERAL HIGH CONDYLARNECK #OPEN REDUCTION DIFFICULT=MMF FOR 6 WEEKS.
![Page 32: Presentation kcd](https://reader036.vdocumento.com/reader036/viewer/2022062316/58837dc61a28ab22688b6c41/html5/thumbnails/32.jpg)
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
![Page 33: Presentation kcd](https://reader036.vdocumento.com/reader036/viewer/2022062316/58837dc61a28ab22688b6c41/html5/thumbnails/33.jpg)
![Page 34: Presentation kcd](https://reader036.vdocumento.com/reader036/viewer/2022062316/58837dc61a28ab22688b6c41/html5/thumbnails/34.jpg)
• SUBMANDIBULARAPPROACH
• Ramus #• Low fractures of condylar
neck• Retromandibularapproach
/postramal incision• Subcondylar/low condylar
#• PREAURICULAR
APPROACH• High condylar #
![Page 35: Presentation kcd](https://reader036.vdocumento.com/reader036/viewer/2022062316/58837dc61a28ab22688b6c41/html5/thumbnails/35.jpg)
![Page 36: Presentation kcd](https://reader036.vdocumento.com/reader036/viewer/2022062316/58837dc61a28ab22688b6c41/html5/thumbnails/36.jpg)
![Page 37: Presentation kcd](https://reader036.vdocumento.com/reader036/viewer/2022062316/58837dc61a28ab22688b6c41/html5/thumbnails/37.jpg)
• THANK YOU• Dr. Qiam-ud-din• Dr. Umer Khitab• Dr. Muslim khan• Dr. Attaurahman• Dr. Murad• TMOS Oral Surgery
![Page 38: Presentation kcd](https://reader036.vdocumento.com/reader036/viewer/2022062316/58837dc61a28ab22688b6c41/html5/thumbnails/38.jpg)
![Page 39: Presentation kcd](https://reader036.vdocumento.com/reader036/viewer/2022062316/58837dc61a28ab22688b6c41/html5/thumbnails/39.jpg)
![Page 40: Presentation kcd](https://reader036.vdocumento.com/reader036/viewer/2022062316/58837dc61a28ab22688b6c41/html5/thumbnails/40.jpg)
![Page 41: Presentation kcd](https://reader036.vdocumento.com/reader036/viewer/2022062316/58837dc61a28ab22688b6c41/html5/thumbnails/41.jpg)
![Page 42: Presentation kcd](https://reader036.vdocumento.com/reader036/viewer/2022062316/58837dc61a28ab22688b6c41/html5/thumbnails/42.jpg)
![Page 43: Presentation kcd](https://reader036.vdocumento.com/reader036/viewer/2022062316/58837dc61a28ab22688b6c41/html5/thumbnails/43.jpg)