MANDIBULAR SUBCONDYLAR FRACTURE PDF
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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The retromandibular antroparotid with a two centimeter incision under the ear lobule is utilized in this center.
Upon conclusion of the gathered information, the authors suggest 4—6 weeks of MMF in the subcondylar fractures in which the TMJ capsule is not involved. When the maxillary top and mandibular bottom teeth are aligned together, this brings the fracture segments into place.
W B Saunders Co. Outside the mouth, signs of swelling, bruising and deformity can all be seen. A Preoperative design of a mini-retromandibular incision.
However, a open reduction was first applied to a low subcondylar fracture in [ 12 ], and recently it has become more common, probably because of the introduction of plate and screw fixation devices that allow for the stabilization of such injuries [ 1 ]. Despite this knowledge, and much debating, authors are still unable to agree on an absolute treatment plan for management of condylar fractures.
Surgical Management of a Mandible Subcondylar Fracture
The single-plate fixation technique does not provide sufficient strength to withstand the strains occurring in subcondylar fractures. A Cochrane review assessed clinical studies on surgical open reduction and non-surgical closed reduction management of mandible fractures that do not involve the condyle. Example of a high neck fracture 3-D reconstructions are useful in identifying fracture height, direction and severity of displacement.
Introduction Condylar injuries are often a matter of discussion and controversy among maxillofacial topics 1.
Fractures of the mandibular body are defined as those that involve a region bounded anteriorly by the parasymphysis defined as a vertical line just distal to the canine tooth and posteriorly by the anterior border of the masseter muscle. The option is sometimes used when a patient is edentulous has no teeth subbcondylar rigid internal fixation cannot be used.
Treatment of subcondylar fractures can follow two different routes: Two prospective randomized, multi-center studies by Eckelt et al. Rigid internal fixation of parasymphasis fracture of the mandible. Mandibular fractures are typically the result of trauma. Journal List Arch Plast Surg v. Open reduction is sometimes combined with use of an endoscope to aid visualization of fracture site. British Journal of Oral and Maxillofacial Surgery. For comparable fractures, patients who received MMF will lose more weight and take longer to regain mouth opening, whereas, those who receive RIF have higher infection rates.
Subcondylae 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. The assumption that a closed reduction will result in fewer complications, though the esthetics and functionality will be just the same as an ORIF treatment, induced this method as the common procedure.
Recently, anatomic reduction and early mobilization of the jaw following surgery have been considered important for the functional rehabilitation of the TMJ [ 5 ].
When we operate on a subcondylar fracture, the treatment plan depends on, 1 whether open or closed reduction must be performed, 2 which approach to the fracture site will be used, and 3 what type of osteosynthesis is required.
A simple fracture describes a complete transection of the bone with minimal fragmentation at the fracture site.
There can be an open bite where the lower teeth, no longer meet the upper teeth. While mandible fractures have similar complication rates whether treated immediately or days later, older fractures are believed to have higher non-union and infection rates although the data on this makes it difficult to draw firm conclusions. Journal of Oral and Maxillofacial Surgery. To treat subcondylar fractures, several surgical approaches have been reported and each approach has its own set of advantages and disadvantages.
Contemporary oral and maxillofacial surgery 5th ed. Instead, the blood supply comes largely from the periosteum.
Mandibular Subcondylar Fractures: A Review on Treatment Strategies
Case Report and Literature Review”. People will also be very sensitive to touching the area of the jaw that is broken, or in the case of condylar fracture the area just in front of the tragus of the ear.
Ellis E, 3rd, Throckmorton GS. Biomechanics Hunting bow concept The mandible is similar to a hunting bow in shape, strongest in the midline symphysis and weakest at both ends condyles. Scaphoid Rolando Bennett’s Boxer’s Busch’s.
Post-surgical scaring is less evident in this approach and no entry to the parotid gland occurs, preventing complications such as salivary fistula A new hypothesis of mechanisms of traumatic ankylosis of temporomandibular joint.