Executive Editor: Marcelo Figari, Gregorio Sánchez Aniceto General Editor: Daniel Buchbinder

Authors: Ricardo Cienfuegos, Carl-Peter Cornelius, Edward Ellis III, George Kushner

Mandible - Condylar process and head, simple and complex

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Glossary

1 Treatment top

General considerations

All condylar fractures can be treated closed.

Management of condylar fractures is a controversial topic. A variety of management techniques has been described in the medical literature.

The surgeon must exercise his or her own judgment on how to treat the specific fracture based on his or her own experience, the nature of the fracture, concomitant injuries and patient expectation and wishes.


Closed treatment options

Closed treatment for condylar fractures may involve the following:

  • A period of MMF
  • Functional therapy (immediate function with elastics)
  • A combination of the above

 


Closed treatment enlarge

Closed treatment - MMF

Although some surgeons favor no MMF for condylar fractures but prefer immediate function with training elastics to rehabilitate the occlusion, many surgeons prefer to use MMF for various durations.

The recommended period of MMF varies from 7 days to 6 weeks. The younger the patient is, the shorter the period of MMF in order to prevent the development of TMJ ankylosis. Therefore, in children, 7–10 days is the maximum usually recommended.

However, in adults, some surgeons recommend 6 weeks of MMF in the case of very low fractures (having a similar biological behavior to ramus fractures). In general, the lower the fracture, the longer the period of MMF recommended.

All surgeons who prescribe periods of MMF advise that this is followed by several weeks of functional treatment.

See here for a description of MMF.


Closed treatment enlarge

Closed treatment – functional treatment

Functional treatment is the use of guiding elastics and a regimen of active mobilization. Some authors explain that the period of active movements with the elastic guidance could be for as long as 3 months. The guiding elastics are initially used full time and the patient is slowly weaned off them. Any elastics are removed for eating.

After a few weeks, many patients only require them at night and during the day they can be omitted. The purpose of guiding elastics is to allow the patient to bite into their proper occlusal relationship. As few elastics as necessary should be used because another goal is the maintenance of good mobility of the jaw.

2 Case Example top

Closed treatment of condylar fractures enlarge

X-ray shows minimally displaced left condylar neck fracture.


Closed treatment of condylar fractures enlarge

X-ray shows minimally displaced left condylar neck fracture.Photograph taken after placement of arch bars shows the mandible shifts left and posteriorly due to loss of condylar support.


Closed treatment of condylar fractures enlarge

No MMF was used. Two light elastics were all that was necessary to provide anterior support of the left mandible so that the patient could bite into normal occlusion.


Closed treatment of condylar fractures enlarge

The patient was weaned off the elastics. This photograph taken 6 weeks postoperatively shows restoration of the normal occlusal relationship.


Closed treatment of condylar fractures enlarge

This photograph demonstrates that the patient was functionally rehabilitated to a wide interincisal opening.


Closed treatment of condylar fractures enlarge

Panoramic x-ray taken at 6 weeks shows solid union of the condylar process fracture.

v1.0 2008-12-01