Diagnosis and treatment protocol of mandibular condylar fracture: experience from the TMJ Center of Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine

doi:10.3969/j.issn.1674-8115.2022.06.001

Abstract

Abstract:

Mandibular condylar fracture is common in clinic. Improper treatment will cause sequelae such as malocclusion, ankylosis and limited mandibular development. This paper combines the literature review and the diagnosis and treatment experience of the team to provide reference for clinicians. Imaging diagnosis, especially coronal CT reconstruction, is the basis for classification and treatment of condylar fracture. According to the fracture location, it is divided into condylar (intracapsular) fracture, condylar neck fracture and subcondylar fracture. And intracapsular fracture can be further divided into four types: A, B, C and M. The treatment of condylar fracture includes non-surgical treatment and surgical treatment. For non-surgical treatment, intermaxillary elastic traction is recommended for malocclusion correction. The absolute indication of surgical treatment is the ramus stump dislocated out of the fossa. The relative indications include the stump of the mandibular ramus contacting the articular fossa, severe displacement or dislocation of the condylar neck and subcondylar fracture. The key points of successful operation include adequate exposure, anatomic reduction and stable fixation, protection of lateral pterygoid muscle attachment and articular cartilage, and reposition of the temporomandibular joint disc. For the condylar fracture combined with mandibular fracture, lingual fissure of the mandible should be closed during reduction and fixation for restoring the mandibular width and condylar position in the fossa. When the condylar fracture is combined with midface fracture, the condylar fracture and occlusal relationship should be restored first, and then the maxillary fracture should be fixed according to the lower dentition. The children under 6 years old have the stronge ability of condylar remodeling, so non-surgical treatment is commonly used. The healing and remodeling ability of condyle gradually decreases with age. The condyles of the teenagers over 12 years old are close to those of the adults, so the indications of surgical treatment for condyle fracture refer to the adults.

Key words: mandibular condyle, mandibular fracture, diagnosis, treatment

CLC Number:

R782.2

HE Dongmei, YANG Chi. Diagnosis and treatment protocol of mandibular condylar fracture: experience from the TMJ Center of Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022, 42(6): 695-701.

Figures/Tables 4

Fig 1 Absolute indication of condylar fracture surgery: ramus stump laterally dislocated out of the fossa

Fig 2 One of the relative indications of condylar fracture surgery: the ramus stump contacting with the fossa

Fig 3 Schematic diagrams of fixation of intracapsular condylar fractures

Fig 4 Schematic diagrams of fixation of stress and tension bands in low condylar fractures

TrendMD

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