Current concepts in the mandibular condyle fracture management part I: overview of condylar fracture

Abstract

The incidence of condylar fractures is high, but the management of fractures of the mandibular condyle continues to be controversial. Historically, maxillomandibular fixation, external fixation, and surgical splints with internal fixation systems were the techniques commonly used in the treatment of the fractured mandible. Condylar fractures can be extracapsular or intracapsular, undisplaced, deviated, displaced, or dislocated. Treatment depends on the age of the patient, the co-existence of other mandibular or maxillary fractures, whether the condylar fracture is unilateral or bilateral, the level and displacement of the fracture, the state of dentition and dental occlusion, and the surgeonnds on the age of the patient, the co-existence of othefrom which it is difficult to recover aesthetically and functionally;an appropriate treatment is required to reconstruct the shape and achieve the function ofthe uninjured status. To do this, accurate diagnosis, appropriate reduction and rigid fixation, and complication prevention are required. In particular, as mandibular condyle fracture may cause long-term complications such as malocclusion, particularly open bite, reduced posterior facial height, and facial asymmetry in addition to chronic pain and mobility limitation, great caution should be taken. Accordingly, the authors review a general overview of condyle fracture.

Keywords: Mandibular condyle; Mandibular fractures; Temporomandibular joint.

Fig. 1

The anatomy of mandibular area (A) Anterior view of mandible. (B) The subregions of the condylar process. The mandible is composed body, angle, ramus, symphysis and parasymphysis, condylar process, coronoid process. The condylar process and head is a subunit of the mandible and is defined by an oblique line running backward from the sigmoid notch to the upper masseteric tuberosity.

Fig. 2

The anatomy of temporo-mandibular joint (A) TMJ state at mouth closing (B) TMJ state at mouth opening. The TMJ is a hinged synovial joint, and is an articulation of the head of the mandible with the mandibular fossa and articular tubercle of the temporal bone. There are 2 movements which occur in the TMJ. First, the head of the mandible rotates anteriorly, secondly, the head of the mandible glides anteriorly as it continues to rotate anteriorly. TMJ, temporomandibular joint.

Fig. 3

The ideal condyle position state From Celenza and Nasedkin, with permission from Quintessence books [3].

Fig. 4

The sequence of functional occlusion (A) Centric occlusion. (B) Anterior guidance. (C) Canine guidance.

Fig. 5

Movement of the mandibular condyle (A) Rotation movement of the condyle. (B) Translation movement of the condyle.

Fig. 6

Movement of the mandibular condyle (A) Axial view of the mandibular movement. Antero-lateral condylar movement. (B) Axial view of the mandibular movement. Lateral condylar movement. (C) Coronal view of the mandibular movement.

Fig. 7

The classification of mandibular condyle fracture according to Lindahl classification (A) The degree of fracture fragment. (B) Two type of the displacement of condyle proximal segment.

Fig. 8

A 21-year-old woman with iatrogenic condyle fracture during facial bone contouring surgery (A) Preoperative 3D head computed tomography (CT). Anterior open bite was observed. The non-union or malunion will be possible. (B) Postoperative 3D head CT. The iatrogenic subcondylar fracture was corrected by open reduction and internal fixation immediately. Anterior open bite was corrected.

Fig. 9

A 24-year-old woman with iatrogenic condyle fracture during orthognatic surgery Open reduction and internal fixation was done. (A) Axial view of 3D head computed tomography (CT). (B) Panorama plain film. 3D head CT and panorama was checked at postoperative 7 weeks. The distal fracture segment was displaced medially and bone gap was checked 1.84 mm. In this case, the non-union or malunion will be occurred.

Fig. 10

An 18-year-old man with mandibular ankylosis at right side due to previous facial trauma Inappropriate bony reduction was done at immediate trauma and the ankylosis of mandible was developed. (A) Preoperative gross photo. (B) Preoperative 3D head computed tomography (CT). (C) Preoperative panorama plain film. (D) The intraoperative mouth opening was checked 45 mm. (E) The intraoperative grossphoto was taken. (F) Immediate postoperative gross photo. (G) Postoperative gross photo at 5 months. (H) Postoperative 3D head CT. (I) Postoperative Panorama plain film.