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Current Concepts in the Mandibular Condyle Fracture Management Part I: Overview of Condylar Fracture

Choi KY, Yang JD, Chung HY, Cho BC - Arch Plast Surg (2012)

Bottom Line: 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.

Affiliation: Department of Plastic and Reconstructive Surgery, Kyungpook National University School of Medicine, Daegu, Korea.

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.

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.
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Figure 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.

Mentions: The mandible, which is the hardest monostotic bone among facial bones, is a U-shaped long bone (Fig. 1). It consists of areas with and without teeth, and binds to the bilateral temporal bones at the left and right TMJ. At the early stage of development, it develops laterally and fuses at the midline 1 to 2 years after birth, forming a complete structure like the maxilla. Name of each area has some variation depending on the literatures. However, the most clinically useful classification of each area divides the mandible into the symphysis and parasymphysis, body, angle and ramus, condylar process, coronoid process, and alveolar process. The symphysis and parasymphysis refers to an area between both canine. The body refers to an area from the canine to the second molar. The angle and ramus refers to the area next to third molar except for the coronoid and condylar process. The mandibular condyle consists of the condylar process and head of the mandible. The condylar process and head subunit refers to a superior area of the extension line connecting the masseteric tuberosity from the deepest area of the sigmoid notch. The condylar process and head subunit consists of the head, neck, and subcondylar area. These are three height level lines that divide the subunit, and define the boundary. The three height level lines consist of an extension line that is parallel to the posterior border of the mandible, an extension line that parallelly heads for the perpendicular from the deepest area of the sigmoid notch, and an extension line that is inferior to the condylar head lateral pole. The condylar head refers to an area that is superior to the extension line that is inferior to the condylar head lateral pole. The condylar neck refers to an area between the extension line that is inferior to the condylar head lateral pole and the extension line that parallelly heads for the perpendicular from the deepest area of the sigmoid notch. The subcondylar area refers to an area that is inferior to the extension line that parallelly heads for the perpendicular from the deepest area of the sigmoid notch. Meanwhile, the condylar neck is divided into the high level and low level, and the reference line dividing them is an extension line that is positioned in the middle of the sigmoid notch line and the lateral pole line of the head (Fig. 1).

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Current Concepts in the Mandibular Condyle Fracture Management Part I: Overview of Condylar Fracture

Choi KY, Yang JD, Chung HY, Cho BC - Arch Plast Surg (2012)

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.
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Figure 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.
Mentions: The mandible, which is the hardest monostotic bone among facial bones, is a U-shaped long bone (Fig. 1). It consists of areas with and without teeth, and binds to the bilateral temporal bones at the left and right TMJ. At the early stage of development, it develops laterally and fuses at the midline 1 to 2 years after birth, forming a complete structure like the maxilla. Name of each area has some variation depending on the literatures. However, the most clinically useful classification of each area divides the mandible into the symphysis and parasymphysis, body, angle and ramus, condylar process, coronoid process, and alveolar process. The symphysis and parasymphysis refers to an area between both canine. The body refers to an area from the canine to the second molar. The angle and ramus refers to the area next to third molar except for the coronoid and condylar process. The mandibular condyle consists of the condylar process and head of the mandible. The condylar process and head subunit refers to a superior area of the extension line connecting the masseteric tuberosity from the deepest area of the sigmoid notch. The condylar process and head subunit consists of the head, neck, and subcondylar area. These are three height level lines that divide the subunit, and define the boundary. The three height level lines consist of an extension line that is parallel to the posterior border of the mandible, an extension line that parallelly heads for the perpendicular from the deepest area of the sigmoid notch, and an extension line that is inferior to the condylar head lateral pole. The condylar head refers to an area that is superior to the extension line that is inferior to the condylar head lateral pole. The condylar neck refers to an area between the extension line that is inferior to the condylar head lateral pole and the extension line that parallelly heads for the perpendicular from the deepest area of the sigmoid notch. The subcondylar area refers to an area that is inferior to the extension line that parallelly heads for the perpendicular from the deepest area of the sigmoid notch. Meanwhile, the condylar neck is divided into the high level and low level, and the reference line dividing them is an extension line that is positioned in the middle of the sigmoid notch line and the lateral pole line of the head (Fig. 1).

Bottom Line: 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.

Affiliation: Department of Plastic and Reconstructive Surgery, Kyungpook National University School of Medicine, Daegu, Korea.

ABSTRACT

Background: 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.

View Similar Images In: Results  - Collection
View Article: Pubmed Central -  PubMed
Show All Figures - Show MeSH
getmorefigures.php?pmc=3408272&rFormat=json&query=null&req=5