Brig waseem closed versus open managemnt of condylar fractures
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Transcript of Brig waseem closed versus open managemnt of condylar fractures
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OPEN VS CLOSE REDUCTION OF MANDIBULAR CONDYLER FRACTURES
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BY Brig Waseem Ahmed AFID
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GOALS OF TREATMENT
Functional Goal:Reestablishment of preoperative function of
masticatory system
Anatomical Goal:Reestablishment of preoperative occlusion and
facial symmetry
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VARIABLES INFLUENSING THE SELECTION OF TREATMENTLevel of #Degree of displacement of Proximal SegStatus of dentitionConcomitant injuries AgeMedical status
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TREATMENT OPTIONSBroadly divided into:
Conservative (Non-surgical)
Open (Surgical)
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WHAT IS CONSERVATIVE MANAGEMENTMay be as simple as observation and soft diet
Or
variable periods of immobilization
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SIMPLE OBSERVATIONOnly responsible patients committed to period of close
follow up to be considered
Strict soft diet and medication.
Be on guard: first signs of occlusal instability, deviation
with pain or increasing paan
An immediate clinical and radiographic reevaluation has
out has to be carried out.
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INDICATIONS OFCONSERVATIVE MANEGMENTMinimal condyler displacementEasily achievable occlusionMinimum painAcceptable range of mand movementsDifficult repositiong of prox segmentFracture of Condyler head / Neck
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IMMOBILIZATION If some degree of malocclusion, deviation with opening or
pain
IMF with any means
: Eyelet wiring, arch bars, splints
Depends on confounding factors: age, level of fracture, degree of displacement, additional fractures etc
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HIGH CONDYLER #
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HIGH LEVEL FRACTURE
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COMPLICATIOS OF CLOSE REDUCTIONChronic painGreater percentage of malocclusionMean shortening of Post Facial height (2-5
mm or 5%).Diagnosed asAnatomical shortening
Superiorly displayed Gonion.Functional shortening
ipsilateral persistent occlusal prematurity Inability to achieve contra lateral occlucion Asymmetry
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WHAT IS SURGICAL MANAGEMENT Open reduction & Internal fixation
(ORIF)
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INDICATIONS OF OPEN REDUCTION ABSOLUTE
When occlusion by close reduction is not achievable
Condyler dislocation Lateral extra cap displacementDisplacement Into middle cranial fossa.Foreign body in joint cap.
RELATIVEBilateral cond # in edentulous Pts.Bilateral cond # with mid face #sIF IMF not possible- Medically comp Pts.
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ADVATAGES OF OPEN REDUCTION Posterior Facial height is maintainedGreater & early functional improvements
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COMPLICATIONS OF OPEN TREATMENTDifficult surgical accessUnsightly Hypertrophic scarFacial nerve deficitInfection, malunionMalocclusionAvascular cond necrosisLonger procedure / Expertise /Facilities
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OPEN vs CLOSE REDUCTION Location of fracture and degree of
displacement primarily determines selection of approach
Functional improvement by open method is greater than with closed
Open treatment is associated with perceptible scar but early mobility and less pain.
Closed treatment is associated with higher percentage of malocclusion and chronic pain
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REVIEW OF LITERATUREThere is no strong correlation between
radiographic finding and choice of treatmentIdeal management of condylar fractures is
still controversial . Considering different variables various
treatment options are considered adequateFocus on SIGNS & SYMPTOMS rather than
on condyler # itself.
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CONCLUSION A careful assessment of the literature and
experiences of surgeons indicates that there is no significant difference between surgical and non surgical treatment modalities.
Acceptable outcomes have been achieved with both techniques. Assessment of factors peculiar to the individual case must be made to determine the mode of therapy most likely to produce a favorable outcome.
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