A 19 y.o. woman falls forward on to her chin; she has a 1 cm lower lip laceration and severe L ear pain

what do you see?

Hint the ear pain is her major complaint

Hint the ear pain is her major complaint

Our patient had a fracture of the condylar head of the mandible which was dislocated from the glenoid fossa into the sigmoid notch. Mandibular fractures are a common result of facial trauma with 19-52% involving the condyle. The condyle can fracture into the external auditory canal as happened in this case.

condylar fracture on the L

condylar fracture on the L

In adults the repair of condylar fractures often involves closed reduction and intermaxillary fixation with arch bars for six weeks.  Surgery is complicated and not only risks damage to the facial nerve but prolonged jaw immobilization can result in muscle atrophy.   In children these are managed without surgery and often in novel ways.  The Kirschner wire is a threaded wire that can applied percutaneously into the displaced fragment and it is pulled into alignment.

intermaxillary fixation.JPG

Intermaxillary fixation is maintained for six weeks. The picture below shows how a Kirschner wire is used to align the displaced condylar fracture.

condylar fr kursh wire.JPG

Our patient had near normal occlusion .  It was thought that reduction of the fracture could not be maintained  with a plate because there was not enough bone on the proximal fragment and she  did not want to pursue maxillomandibular fixation. The complication of ankylosis (fusion of the joint with inability to move the jaw) was addressed by physical therapy

Valiati R, Ibrahim D, Abreu M, et al. The treatment of condylar fractures: to open or not to open? A critical review of theis controversy.  Int J Med Sci 2008;5(6): 313-316.  

Choi K, Yang J, Chung H, Cho B. Current concepts in the mandibular condyle fracture management Part II: open reduction versus closed reduction. Arch Plast Surg 2012. 39(4);

Kim J, Nam H, closed reductionof displaced or dislocated mandibular condyle fractures in children using threaded Kirschner wire and external rubber traction. 2015 Oral & Maxillofac Surg . 44:1255-59.

anatomy of the jaw

anatomy of the jaw