FRACTURES OF THE MANDIBULAR CONDYLES

If possible, refer the patient, because ankylosis and deviation of his jaw may follow unsuccessful treatment. If you cannot refer him, proceed as follows.

FRACTURES WITH A NORMAL BITE

All unilateral fractures have a normal bite (if there is no other associated fracture) and so do some bilateral ones.

Encourage the patient to move his jaw. Deviation of his mandible towards the injured side is usually due to muscle spasm, and soon improves, so that his bite becomes normal. Observe him to make sure that it does so.

CAUTION! If you decide to immobilize his jaw because of pain, don’t do so for more than 10 days, or he may later have so little movement that he will be unable to open his mouth normally.

FRACTURES WITH AN ANTERIOR OPEN BITE

All these patients have bilateral fractures, or fracture dislocations.

If the fragments are not impacted, you may be able to splint them using interdental wiring. If the patient has few teeth, you may need to use an arch bar.

If the fragments are impacted, splint his jaws so as to distract the ramus in the condylar region. Take an ordinary rubber. Cut two pieces from it 6 mm thick, and put them between his molar teeth on both sides. Then use adhesive tape traction or interdental wiring to make his incisors meet, as in treating an old dislocation (62.6). Maintain this splinting for 5 weeks.

DIFFICULTIES WITH FRACTURES OF THE MANDIBULAR CONDYLES

If the patient Is a CHILD, no treatment is needed initially. But follow him up carefully, because the growth of his mandible may be arrested.

If a patient’s BITE DOES NOT IMPROVE, refer him to a dentist. If serious malunion occurs condylectomy may be necessary.

FRACTURES OF THE CONDYLES ARE OFTEN MISSED