Condylar Fractures in Car Crashes

Mandibular condylar fractures are common among mandibular fractures and tend to occur when forces from a fall, bicycle accident or car crashes are placed upon the mandible and pushed upward toward the ball and socket joint in the jaw, of which the condyle is the ball part of the joint. A condylar fracture shows up as pain in the side of the face, an abnormal bite and an inability to properly open and close the jaw. Because of the importance of this joint, it is vitally important to fix the condylar fracture in order to have a return of proper mastication.

A fracture of only one condyle is three times more common than a fracture of both condyles. Condylar fractures can come in any age group but is more common in children after falls off a bicycle or playground. This type of fracture can also happen in ATV accidents and auto accidents. Hitting the jaw on the tip transmits the force backwards and upwards toward the condyle which then breaks.

Fractures of the condyle can be overlooked because of the presence of other injuries. If the fracture is not dislocated, it can be missed on a plain film x-ray so that CT scan of the head and face needs to be done if there is a high index of suspicion of condylar fractures. Doctors also take a careful look at dental occlusion to see if there is a possibility of a fracture of the mandible or maxillary bone. The area in front of the ear, the preauricular area, will be tender, swollen and possibly bruised.

The repair of the condylar fracture is done by an oral and maxillofacial surgeon. The treatment plan depends on what kind of fracture is involved, the age of the patient and the dislocation of the condyle. Simple intracapsular condylar fractures can be treated with regular physical therapy. Later complications involve degenerative arthritis of the joint. The patient often needs arch bars and elastics to keep the bite normal while the exercises are being done and before healing takes place. Children recover faster and better than older adults. Even though this is a minor fracture, failure to properly heal it will lead to chronic pain and possible mandibular malunion. Later surgery might be necessary.

Fractures of the subcondylar region usually can be treated with closed reduction and wiring of the jaw region. Aggressive physical therapy is necessary to keep the alignment of the jaw normal. Kids can get away with non-operative management of their fracture but adults usually need some kind of surgical intervention. Doctors must be very careful to put the condyle back in its normal physiological position or it will heal wrong and the bite will be permanently off. This is followed by rigid fixation to keep the subcondylar fracture in its right position. Closed fractures almost never result in a nonunion of the fracture.
Open therapy is preferred in adults and in cases of severe dislocation and displacement of the fracture. If the fracture is dislocated into the ear canal or middle cranial fossa, if there is extracapsular displacement, if occlusion is difficult or if there is an open fracture, open surgery must be done to put the fracture fragments together and to use hardware to keep the fracture sealed.

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