Traumatic Injury of the Condyloid Process of the Mandible

Abstract

Abstract Traumatic injury of the condyloid process frequently results from minor trauma, such as occurs from application of undue force when extracting teeth, or from careless use of the mouth gag under general anesthesia. This often causes an injury involving the joint, capsule or the meniscus, or both, and produces a weakness of the joint that may be associated with an audible noise when eating. More severe injury may produce dislocation of the mandibular joint. Forward, backward, and upward dislocations are distinguished. Diagnosis is made by clinical signs and x-ray examination. In forward dislocations the treatment is reduction, often under general anesthesia, to effect complete relaxation of the muscles, and the application of an appliance to limit motion for a few weeks. In case of backward and upward dislocations a rubber plate inserted over the teeth may be used to keep the condyle out of the joint fossa until the tissues have been restored to normal. Fractures of the condyle occur more frequently than statistics indicate. In case of multiple fractures a collum fracture of the mandible may be easily overlooked. Careful x-ray examination from various positions is necessary for a complete diagnosis, as this fracture often is associated with forward, medial, or lateral displacement of the neck of the condyle, or with medial or lateral dislocation of the head of the condyle. The fracture can generally be reduced by manipulation under ether, after which intermaxillary ligation or the use of a splint is employed to immobilize the jaw. If there is marked displacement of the neck, or in cases of dislocation of the head of the condyle, open reduction may have to be resorted to in order to avoid malocclusion and associated masticatory difficulties. This is effected through an incision along the lower border of the zygomatic arch. The condyle can be pulled into position with a hook while the ramus is pressed down by an assistant. In cases of traumatic destruction of the joint, or in untreated cases which have become ankylosed, osteoarthrotomy may be indicated.