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absolute indications for open treatment of subcondylar fract

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tirath's picture
Joined: 31 Oct 2009

absolute indications for open treatment of subcondylar fractures are as follows:

Dislocation into the middle cranial fossa or external auditory canal
Lateral extracapsular displacement
Inability to obtain adequate occlusion
Open joint wound with foreign body or gross contamination
Few authorities would argue with any of these ideas. Note that the second criterion is lateral extracapsular displacement and not just mild lateral displacement. The relative indications listed by Kent and Zide are as follows:

Bilateral subcondylar fractures in a patient who has no dentition and where a splint is unavailable or when splinting is impossible because of alveolar ridge atrophy
Bilateral or unilateral subcondylar fractures when splinting is not recommended for medical reasons or where adequate physiotherapy is impossible
Bilateral condylar fractures associated with comminuted midfacial fractures
Bilateral subcondylar fractures with associated gnathologic problems, such as (1) retrognathia or prognathism, 2 )open bite with periodontal problems or lack of posterior support, (3) loss of multiple teeth and later need for elaborate reconstruction, (4) bilateral condylar fractures with unstable occlusion due to orthodontics, and (5) unilateral condylar fracture with unstable fracture base

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