J Oral Maxillofac
Surg
50:1032-1037.1992
Different Patterns of Condylar Fractures: An Analysis of 382 Patients in a 3-Year Period URPO SILVENNOINEN, DDS,* TATEYUKI IIZUKA, MD, DDS, PHD,t CHRISTIAN LINDQVIST, MD, DDS, PHD,+ AND KY&T1 OIKARINEN, DDS, PHD$ Three hundred eighty-two patients with 443 condylar fractures, accounting for 52.4% of all mandibular fractures, were given diagnoses and treated in our department between 1987 and 1989. A high proportion of the fractures (44%) were caused by interpersonal violence, followed in incidence by falls (29%) and road traffic accidents (21%). The type of condylar fracture seems to be influenced directly by its cause. Severe fractures in which the condyle was dislocated out of the glenoid fossa resulted more often from falls (22%) and road traffic accidents (26%) than from violence (8%). Fractures caused by violence showed a uniform type characterized by a subcondylar location and nondisplacement or deviation at the fracture line. A relatively large number of patients (56,15%) were considered to have an indication for open reduction of the fracture.
however, cause occlusal disturbances that, in turn, may result in late complications, such as dysfunction of the temporomandibular joint (TMJ) and/or condylar deformity.4-9 Although a large number of studies on the etiology of mandibular fractures have been published, detailed statistics concerning only condylar fractures are seldom presented. lo Therefore, we chose to restrict our study to trauma patients with different unilateral and bilateral condylar fractures. The aim of the study was to determine the frequency and characteristics of these fractures. The need for open reduction was also evaluated.
The condylar region is one of the most common sites of mandibular fractures.‘” However, condylar fractures differ from other mandibular fractures in several respects. The fracture is usually caused indirectly by a force acting primarily on the mandibular body or symphysis rather than by a direct force. Whereas fractures in the toothbearing horizontal part are usually reducible by maxillomandibular fixation (MMF), condylar displacements can seldom be properly repositioned by such means. Moreover, open reduction of a fracture in this region is often difficult. Thus, condylar fractures are usually treated conservatively by shortterm MMF. Displacement of the fractured condyle can,
Patients and Methods * Formerly, Oral Surgeon, Department of Oral and Maxillofacial Since 1987, all diagnoses made at Helsinki University Central Hospital have been stored on a computer. All patient files coded for a mandibular fracture (8022A) during the period 1987 to 1989 were reevaluated. Seven hundred twenty-nine patients (mean age, 3 1.O years; male: female ratio, 3.3: 1) with mandibular fractures were given diagnoses and treated during the study period. Included in the study were 382 patients (52.4%) with 443 condylar fractures. The case histories of the patients were reviewed and information collected on sex, age, time and cause of the accident, type and location of the fractures, dental status, and the presence and location of associated fractures in the mandible.
Surgery, IV Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland; Assistant Lecturer, Department of Oral and Maxillofacial Surgery, Institute of Dentistry, University of Oulu, Oulu, Finland. j Senior Maxillofacial Surgeon, Department of Oral and Maxillofacial Surgery, IV Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland. $ Head, Department of Oral and Maxillofacial Surgery, IV Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland. 0 Senior Lecturer, Department of Oral and Maxillofacial Surgery, Institute of Dentistry, University of Oulu, Oulu, Finland. Address correspondence and reprint requests to Dr Silvennoinen: Institute of Dentistry, University of Oulu, Aapistie 3, SF-90220 Finland. 0 1992 American Association of Oral and Maxillofacial Surgeons 0278-2391/92/5010-0002$3.00/O
1032
1033
SILVENNOINEN ET AL
number of patients
140r
60-
I
120
121
I
102
60 100 1 SO;
60,
55
51 37
L
40,
number of patients
L
,;I,,
Surg
50:1032-1037.1992
Different Patterns of Condylar Fractures: An Analysis of 382 Patients in a 3-Year Period URPO SILVENNOINEN, DDS,* TATEYUKI IIZUKA, MD, DDS, PHD,t CHRISTIAN LINDQVIST, MD, DDS, PHD,+ AND KY&T1 OIKARINEN, DDS, PHD$ Three hundred eighty-two patients with 443 condylar fractures, accounting for 52.4% of all mandibular fractures, were given diagnoses and treated in our department between 1987 and 1989. A high proportion of the fractures (44%) were caused by interpersonal violence, followed in incidence by falls (29%) and road traffic accidents (21%). The type of condylar fracture seems to be influenced directly by its cause. Severe fractures in which the condyle was dislocated out of the glenoid fossa resulted more often from falls (22%) and road traffic accidents (26%) than from violence (8%). Fractures caused by violence showed a uniform type characterized by a subcondylar location and nondisplacement or deviation at the fracture line. A relatively large number of patients (56,15%) were considered to have an indication for open reduction of the fracture.
however, cause occlusal disturbances that, in turn, may result in late complications, such as dysfunction of the temporomandibular joint (TMJ) and/or condylar deformity.4-9 Although a large number of studies on the etiology of mandibular fractures have been published, detailed statistics concerning only condylar fractures are seldom presented. lo Therefore, we chose to restrict our study to trauma patients with different unilateral and bilateral condylar fractures. The aim of the study was to determine the frequency and characteristics of these fractures. The need for open reduction was also evaluated.
The condylar region is one of the most common sites of mandibular fractures.‘” However, condylar fractures differ from other mandibular fractures in several respects. The fracture is usually caused indirectly by a force acting primarily on the mandibular body or symphysis rather than by a direct force. Whereas fractures in the toothbearing horizontal part are usually reducible by maxillomandibular fixation (MMF), condylar displacements can seldom be properly repositioned by such means. Moreover, open reduction of a fracture in this region is often difficult. Thus, condylar fractures are usually treated conservatively by shortterm MMF. Displacement of the fractured condyle can,
Patients and Methods * Formerly, Oral Surgeon, Department of Oral and Maxillofacial Since 1987, all diagnoses made at Helsinki University Central Hospital have been stored on a computer. All patient files coded for a mandibular fracture (8022A) during the period 1987 to 1989 were reevaluated. Seven hundred twenty-nine patients (mean age, 3 1.O years; male: female ratio, 3.3: 1) with mandibular fractures were given diagnoses and treated during the study period. Included in the study were 382 patients (52.4%) with 443 condylar fractures. The case histories of the patients were reviewed and information collected on sex, age, time and cause of the accident, type and location of the fractures, dental status, and the presence and location of associated fractures in the mandible.
Surgery, IV Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland; Assistant Lecturer, Department of Oral and Maxillofacial Surgery, Institute of Dentistry, University of Oulu, Oulu, Finland. j Senior Maxillofacial Surgeon, Department of Oral and Maxillofacial Surgery, IV Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland. $ Head, Department of Oral and Maxillofacial Surgery, IV Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland. 0 Senior Lecturer, Department of Oral and Maxillofacial Surgery, Institute of Dentistry, University of Oulu, Oulu, Finland. Address correspondence and reprint requests to Dr Silvennoinen: Institute of Dentistry, University of Oulu, Aapistie 3, SF-90220 Finland. 0 1992 American Association of Oral and Maxillofacial Surgeons 0278-2391/92/5010-0002$3.00/O
1032
1033
SILVENNOINEN ET AL
number of patients
140r
60-
I
120
121
I
102
60 100 1 SO;
60,
55
51 37
L
40,
number of patients
L
,;I,,
