Fractures of Temporo mandibular joint (TMJ)
What are the fractures involving the Temporomandibular joint?
Fractures involving the mandibular condyle are the most difficult to treat because the condyle is most close to temporomandibular joint (TMJ).
How is the temporomandibular joint different from other joints?
TMJ is one of the most complex joints in the body. It involves both sliding and rotational movements. Also condylar part of the mandible has muscle attachments with the skull. Fractures involving condyle are likely to be displaced in an unfavorable manner due to these muscle attachments.
Why is treatment difficult in the TMJ fractures?
Surgical treatment in this area is also difficult because of the possibility of complications like damage to the facial nerve. Fractures proximal to the Temporomandibular joint are treated conservatively more often. Fractures involving the condylar neck and the subcondylar region are treated with open reduction and internal fixation. The reduced access available for this area during open reduction is also one of the reasons for difficulties in treatment.
What are the various methods of treatment for these fractures?
Conservative methods of treating mandibular condyle fractures include arch bar fixation, maxillomandibular fixation (MMF) and/or elastics. Open reduction involves surgically exposing the site of the fracture, followed by reduction and fixation with plates & screws.
What are the conservative methods of treatment for condylar fractures?
The upper and lower jaws are tied together with the help of stainless steel wires and arch bars. This is known as maxillomandibular fixation. This immobilization helps in healing of the fractured TMJ. This fixation is held in place for a minimum of 3 weeks. During this period of MMF, the patients are advised to take liquid diet only.
What are the various precautions that are to be followed by these patients?
Patients are encouraged to do mouth opening exercises after a stipulated time. This is done to prevent stiffness of the joint and decreased mouth opening. The chances of decreased mouth opening and TMJ ankylosis (fusion of the mandibular condyle to the skull) are more pronounced in cases treated by conservative methods.
The upper and lower jaws are tied together with the help of stainless steel wires and arch bars
Why is an open reduction of subcondylar fractures preferred?
The fractures involving the subcondylar area of the mandible are more likely to cause deformities like shortening of the lower jaw on one side and discrepancies in occlusion (the way the upper and lower teeth meet together during functional activities). The surgical method used for these types of fractures has a lesser incidence of complications (retromandibular approach).
What are the advantages of open reduction in the treatment of condylar fractures?
Another advantage of an open reduction in these patients is the lack of need for maxillomandibular fixation. Thus the patients can return early to their work and functional form is achieved early. Also, the need for patients to remain on the liquid diet is eliminated and nutrition need not be compromised, thus promoting a speedy recovery.