TMJ (Jaw)
Mandibular Condylar Fracture
하악과두 골절
Traumatic fracture of condyle or condylar neck
- How common
- 25–35% of mandibular fractures
- Typical age
- All ages, young male predominant
What is it?
Force from chin/lateral impact transmits through mandible to fracture the condylar neck or head — indirect injury most common.
Commonly affected: Condylar head (intracapsular), neck, or subcondylar
How it develops
- Chin/Lateral ImpactFall, MVA, assault
- Force TransmissionForce transmitted to condyle
- Condylar FractureIntracapsular, neck, or subcondylar fracture
- Displacement/MalocclusionLateral pterygoid pulls fragment anteromedially, causing malocclusion
Symptoms
- Preauricular painSevere pain at affected TMJ
- Limited openingPain and mechanical limitation
- MalocclusionIpsilateral posterior open bite, jaw deviation
- Preauricular swelling/hematomaSwelling on affected side
- EAC laceration/bleedingCondyle may lacerate anterior EAC wall
How it is examined
- Deviation to injured sideOpens deviating toward fracture side
- Ipsilateral posterior open biteCannot bite on posterior teeth on fractured side
- Joint tendernessMarked tenderness, swelling, hematoma
- EAC examinationCheck for EAC bleeding/tear
Imaging
Panoramic + reverse Towne views; CT is standard.
- Fracture line at condylar neck
- Fragment displacement/shortening
- Anteromedial condylar deviation
- Possible other mandibular fractures
MRI for soft tissue/disc injury (CT for emergency).
- Joint effusion
- Possible disc displacement
- Capsular injury
Non-surgical care
- Soft diet/observationNon/minimally displaced fractures
- Intermaxillary fixation (IMF)2–4 weeks of IMF to maintain occlusion
- Early functional therapyEarly mobilization in children/undisplaced fractures
- Analgesics/NSAIDsPain control
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Significant displacement (>30°), ramus shortening (>4 mm), uncorrectable malocclusion, foreign body
Procedures that may be discussed
- Open reduction internal fixation (ORIF)
- Endoscopic-assisted ORIF
- Total joint replacement (ankylosis)
Outlook
Good outcomes with appropriate treatment; children risk growth disturbance/ankylosis.