OPTION 2

Clinical features of unilateral Subcondylar fractures

•            Swelling and tenderness over the affected preauricular area.

•            Haemorrhage from ear on that side results from laceration of the anterior wall of the external auditory meatus. It is important to distinguish bleeding originating in the external auditory canal from the middle ear haemorrhage.

•            The latter signifies a fracture of the petrous temporal bone.

•            Ecchymosis of the skin just below the mastoid process on the same side.

•            This particular physical sign also occurs with fractures of the base of the skull

when it is known as ‘Battle’s sign’.

•            If the condylar head is dislocated medially, a characteristic hollow over the region of the condylar head may occur.

•            On opening the mouth, mandible deviates towards the side of the fracture.

 

 

•            Occlusion: Unilateral posterior crossbite or contralateral open bite (gagging of the occlusion on the ipsilateral molar teeth) and retrognathic occlusion may also be associated. Displacement of the condyle from the fossa or overriding of the fractured condylar neck shortens the ramus on that side producing the malocclusion.

•            Painful limitation of protrusion and lateral excursion to the opposite side.

•            Palpation (preauricular or intra-aural) reveals reduced or no palpable condylar movement on ipsilateral side in comparison to contralateral.

•            Cerebrospinal fluid (CSF) otorrhoea involving condylar fracture in association with middle cranial fossa.

 

 

Clinical features of bilateral Subcondylar fractures

 

•            The signs and symptoms for unilateral fracture may be present on both sides.

•            Swelling over both fracture sites.

•            Overall mandibular movement is usually more restricted than in unilateral fracture.

•            If there is displacement of the condyles from the glenoid fossa or overriding of the fractured bone ends, an anterior open bite is classically present.

•            Pain and limitation of opening and restricted protrusion and lateral excursions.

•            The appearance of an elongated face may be the result of bilateral subcondylar fracture.

•            Bilateral condylar fractures are frequently associated with fracture of the symphysis or parasymphysis.

 

 

Key Concept:

CLINICAL FEATURES OF SUBCONDYLAR FRACTURES

•            Contusion, abrasions, laceration of chin, ecchymosis and hematoma in the temporomandibular joint region.

•            Laceration or bleeding of external auditory canal.

•            Swelling over TMJ – secondary to hematoma, edema, in indicating laterally dislocated condylar head.

•            Facial asymmetry – secondary to foreshortening of mandibular ramus.

•            Pain and tenderness spontaneously or in response to pressure.

•            Deviation of mandibular midline towards the fracture side.

•            Mandibular dislocation, open bite