This study aims to evaluate incidence, patterns and epidemiology of mandibular condylar fractures (MCF) to propose a treatment strategy for managing MCF and analyze the factors which influence the outcome. One hundred and seventy-five MCF's were evaluated over a four year period and their pattern was recorded in terms of displacement, level of fracture, age of incidence and dental occlusion. Of the 2,718 facial bone fractures, MCF incidence was the third most common at 18.39 %. Of 175 MCF 58.8 % were unilateral and 41.12 % were bilateral. 67 % of bilateral fractures and 43.8 % of unilateral fractures were associated with midline symphysis and contralateral parasymphysis fractures respectively. Most of the MCF was seen in the age group of above 16 years and 50 % of them were at subcondylar level (below the neck of the condyle). Majority of MCF sustained due to inter personal violence were undisplaced (72.7 %) and contrary to this majority of MCF sustained during road traffic accident were displaced. 62.9 % of total fractures required open reduction and rigid fixation and 37.1 % were managed with closed reduction. 80 % of MCF managed with closed reduction were in the age group of below 16 years. From this study it can be concluded that the treatment algorithm proposed for managing MCF is reliable and easy to adopt. We observed that absolute indication for open reduction of MCF is inability to achieve satisfactory occlusion by closed method and absolute contraindication for open reduction is condylar head fracture irrespective of the age of the patient.
Traditionally, for correction of dentofacial deformities “orthodontics first” protocol has been universally adopted wherein the surgery is performed after the goals of the presurgical orthodontics have been achieved. The advantages of orthodontics first approach like preoperative leveling of arches and establishing overjet and overbite relationship by decompensation will help in accurate spatial positioning of maxillomandibular complex during surgery. However, prolonged treatment time and initial worsening of the deformity during decompensation has always been its shortcoming.The concept of “Surgery First Orthognathic Approach (SFOA)” challenges the traditional protocol by overcoming its principal disadvantages. In SFOA, the Orthognathic surgery is performed before any orthodontics is initiated and this will help in shortening the overall treatment time, thereby increasing the patient’s compliance and acceptance towards the treatment in a better way. This chapter is intended to apprise on the details of planning, indications, contraindications, advantages and technical considerations of SFOA and also throws light on the recent advances pertaining to SFOA.
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