A new non-surgical technique for management of high condylar neck fractures

Background

A closed reduction technique is described, which offers an alternative to arch bars and avoids dental impressions.

Technique

A closed reduction technique for a condylar fracture (Fig 1) may be carried out using orthodontic brackets, stainless steel archwires and elastics. A rigid 0.018” stainless steel archwire is customised to the upper and lower dental arches at the chairside. The archwire is used as a guide to bracket placement. Wire bends are placed as required to ensure the archwire lies passively against the teeth. Self-ligating brackets for molar teeth are used, thereby allowing passive placement of the archwire. Kobayashi hooks are placed around the premolar teeth to allow immediate placement of intermaxillary elastics (Fig 2). The patient should be instructed to wear elastics full time for one week to correct any mandibular displacement and to gradually reduce elastic wear over a six-week period.

Figure 1.

Dental panoramic tomography showing left condylar neck and coronoid fracture

Figure 2.

Orthodontic appliance with immediately placed stainless steel archwires contoured to the labial aspects of the teeth and resting passively, allowing immediate placement of intermaxillary elastics

Discussion

This type of fracture would commonly be treated with placement of arch bars, perhaps requiring general anaesthesia. However, limited mouth opening and discomfort can make impressions and arch bar placement difficult. Direct bonding of brackets and immediate placement of stainless steel archwires and intermaxillary elastics avoids the need for general anaesthesia and dental impressions. As opposed to initial placement of brackets on selected teeth and risking overeruption when placing intermaxillary elastics,¹ this technique involves immediate placement of stainless steel archwires contoured to the labial aspects of the teeth, resting passively and not causing unwanted tooth movement. Immediate intermaxillary elastics are used to hold the patient’s malocclusion in a non-displaced position and permit uneventful healing.