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International Poster Journal of Dentistry and Oral Medicine
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Int Poster J Dent Oral Med 4 (2002), No. 2     15. June 2002

Int Poster J Dent Oral Med 2002, Vol 4 No 2, Poster 123

Treatment of condylar neck fracture by Otten's minihooks

Language: English

Authors: Dr.Dr. Sirichai Kiattavorncharoen1, PD.Dr.Dr.Johannes Kleinheinz2, Prof.Dr.Dr.Dr. hc Ulrich Joos2
1Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Thailand
2Department of Cranio- and Maxillofacial Surgery, University of Muenster, Germany

Date/Event/Venue: 
18-23 January 1998
20th Asia Pacific Dental Congress
Bangkok, Thailand

 

Introduction

Nowadays there are two different concepts of the treatment of condylar neck fracture. They are conservative and surgical treatment. The conservative treatments have traditionally been treated by maxillomandibular fixation. One technique for conservative treatment using Otten's minihooks is described. This technique has been described by J-E Otten 1981. 


Materials

  1. Otten's minihook is a S-shaped 0.8 mm wire hook.
  2. Osteosynthesis minihooks (Diameter 2 mm.)

Fig. 1 Otten's minihooks and osteosynthesis miniscrews 

Technique

  1. Local anesthesia
  2. Vertical incision oral mucosa in area of nasal spine and symphysis of mandible.
  3. Exposing the bone.
  4. Drilling the bone with drill 1.5 mm
  5. Fixing Otten's minihooks with 2 mm osteosynthesis miniscrews, which inserted into the nasal spine and the symphyseal region of mandible.
  6. Suture the wounds
  7. Insert maxillary splint
  8. Intermaxillary fixation with elastics or wire
  9. After the 10 days of intermaxillary fixation, the Otten's minihooks and osteosynthesis microscrews are removed under local anesthesia.
  10. Active functional treatment

Fig. 2 Maxillary splint 

Fig. 3 Intermaxillary fixation with elastics and wire over Otten's minihooks and maxillary splint. 

 
Fig. 4 X-ray OP postoperative 

Fig. 5 Splint with hypomochlion 

Indications

  1. High condylar neck fractures without dislocation
  2. Intracapsular condylar fractures
  3. Condylar neck fracture in children (<16 years)

In case of condylar neck fracture with mild dislocation, if the establishment of correct relationships does not bring about the correct position of the displaced condylar fragment, one can make use of the indirect action of reducing forces by insertion of a fulcrum (Hypomochlion) in the molar region of maxillary splint on the fracture site and by means of intermaxillary traction in the incisor region.  

Fig. 6 Maxillary splint with hypomochlion in place intraorally 

Fig. 7 X-ray OP in case of condylar neck fracture with mild dislocation 

 
Fig. 8 X-ray OP postoperative with hypomochlion in place 

Fig. 9 X-ray lateral view with hypomochlion in place 

Summary

The technique for conservation treatment of condylar neck fracture by Otten's minihooks is simple and appears to be a time-saving method. It is also easy to maintain proper oral hygiene and can be performed under local anesthesia. 


References

  1. Otten JE. Modifizierte Methode zur intermaxillaren Immobilisation. Dtsch Zahn Arztl Z 1981;36:91-2.
  2. Win KKS et al. Intermaxillary fixation using screws. Report of a technique. Int J Oral Maxillofac Surg 1991;20:283-4.
 

This poster was submitted by Dr.Dr. Sirichai Kiattavorncharoen.

Correspondence address:
Dr.Dr. Sirichai Kiattavorncharoen
Department of Oral and Maxillofacial Surgery
Faculty of Dentistry
Mahidol University
Yotee Road
Bangkok 10400
Thailand