Condylar Fractures Chapter 2 Oral & Maxillofacial Surgery Ruchi Singhal 1 ; Virendra Singh 2 ; Amrish Bhagol* 1 Jaipur Dental College, Jaipur, India 2 Senior Professor, PGIDS, Rohtak, India Amrish Bhagol Department of Oral and Maxillofacial Surgery, Postgraduate Institute of Dental Sciences, Pandit Bhagwat Dayal Sharma University of Health, Haryana, India. Email: bhagol.amrish@gmail.com 1. Introduction Fractures of the condyle can involve the head (intracapsular), neck, or subcondylar re- gion. The head of the condyle may be dislocated outside of the fossa. The most common direction of displacement is in an anteromedial direction because of the pull from the lateral pterygoid muscle, which inserts on the anterior portion of the head of the condyle. No other type of mandibular fracture is associated with as much controversy regarding treatment as those involving the condyle. Factors considered in deciding whether to treat a condyle fracture open or closed include the fracture level, amount of displacement, adequacy of the occlusion, and whether the patient can tolerate maxillomandibular fxation. Those who advocate open treatment cite advantages including early mobilization of the mandible, better occlusal results, better function, maintenance of posterior ramal height, and avoidance of facial asymmetries [1]. The ramal height shortening can be assessed on panoramic radiograph [Figure 1] and can be restored by open treatment of condylar fractures [Figure 2]. Others prefer closed reduction mainly because of the possible complications associated with open reduction including damage to branches of the facial nerve and a cutaneous scar. Re- cently endoscopic subcondylar fracture repair has been described with encouraging results [2]. Nonsurgical management (closed reduction) includes MMF with elastics for a variable period followed by guiding elastics so as to maintain the occlusion while allowing jaw physiotherapy during healing [Figure 3,4]. Measurable criteria should be assessed whether treating by closed or open methods. These should include pain-free movement, mouth-opening, jaw movement