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2020/7/6 周O斌 36603700 Dx: Medial pole of condyle head fracture - Coggle…
2020/7/6 周O斌 36603700
Dx: Medial pole of condyle head fracture
Clinical approach
Cause of the injury: When? How? Where?
ILOC(+), Headache, nausea and vomiting (-), disorientation(-)
Substance: Drug(-), Alcohol(+)
Medical history: HTN, DM under medical control.
Present illness: sent to 慈濟 on 7/3 but AAD due to persona issue after laceration wound sutured. Came toVGHTPE ER on 7/5 night due to progression of trismus
Current symptoms and sign:
(1)Malocclusion noted after falling down, improved today.
(2)Pain over left face
(3)Trismus noted after falling down, progression noted yesterday
Chief complaint
Change in occlusion noted after falling down 3 days ago when got drunk.
Physical examination
Intraoral examination:
Occlusion: Only lower teeth for occlusion. No obvious premature contact, stable and repeatable
No mouth floor or other mucosal ecchymosis.
MMO: 30mm, no clicking or deviation noted during jaw movement
Tooth fracture(-), Mobility(-)
Extraoral examination:
Palpation:
Bone block mobility(-), Step formation(-), Tenderness at left face
ecchymosis(-)
Lacerations (+, Chin s/p suture), rhinorrhea(-),
Inspection: Swelling(+, left face), Abrasions(+, left face),
Radiographic examination
Panoramic film: Not available
Face CT scan:
(1)Fracture of the medial pole of left condyle head noted without alternation in vertical height of ramus.
(2)No foreign body impingement in the facial soft tissue
(3)Intracapsular condyle head fracture at left condyle head
Treatment
Open reduction + internal fixation
Why not use ORIF:
Difficult due to small fracture bone of medial pole for fixation
Risk of facial nerve trauma during open surgery
Limited surgical field
Scar formation and joint ankylosis
Intermaxillary fixation
Why not use IMF:
Multiple retained root with only 3 teeth in occlusion
Stable and repeatable current occlusion
Follow up
Why follow-up:
Acceptable jaw movement function
Difficult in open reduction and internal fixation
Difficult or incapable of IMF