History of sub-condylar fractures

Symposia observe order in patterns which before appeared to be dominated by randomness and not accessible to any geometric analysis. In fact, self-similarity is the key platform for a new geometry—the fractal geometry conceived by Benoit Mandelbrot—which allows us to analyze the geometry of nature and find laws which provides us with tools to simulate natural pattern formation processes such as the vascular growth in an organ. As an application of the strands of chaos theory and self-organization the lecture will present breakthrough research and results dedicated to the detection, evaluation and exclusion of risks in tumor surgery. Particular attention

will be given to brain, lung and liver lesions. Finally, applications of these new tools for living-donor-livertransplantation will be discussed. References Gleick J: Chaos: Making a New Science. Penguin Books, 1988 Peitgen H-O, Ju ¨ rgens H, Saupe D: Chaos and Fractals, New Frontiers of Science (ed 2). New York, NY, Springer, 2004 Peitgen H-O, et al: Computer-assisted planning and decision-making in living-donor liver transplantation, in Tanaka K, et al (eds): LivingDonor Liver Transplantation—Surgical Techniques and Innovations. Barcelona, Spain, Prous Science 2003

SYMPOSIUM ON MANAGEMENT OF SUBCONDYLAR FRACTURES: HISTORICAL PERSPECTIVES AND NEW HORIZONS Presented on Friday, October 1, 2004, 12:30 pm—2:30 pm Moderator: Joseph P. McCain, DMD, Miami, FL

History of Sub-Condylar Fractures Edward Ellis III, DDS, MS, Dallas, TX For most of history, condylar process fractures were either not treated because the diagnosis was not made, or were managed minimally using external bandages to immobilize the mandible. The beginning of the 20th century is when articles on the management of condylar fractures became common in the literature. Surprisingly, open treatment was mentioned often, perhaps because closed treatment was common and not worthy of publication, which at that time was usually case reports. All methods that one might dream up were applied to condylar fractures, including: 1. Open reduction via a medial approach to the ramus 2. Condylectomy to prevent hypomobility 3. Varying periods of MMF from none to 6 weeks 4. Closed manipulation under general anesthesia This talk will center on historical progress in the treatment of condylar fractures, and arguments such as the need for a period of MMF. References Zemsky JL: New conservative treatment versus surgical operation for displaced fractures of the neck of the mandibular condyle. Dent Cosmos 68:43, 1926 Chalmers J: Lyons Club: Fractures of the mandibular condyle: A post-treatment survey of 120 cases. J Oral Surg 5:45, 1947 MacLennan DW: Consideration of 180 cases of typical fractures of the mandibular condylar process. Br J Plast Surg 5:122, 1952

Indications for Open Reduction and Closed Reduction Treatment Edward Ellis III, DDS, MS, Dallas, TX The treatment of condylar fractures is still a highly debated theme. With the advent of stable internal fixa12

tion devices, open treatment has become more popular. However, there is still no universal agreement on the indications for open or closed treatment. These seem to vary with every surgeon who treats such injuries. This talk will focus on factors that may be taken into account when one decides how a given condyle fracture is to be treated. The basis of the talk, however, will be that the majority of condylar fractures can be treated satisfactorily by closed techniques. The question is, Which fractures might have better outcomes when treated open? Absolute Indications for Open Treatment 1. Displacement of condyle into the middle cranial fossa (with or without fracture) 2. Lateral extracapsular displacement of condyle (with or without fracture) 3. Impossibility of obtaining proper occlusion by closed techniques 4. Condylar fractures associated with comminuted fractures at or above the LF 1 level Relative Indications for Open Treatment All other condylar fractures may be treated closed or open. The decision to choose one method over another will vary depending upon the experience and philosophy of the surgeon, the expected outcomes from either treatment, and the factors discussed below. I therefore will not list any relative indications because what is a relative indication in my opinion may not be in another’s. I. Loss of Ramus Height. Fractures that are displaced will lead to decreases in the height of the ramus. In most cases this loss of ramus height is acceptable and will be manifest by a small cant in the occlusal plane (if the fracture is unilateral). However, if few posterior teeth are present, control of ramus height by functional (nonAAOMS • 2004