Clinical tip

Hypomochlion aided reduction for

sub-condylar fractures
* Yeshaswini Thelekkat, ** Shyammohan

Sub-condylar fractures have

always been a point of controversy.
Although surgical mode of
management of these fractures has
become popular, there are many
who prefer the non-surgical
management due to the
complications possible from
surgical intervention.1 In displaced
fractures, it is often observed that
the fragments over-ride when
brought into occlusion, shortening
the ramal height significantly. The
condylar fragment also gets locked
in the incorrect position.2
The use of a hypomochlion
(hypo small; mochlos - lever) to
distract the posterior mandible
downwards and elastics, to rotate
the mandible upwards anteriorly can
preclude this problem. With
distraction posteriorly, the condylar
fragment does get released and may
get better aligned in the fossa. This
paper describes a similar technique
using acrylic jigs as hypomochlion
for reducing a sub-condylar fracture
and attaining complete occlusion.

Technique
The associated fractures of the
mandible such as the symphysis/
parasymphysis are treated by open
reduction and internal fixation prior
to tackling the open bite problem.
The hypomochlion is used here in a
case of bilateral sub-condylar fracture
associated with symphysis fracture.
The amount of anterior open bite is

measured with dividers. This will give

an idea regarding the amount of
distraction required posteriorly. Clear
cold cure PMMA resin (DPI,
Mumbai) is mixed to a thick
consistency and hand moulded in the
dough stage, with the aid of
petrolatum jelly, into blocks
measuring approximately 2.5 x 1cm.
This is inserted posteriorly along the
molar area. The patient is gently
assisted to occlude onto the jig to get
the teeth indentations on both sides,
taking care that the excess resin is not
flowing to any soft/hard tissue
undercuts. Once the polymerisation
starts progressing to the exothermic
stage, the jig is carefully retrieved and
stored in water until it fully hardens.
This is then trimmed and rechecked
intra-orally for fit and stability. The
acrylic jig of the contralateral side is
similarly made with the completed
jig in place as a guide. Both the jigs
are trimmed and polished (fig 1) and
inserted bilaterally as assisted by the
recorded indentations on the surface
(fig 2). Inter arch traction elastics are
put in such a way allowing rotation
of the mandible along the jigs
(hypomochlion) without any
resistance. The jigs are periodically
trimmed to aid complete
intercuspation (fig 3) which usually
occurs within 48hrs-72hrs. The
placement of the jig usually distracts
the mandible posteriorly and
satisfactorily reduces the condylar
segment. The occlusion is maintained

in perfect intercuspation after

removal of arch bars at 3 months
post-op (fig 4).

Summary
Nonsurgical treatment using
maxillomandibular fixation (MMF)
accompanied
by
adequate
physiotherapy has known to yield
acceptable results and has stood the
test of time. However, shortening of
the ascending ramus of more than 8
mm resulting in functional
disturbances and TMJ dysfunction
does occur following non-surgical
management.2,4 There are reports of
patients having to undergo
orthognathic surgery to correct the
persistent anterior open bite, despite
prolonged periods of intermaxillary
fixation.5 Maxillary splint with a
hypomochlion has been used to
distract the posterior mandible for
moderately displaced condylar
fractures. 6 The acrylic blocks
described here eliminates the
discomfort of making an impression
& complete palatal coverage and can
be prepared easily bed/chair side. It
is easier to remove and trim
periodically till occlusion is achieved.
The possibility of dislodgement is also
nullified due to the firm anchoring
of the jaws on to the jig by the elastics.

References
1.

Ecklet U, Schneider M, Erasmus F,

Gerlach KL, Kuhlisch E, Loukota R et
al. Open versus Closed treatment of

* Reader, Department of Oral & Ma xillofacial Surgery, Azeezia Dental College & Research Centre, Kollam; ** Professor & Head,
Department of Prosthodontics, Sri Sankara Dental College, Varkala, Trivandrum. Corresponding Author: Dr. Yeshaswini Thelekkat, Email: yeshas26575@yahoo.com
72

KDJ Vol. 37 No. 1 January 2014

Hypomochlion aided reduction for sub-condylar fractures

Fig 1. acrylic jig

2.

3.

4.

5.

Fig 2. jig inserted

fractures of the mandibular condylar process a

prospective randomised multicentre study. J of
CraniomaxillofacSurg 2006;34: 306-14
Silvennoinen U, Iizuka T, Oikarinen K, Lindqvist C: Analysis
of possible factors leading to problems after nonsurgical
treatment of condylar fractures. J Oral MaxillofacSurg 52:
793799, 1994;
K. Abdel-Galil, R. Loukota. Fractures of the mandibular
condyle: evidence base and current concepts of management
Br J Oral MaxillofacSurg, 48 (2010), pp. 520526
Luc M.H. Smets, Philip A. Van Damme, Paul J.W. Stoelinga.
Non-surgical treatment of condylar fractures in adults: a
retrospective analysis: Journal of Cranio-Maxillofacial Surgery
(2003) 31, 162167.
L Newman. A clinical evaluation of the long-term outcome
of patients treated for bilateral fracture of the mandibular
condyles. British Journal of Oral & Maxillofacial Surgery.
1998; 36; 176-179

Fig 3. intercuspation attained

Fig 4
6.

Dr.Dr. SirichaiKiattavorncharoen, PD.

Dr.Dr.JohannesKleinheinz, Prof.Dr.Dr.Dr. hc Ulrich Joos.
Treatment of condylar neck fracture by Ottensminihooks. Int
Poster J Dent Oral Med 2002, Vol 4 No 2, Poster 123

KDJ Vol. 37 No. 1 January 2014

73