Abstract
Three cases of fracture of the madibular condyle in patients under treatment of epilepsy is reported. All cases were suffered from the trauma due to falling down by epileptic seizure and visited our branch complaining masticatory disturbance. They were treated with nonsurgical management and satisfactory result was produced.
The first case was a 33-year-old male patient (Fig. 1). The CT examination showed that the fracture seperated left condylar head sugitally. As smaller segment, the inner pole was displaced anteriorly with the contraction of left lateral pterygoid muscle. The spasmodic tonic contraction of the muscle by the epileptic seizure was considered as one of the causative factors of the longitudinal fracture of condyle. Because of mental retardation he could not accept tight intermaxillary fixation with metal wire ligamentation even a day, and broke down the arch bars. By means of intermaxillaly elastic traction about two weeks under frequent observations on his occlusion and early training of mouth opening brouht a good result.
The second case was a 32-year-old male patient (Fig. 2). He was suffered from fractures of right mandibular angle and left condyle. The condylar fracture was simple crack with no deviation of fragments, so that the detection of the lesion at first visit was difficult. About four weeks after intermaxillaly fixation, the ligamnets were removed. His occlusion and TMJ function got well. However, inflammation and hypergrowth of gingiva was occured due to insufficient oral hygiene during the intermaxillary fixation. The abnormal state of gingiva was diminished after removal of arch bars and with sufficient tooth brushing. Soon after, he suffered from left TMJ trouble due to epileptic seizure but his occlusion and masticatory function were kept in safety.
The third case was a 54-year-old male patient (Fig. 3). His fracture occured in the right condyle with deviation of fragments. He was treated with intermaxillary fixation. In the clinical process he hit him on his face due to epileptic attack. Despite of such trouble the clinical result was good.
Through management of these three cases it was suggested that nonsurgical management, in compairing with surgical one, has several advanteges in the case of the treatment of condylar fracture in patients under treatment of epilepsy. The largest advantage is easiness of correction of malocclusion brought with epileptic attack during the treatment of fracture.
