Pain in front of the ear
The area in front of the ear on the side of the fracture hurts and swells, especially when opening the mouth or chewing.
CONDITION / JAWS, MOUTH AND NECK
Fracture of the condyle of the jaw.
Fracture of the condyle is a fracture of the part of the lower jaw that enters the joint in front of the ear. After it, it hurts near the ear, the mouth opens worse, the chin shifts to the side, the teeth close differently. Some of these fractures are treated without surgery, some are fixed with plates or screws.
CONCEPTUAL VISUALIZATION- What it is
- Fracture of the process by which the lower jaw enters the joint in front of the ear.
- How common
- According to a 2017 review, it accounts for 25–35% of all mandibular fractures.
- Main signs
- Pain near the ear, the mouth opens worse, the chin goes to the side.
- In children
- More often, they are treated without surgery: the child's appendage is capable of rebuilding itself.
01 / WHAT IS ITWhat is
What is
fracture of the condylar process.
Behind, the lower jaw rises up with two branches. Each ends with a condylar process: its head lies in the joint just in front of the ear. How the jaw moves, how wide the mouth opens and how the teeth converge depends on this process.
Doctors distinguish between three levels of a fracture: the base of the process, its neck, and the head — the part that lies inside the joint. Treatment and risks of surgery depend on the level. The fracture is on one side or both.
How to treat such fractures, surgeons have been arguing for decades. Previously, they mostly did without surgery; research in recent years for some displaced fractures shows the benefits of surgery, but it has its own risks. Fractures of the body and the corner of the jaw, where the teeth stand, are treated differently - a separate page is devoted to them.
This is general information. The doctor will tell you what will suit you after the examination.
02 / SIGNSHow
How
fracture near the joint presents.
The blow could hit the chin, but it hurts near the ear: the force is transmitted through the jaw to the joint.
The mouth opens worse
It is not possible to open the mouth wide, and the chin at the same time shifts in the direction of the fracture.
The teeth converge differently
On the side of the fracture, the canines meet earlier. If both processes are broken, the front teeth may not close at all.
Blood in the ear
After a blow, blood may flow from the ear - this is a sign with which 103 is called.
Later
If the fracture did not fuse properly: the jaw moves limitedly, the joint clicks or hurts, the face becomes asymmetric.
Dysfunction of the joint03 / REASONSWhy does it break?
Why does it break?
and what threatens
The condylar process is more often broken in a fall or in a car accident, and in children such a fracture is easy to miss.
Falls and road accidents
In a 13-year analysis of isolated jaw fractures, falls from a height and traffic accidents were associated with a higher likelihood of fracture of the condyle itself (odds ratio 4.75 and 3.02).
Children
In preschool children, it is easy to miss a fracture of the appendage, so after falling on the chin, the child should be shown to the doctor.
Ankylosis
This is the name given to the condition when the joint grows and the mouth stops opening. If a child's fracture is not recognized or treated incorrectly, some children may experience ankylosis, facial deformity, malocclusion, and long-term pain.
Ankylosis of the jointBroken head
If persistent pain, ankylosis or bone inflammation remain after treatment, the joint is sometimes replaced with a prosthesis.
Destruction of the joint head
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
A fracture of the appendage occurs after falls and road accidents, and such a blow can damage both the head and the neck. Therefore, a head injury is first ruled out. Do not get behind the wheel. Call 103 if at least one of the following symptoms appears after the impact:
103 immediately if:
- severe difficulty in breathing: a person gasps for air with his mouth, suffocates, cannot utter a word;
- difficult to swallow;
- swelling in the mouth, under the tongue, or on the neck grows rapidly;
- the bleeding does not stop;
- blood flows from the ear or a bruise appeared behind the ear;
- a clear watery liquid flows from the ear or nose;
- the person was unconscious and still has not regained consciousness;
- drowsiness: it is difficult to stay awake, eyes close;
- seizure attack;
- impaired vision or hearing;
- a bruise around the eye, although there was no blow to the eye;
- new weakness or numbness in any part of the body;
- it is difficult to walk or keep balance, the person does not understand what is said or cannot choose the words;
- irritability, inattention or indifference that was not there before;
- the neck hurts or is stiff, and the hands are numb or tingling;
- a large open wound on the face, with debris or glass in the wound;
- falling from a height of more than 1 meter or 5 steps or impact at high speed, as in a car accident.
Do not delay:
On the same day - to the maxillofacial surgeon or to the reception department: after the blow, it hurts in front of the ear, the mouth does not open as before, the chin shifts to the side, the teeth close differently. A child with such complaints after a fall should also be shown to the doctor on the same day. If a person loses consciousness for a short time after a blow, immediately go to the reception room (let them take you away). On the same day, go to the doctor - and after a blow to the head, if you feel nauseous or have vomited, feel dizzy, are on blood-thinning drugs, or have been drinking. After the operation - immediately to the surgeon who operated, and if it does not work - to the waiting room: increasing pain or swelling in front of the ear or under the jaw. Rapid swelling of the face or neck with difficulty breathing is 103. On the same day, to your surgeon: the temperature has risen, pus or a clear liquid is coming out of the wound, facial expression is weakening on the side of the operation: the eye does not close or the corner of the mouth is lowered. Planned: the fracture has healed, but the mouth opens limitedly, the joint clicks or hurts, the face has become asymmetric. After such a fracture, the child is shown to the doctor again while the jaw is growing.
05 / DIAGNOSTICSAs defined,
As defined,
what to treat
- Review after impact
First, the head, neck and ear: blood in the ear, clear fluid, hearing.
- Joint and bite
The doctor checks how much the mouth opens, where the chin moves, how the teeth close on both sides.
- CT
Shows the level of the fracture—base, neck, or head—how much the fragment is displaced and whether the head is out of joint, as well as a second jaw fracture.
- The solution
The surgeon considers the level and displacement of the fracture, age, bite and general condition.
- Control
Repeated examinations of mouth opening and bite, in children - while the jaw is growing.
06 / TREATMENTHow we treat
How we treat
fracture of the process.
There is no single rule. A review of systematic reviews in 2020 suggested that decisions should be made based on whether the fragment can be reliably fixed, the joint and bite restored, and the characteristics of the patient himself.
01
Without surgery
The fragment is almost not displaced; most children.
- What are they doing?
- Analgesia, soft food and observation; functional treatment — rubber braces between the teeth, orthodontic appliances and exercises that lead the jaw to the correct bite; in adults, sometimes the jaws are temporarily clamped; for children, according to a review of the literature, it is better to avoid it.
- Possible consequences
- In a review of 16 studies, malocclusion, limited mouth opening, reduced jaw range of motion, and persistent pain were described after closed treatment. There is no single protocol for such treatment.
02
Surgery
Displaced fractures of the base and neck of the process in adults.
- What gives
- In a meta-analysis of 14 studies, joint pain and occlusion disorders were less likely to remain after surgery, and lateral jaw movements were better restored. The authors counted more infections after surgery (relative risk 3.6; the result is imprecise — confidence interval 0.9–13.8).
- Expert opinion
- At an international symposium, 14 experts and 41 surgeons agreed that for displaced fractures of the base and neck of the process in adults, surgery with fixation is the method of choice.
- Facial nerve
- Branches of the nerve that moves the muscles of the face pass near the process. In an analysis of 96 studies (3,873 patients), temporary facial weakness depended on access — from 0% to 19%, persistent — from 0.3% to 2.2%.
- Other risks
- Among the complications of the operation, hematoma, wound infection, accumulation or leakage of saliva, numbness of the skin near the ear, visible scarring and destruction of fixation are described.
- Through the mouth with an endoscope
- Some fractures of the base of the process are fixed through the mouth under the control of the endoscope. In 10 studies, temporary weakness of the facial nerve afterwards was between 0% and 10%, but the operation takes longer and requires special equipment.
03
Special cases
Head, children, bilateral fractures.
- Fracture of the head
- In a meta-analysis of 9 studies (547 patients), there were less malocclusions after surgery, and the mouth opened slightly wider — on average, 2.7 mm. The certainty of the evidence is low, so both approaches remain acceptable.
- Children
- Experts advise children under the age of 6 to choose non-surgical treatment as the first treatment, and to treat children over 12 as adults. In a series of 60 children (mean age 9.55 years), all nonoperative fractures healed with process remodeling, 20% had minor complications; after about 12 years, the ability to rebuild weakened.
- Bilateral fracture
- In the registry, 226 patients were treated with surgery, without it or in combination; all groups improved over 3 months, and the proportion of people with malocclusion decreased from 25.8% at 6 weeks to 18.6% at 3 months.
- Joint prosthesis
- It is placed if persistent pain, ankylosis or inflammation of the bone remains after closed or open treatment.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
At Dr. Valikhnovskyi's Institute of Surgery, fractures of the condylar process are dealt with by the "New Face" department - from a fresh fracture to joint restoration. Head trauma is managed by a neurosurgeon, orthodontic treatment of the bite by an orthodontist.
CLINIC SERVICE
A new face
Form, symmetry, facial expressions and functions after injuries, wounds, burns, removal of tumors and congenital changes.
View service
What we do for this condition
- Treatment without surgery — when the process is almost not displaced — observation or closed reposition with bite control.
- Titanium plates — the displaced process is returned to its place and fixed in order to restore the height of the jaw and bite.
- CT and 3D planning — based on CT, the position of fragments is modeled and, if necessary, templates or individual implants are printed.
- Osteotomy — if the jaw after the fracture has grown together with displacement and the bite is disturbed, the bone is dissected and rearranged.
- Joint implant — if the head is destroyed or the joint is fused, it is replaced with a prosthesis.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How treatment works with us
- Pictures onlineSend the CT scan and the discharges - the doctor will pre-evaluate the level of the fracture.
- ConsultationExamination of the joint, mouth opening and bite; if necessary, a new CT scan.
- PlanTreatment without surgery or fixation, from which access and how to protect the facial nerve.
- TreatmentClosed treatment with bite control or process fixation with plates.
- RecoverySoft food, exercises for the jaw as prescribed, control of mouth opening and bite.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
Is it necessary to operate a condylar fracture?
No. Non-displaced or slightly displaced fractures and most fractures in children are treated without surgery. For displaced fractures of the base and neck in adults, experts recommend surgery.
Is surgery dangerous for the facial nerve?
There is a risk: the branches of the nerve pass nearby. Temporary facial weakness is more common than permanent and depends on the approach chosen by the surgeon.
Why is the child not operated on more often?
A child's appendage is capable of rebuilding itself and regaining its shape, especially at a younger age. But you need to monitor the child: incorrect fusion can limit the opening of the mouth.
After a blow to the chin, blood flows from the ear. What to do?
Call 103. Blood from the ear after a blow can be a sign of a serious head injury.
Will the bite return?
The bite may improve over time, but not always completely. In the register of patients with a bilateral fracture, after 3 months, a disturbed bite remained in 18.6%.
What will happen if not treated?
If the fracture was not recognized or treated incorrectly, occlusion disorders, limited opening of the mouth and long-term pain are possible, as well as facial deformity or joint ankylosis in children.
Sources
18 sources · expert consensus, systematic reviews, meta-analyses, cohorts and the NHSshowCollapse
- Closed treatment of unilateral mandibular condyle fractures in adults: a systematic reviewInternational Journal of Oral and Maxillofacial Surgery, 2017doi:10.1016/j.ijom.2016.11.009 ↗
- Open treatment of unilateral mandibular condyle fractures in adults: a systematic reviewInternational Journal of Oral and Maxillofacial Surgery, 2017doi:10.1016/j.ijom.2017.06.018 ↗
- Comparative Benefits of Open versus Closed Reduction of Condylar Fractures: A Systematic Review and Meta-AnalysisPlastic and Reconstructive Surgery, 2023doi:10.1097/PRS.0000000000010009 ↗
- Mandibular condylar fracture: a systematic review of systematic reviews and a proposed algorithm for managementBritish Journal of Oral and Maxillofacial Surgery, 2020doi:10.1016/j.bjoms.2020.03.014 ↗
- Position paper from the IBRA Symposium on Surgery of the Head — the 2nd International Symposium for Condylar Fracture Osteosynthesis, Marseille, France 2012Journal of Cranio-Maxillofacial Surgery, 2014doi:10.1016/j.jcms.2014.03.005 ↗
- Current Management of Subcondylar Fractures: A Systematic ReviewOtolaryngology–Head and Neck Surgery, 2023doi:10.1002/ohn.185 ↗
- Does the surgical approach for treating mandibular condylar fractures affect the rate of seventh cranial nerve injuries? A systematic review and meta-analysis based on a new classification for surgical approachesJournal of Cranio-Maxillofacial Surgery, 2018doi:10.1016/j.jcms.2017.10.024 ↗
- Closed treatment versus open reduction and internal fixation for mandibular condylar head fractures: A systematic review and meta-analysisJournal of Cranio-Maxillofacial Surgery, 2026doi:10.1016/j.jcms.2026.104560 ↗
- Conservative treatment of temporomandibular joint condylar fractures: A systematic review conducted according to PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of InterventionsJournal of Oral Rehabilitation, 2023doi:10.1111/joor.13497 ↗
- Conservative Management of Pediatric Mandibular Condylar Fractures: A Systematic ReviewDental Traumatology, 2026doi:10.1111/edt.70139 ↗
- Pediatric mandibular condyle fractures: A decade of experienceJournal of Cranio-Maxillofacial Surgery, 2026doi:10.1016/j.jcms.2026.104455 ↗
- Management of Pediatric Mandibular Condyle Fractures: A Literature ReviewJournal of Clinical Medicine, 2024doi:10.3390/jcm13226921 ↗
- Clinical and Patient-Reported Outcomes After Treatment of Bilateral Condylar Fractures: Results of a Retrospective Cohort Study Derived From the BCFx RegistryJournal of Oral and Maxillofacial Surgery, 2026doi:10.1016/j.joms.2026.06.003 ↗
- Temporomandibular joint prosthesis as treatment option for mandibular condyle fractures: a systematic review and meta-analysisInternational Journal of Oral and Maxillofacial Surgery, 2023doi:10.1016/j.ijom.2022.05.014 ↗
- Association Between Trauma Mechanism and Mandibular Fracture Pattern: A 13-Year Retrospective Analysis at a Regional Trauma CenterCraniomaxillofacial Trauma & Reconstruction, 2026doi:10.3390/cmtr19020022 ↗
- Head injury and concussionNHS, 2025nhs.uk/conditions/head-injury-and-concussion ↗
- Shortness of breathNHS, 2024nhs.uk/symptoms/shortness-of-breath ↗
- Broken noseNHS, 2023nhs.uk/conditions/broken-nose ↗
The figures on the page are from these sources.
It hurts after the blow
near the ear?
Send CT scans and discharges. The doctor will tell if an operation is necessary or if the fracture can be managed without it.