Long-term results of nonsurgical management of condylar fractures in children

Abstract

Twenty-five patients with 28 condylar or subcondylar fractures, sustained during their growth period and treated nonsurgically, have been followed for an average period of 15 years. The fractures were classified as intracapsular, high condylar neck and low condylar neck fractures. In 5 patients, two weeks of intermaxillary fixation, followed by elastic traction in order to achieve a proper occlusion, was applied. All the other patients were treated by instruction, exercises and observation. In 4 patients, subsequent orthodontic treatment was provided. It is not advocated to perform orthodontic aftercare as a routine action in all patients. Satisfaction with the treatment results, as measured on a visual analogue scale (VAS), was very high. The masticatory function of all patients at last follow-up was good to excellent. From this study, it appears that especially the commonly occurring high condylar fractures (64%) show good regeneration tendency as observed on radiographs. Low condylar and intracapsular fractures may give rise to some asymmetry. In 4 cases this asymmetry was clearly visible to the experienced observer, but did not concern the patient. One patient (low condylar neck fracture) showed obvious malocclusion and facial asymmetry, which needed to be corrected by orthognathic surgery. Unfortunately, it is impossible to predict which type of fracture is at risk of facial asymmetry. It is concluded that nonsurgical management of condylar fractures of the mandible in children is still the method of choice.

Pediatric Maxillofacial Trauma Outcomes Based on a Survey of 65 Patients: A Prospective Study of Etiology, Incidence and Methods of Treatment

“…The higher incidence of condylar fractures in children may be explained by the higher proportion of medullary bone with only a thin rim of cortex. Nonsurgical management of condylar fractures of the mandible in children is still the method of choice [10]. Para-symphyseal fractures at 19.14 % were the second most common site in our series.…”

Evaluation of Retro Mandibular Approach to Open Reduction and Internal Fixation of Condylar Fractures: A Cross-sectional Study

“…With the exception of undisplaced, intracapsular fractures and fractures in pediatric patients younger than 12 years of age [14][15], most mandibular condylar fractures should be treated with open reduction and rigid fixation. Points to be clarified regarding surgical treatment, is how many fixation devices should be used [6], and the choice of approach for treating condylar fractures.…”

“…A number of reports have suggested that the treatment of condylar fractures by open reduction and rigid fixation offers much better anatomic results [6][7][8][9][10][11][12][13]. Conservative treatment is still the choice of treatment for intracapsular or comminuted fractures and fractures in pediatric patients [14,15]. Though closed reduction is a simple and easy method of treatment of condylar fractures but long-term complications like pain, arthritis, open bite, inadequate restoration of vertical height of the ramus leading to malocclusion and ankylosis do exist with closed reduction method [16].…”

Vertical-split fracture of mandibular condyle and its sequelae

“…It concluded that non-surgical treatment of condylar fractures in children was still the method of choice. 5 This particular case is unusual in that the trauma caused an intracapsular vertical split fracture of the condyle head. Interestingly a retrospective study of paediatric condylar fractures in Finland found that intracapsular fractures were more common in 6-year-olds and under than any other type of condylar fracture.…”