Mandibular Condylar Fractures in Children: Morphofunctional Results After Treatment With External Fixation

Abstract

Best treatment for paediatric patients with mandibular condylar fractures is still debated, and many approaches have been proposed. Closed treatment is the most used, but there is evidence showing long-term problems in patients with dislocated fractures. On the other hand, there are concerns on surgical treatment with open reduction internal fixation, particularly on the implanted hardware during growth. The aim of this study is to evaluate the long-term outcomes of paediatric patients treated surgically with external fixation. A total of 21 paediatric patients were treated. Diagnostic procedures included clinical and radiographic examinations. Of those 21 patients, 16 presented monocondylar fractures, 5 bicondylar fractures. They were treated surgically with open reduction and external fixation. Patients showed good recovery in maximal mouth opening, maximal lateral excursion and in vertical height of ramus, and all returned to preinjury occlusion. No patient presented permanent facial nerve palsy, and none referred pain or stiffness in the operated area. Minimal scars were visible. Just 1 patient referred clicking in the operated temporo-mandibular joint. Surgical approach using external fixation could be considered an option for treatment of mandibular condylar fractures in paediatric patient. Vertical height recovery, early mobilization, and good occlusion can be achieved, minimizing the risk of facial asymmetry.

Open reduction and internal fixation of mandibular condylar fractures

“…In an evaluation of long-term outcomes of 21 pediatric patients with mono- and bicondylar fractures who received oral reduction and external fixation, good recovery was reported in maximal mouth opening, lateral excursion, and vertical height of ramus, and preinjury occlusion was restored in all patients. [25] No permanent facial nerve palsy was noted, no referred pain or stiffness at the operative site and minimal scarring. The authors emphasized that good functionality of the temporomandibular joint (TMJ) structures and the absence of permanent hardware with external fixation was especially important in children because it allowed symmetrical growth.…”

Change of the Inclination Angle in a Pediatric Bilateral Condylar Fracture Treated With Intermaxillary Fixation and an Occlusal Stop

“…4 Cascone treated 5 bicondylar fractures surgically with open reduction and external fixation and achieved good vertical height recovery. 9 Zhou treated 2 cases (both 11 years old) of bilateral condylar fractures associated with symphyseal fractures using traction with elastics for 4 weeks. A soft diet and functional exercise were added.…”

“…Farber performed IMF for 2 weeks using 0 silk sutures for the treatment of a 4-year-old patient with a bilateral condylar fracture 4 . Cascone treated 5 bicondylar fractures surgically with open reduction and external fixation and achieved good vertical height recovery 9 …”

“…Several treatments for bilateral condylar fractures in children have been reported. [6][7][8][9] Xu treated a 10-year-old boy with a bilateral condylar fracture using a fixed orthodontic appliance instead of an arch bar splint, followed by elastic traction, and achieved a proper occlusion and condylar remodeling. 5 Farber performed IMF for 2 weeks using 0 silk sutures for the treatment of a 4-year-old patient with a bilateral condylar fracture.…”

“…5 Several treatments of bilateral condylar fractures in children have been reported. [6][7][8][9] However, changes in the inclination of the fractured condyle (IFC) have not been reported.…”