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

doi:10.1016/S0901-5027(99)80056-3

International Journal of Oral and Maxillofacial Surgery

Volume 28, Issue 6, December 1999, Pages 429-440

https://doi.org/10.1016/S0901-5027(99)80056-3 Get rights and content

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 observed, 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.

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Despite decades of study, a consensus on therapeutic approaches to condylar fractures remains elusive, and the vexing question of invasive or noninvasive therapy remains to be definitively answered. This randomized clinical study aimed to compare the outcomes of mandibular condylar fractures (MCFs) treated by closed reduction (CR) with those treated by open reduction and internal fixation (ORIF).
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Mandibular fractures account for over 50% of all facial fractures in children, with the majority of these occurring at the condyle. There is currently no consensus on the management of mandibular condyle fractures in the paediatric population. Treatment options range from conservative management, with or without maxillomandibular fixation (MMF) and physiotherapy, to open reduction and internal fixation (ORIF).
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⁺: Address: Jelle Hovinga, DMD PhD Department of Oral and Maxillofacial Surgery Kennemer Gasthuis, location EG Boerhaavelaan 22 2035 RC Haarlem The Netherlands

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

Abstract

Int J Oral Maxillofac Surg

Int J Oral Maxillofac Surg

Int J Oral Maxillofac Surg

Int J Oral Maxillofac Surg

J oral Maxillofac Surg

J Oral Maxillofac Surg

J Oral Maxillofac Surg

Int J Oral Maxillofac Surg

J Oral Maxillofac Surg

Int J Oral Maxillofac Surg

Int J Oral Surg

Int J Oral Surg

J Oral Maxillofac Surg

J Craniomaxillofac Surg

J Oral Maxillofac Surg

Int J Oral Maxillofac Surg