Closed reduction of displaced or dislocated mandibular condyle fractures in children using threaded Kirschner wire and external rubber traction

Surgical treatment of paediatric fractures of the mandibular condyle: a systematic review of the literature

This study aims to review surgical treatment in paediatric condylar fractures and describe different types of techniques performed, along with the results obtained from them. A retrospective review was conducted from records of paediatric patients (from one to 17 years old) who sustained fractures of the mandibular condyle and underwent surgical treatment from 2003 to 2023. The number of patients, age, location, and type of fracture, clinical and imaging examinations, treatment methods, intraoperative/postoperative complications, removal of osteosynthesis material, follow up and outcomes were recorded and analysed. A total of 68 patients with 79 fractures were identified. The most common fracture pattern was condylar neck fracture (61.1%). Of the 68 patients who underwent surgical treatment, one had a complication of minimal temporal paraesthesia and another patient had near-complete resorption of the condyle. A total of 55 patients (81%) reported normal dental occlusion, mouth opening (>35 mm), lateral excursions (7-8 mm), TMJ function, no pain, no deviation of the midline or the jaw, and no ankylosis. Thirteen patients (19%) developed an unsatisfactory result, nine patients (13%) had a jaw deviation on mouth opening, four patients (6%) had mandibular retrusion, and seven patients (10%) had signs of TMJ dysfunction. A total of 59 patients (87%) reported bone completely healed with no signs of bone abnormality; seven patients (10%) had shortening of the condylar neck and/or ramus. Surgical treatment can lead to good or excellent results for severely dislocated and displaced condylar fractures in children and can reduce the unsatisfactory results resulting from closed treatment.

Management of Mandibular Condyle Fractures in Paediatric Patients: a Systematic Review

Objectives

This systematic review searched three of the most used databases to assess if current evidence suggested a difference between surgical and non-surgical management of mandibular condyle fractures in paediatric patients.

Material and Methods

An electronic literature search was conducted of three well known databases - Ovid, PubMed and Web of Science. Studies included were conducted paediatric patients, in humans, written in English and published from January 1st 1996 until April 1st 2022. Data collection was carried out by two independent reviewers. Data collated from studies without high risk of bias was pooled for surgical vs non-surgical management and total tallies of all outcomes presented. Presence or absence of complications was recorded in 4 x 4 tables for each outcome and compared using a Chi-Square test.

Results

After duplicate records were removed, 182 records were screened. After exclusion of unsuitable reports, 20 were included in the review. Further analysis showed the included studies had high risk of bias. Given this, comparison of this pooled data showed no significant difference between management methods.

Conclusions

Presently it appears conservative management is functionally adequate without risks associated with surgical management, even though incidence of these risks was shown to be low in the studies included in this review.

Does the Treatment Approach for Mandibular Condyle Fractures Impact Self-Perceived Quality of Life?

PURPOSE

There is no consensus in mandibular condylar fracture/s treatment. In medicine, quality of life (QOL) includes the individual's satisfaction toward their own health condition, disease, or treatment. The purpose of this study was to investigate self-perception QOL outcomes for patients who sustained mandibular condylar fracture/s.

METHODS

This cross-sectional study surveyed patients at Grady Memorial Hospital in Atlanta, Georgia from November 2016 to June 2020. The study included patients who were at least 16 years old at the time of injury, diagnosed with mandibular condylar fracture/s, treated by close reduction or open reduction and internal fixation (ORIF), presented for 6-months post-operative follow-up, and had a valid phone number. The primary predictor variable was treatment approach. The primary outcome variable was mood. Covariates were demographics, injury details, and self-perception QOL questionnaire. Univariate, bivariate, and ordinal regression analysis were performed (P < .05 significance).

RESULTS

A total of 108 patients met inclusion criteria. Response rate was 84.2%. Our data showed that patients who underwent ORIF treatment were statistically more likely to experience no or milder pain when chewing (tau = 0.390, P = .002), to not require pain medications (tau = 0.389, P = .002), to report larger maximum mouth opening (tau = 0.402, P = .0003), and to report better QOL (tau = 0.440, P = 7.407e-05). Ordinal regression analysis showed that patients who had undergone ORIF treatment were positively associated with better mood (estimate: -0.062; OR: 0.54; P = .29) and statistically significant associated with excellent QOL (estimate: -2; OR: 0.13; P = 3.99e-05). Patients who sustained class III Lindahl mandibular condyle fracture were statistically significantly associated with depressed mood (estimate: 1.46; OR: 4.33; P = .002).

CONCLUSION

ORIF treatment was positively associated with better QOL when compared to closed reduction for mandibular condyle fracture.

Management of Medially Displaced Sub-Condylar Mandibular Fractures in Pediatric Population Using Novel Atraumatic Approach

ABSTRACT

The appropriate treatment of pediatric mandibular condyle fractures is subject to much debate and concern among surgeons, with improper treatment potentially resulting in a number of adverse outcomes. Such outcomes include the disruption of mandible growth, decreased posterior facial height, facial asymmetry, and temporomandibular joint ankylosis. Several surgical and nonsurgical approaches to these fractures have been described in the literature; however, each one carries its own risk of various complications. In this study, the authors illustrate a new atraumatic approach for mild to moderately displaced subcondylar fractures, with least possible complications and unexpected outcomes. In this study, 6 patients (2 female and 4 male) with unilateral medially displaced condylar base and neck fractures, angulated between 30 and 45 degrees, were treated using a novel intraoral approach. The follow-up period varied from 12 to 18 months. All patients achieved normal occlusion and had painless functioning of the temporomandibular joint with proper mouth opening (>35 mm) without any recurrence at long term follow up. This minimally invasive approach could eliminate the possibility of major complications and be considered a safe and feasible surgical technique for certain cases of pediatric mandibular condyle fracture.

Preauricular Swelling Mimicking a Tumour: Dissolution of Mandibular Capitulum Following Trauma in a 15-Year Old Child

AIM

The report is about diagnosis, therapy, and follow-up of a 15-year old boy, who experienced facial swelling and impaired mouth opening after a sport accident.

CASE REPORT

Diagnosis of mandibular damage was delayed due to inadequate clinical investigation and radiography after trauma and only became clear after a parotid swelling occurred sometime later resulting from the dissolution of the upper part of the articular process. Follow-up control over a period of three years showed a partial restoration of the articular process but some inhibition of mouth opening combined with slight deviation of the mandible to the affected side remained over the years.

CONCLUSION

This report reminds us that parotid swelling can be the result of mandibular trauma without a recent history of physical injury to this region. Therefore, the basic standards of radiologic diagnosis should be maintained and the limited restoring capacity of the condylar process in adolescence should be acknowledged.

Closed versus open reduction of facial fractures in children and adolescents: A systematic review and meta-analysis

BACKGROUND

Treatment of facial fractures in children and adolescents has always been a challenge for oral surgeon. The choice of treatment type must take into account several factors. This systematic review aimed to evaluate closed versus open reduction of facial fractures for pediatric facial fractures.

MATERIAL AND METHODS

A systematic review of the literature was conducted in three databases (PubMed/MEDLINE, Embase and The Cochrane Library) in accordance with the PRISMA statement. The PICO question was: Conservative treatment is more appropriate than surgical treatment for reducing facial fractures in children and adolescents? The full papers of 41 references were analyzed in detail. Eleven papers were included in this systematic review: one prospective study and ten retrospective studies. All studies evaluated the complication rate.

RESULTS

A total of 73 (7.68%) of the 950 patients experienced complications. Among these patients, 24 (3.85%) had been treated with conservative treatment and 49 (15.03%) with surgical treatment. The fixed-effects model revealed a lower complication rate with conservative treatment than surgical treatment (P<0.00001; RR: 0.18; 95% CI: 0.11-0.28). Heterogeneity was low for the complication rate outcome (X2: 5.64; P = 0.69; I2: 0%).

CONCLUSIONS

The present findings show that conservative treatment is more commonly performed for pediatric facial fractures and complications occur more with surgical treatment. Therefore, surgeons must evaluate all variables involved in choosing the most appropriate treatment method to ensure greater benefits to the patient with fewer complications. Key words:Closed fracture reduction, open fracture reduction, pediatrics, treatment failure.

Fractures of the lower jaw in children (causes, types, diagnosis and treatment). Retrospective 5 year analysis

Background/aim

Epidemiology of the lower jaw fractures varies between populations. This study explores the epidemiology of the lower jaw fractures at the Department of Surgical Dentistry and Maxillofacial Surgery of Childhood, Bogomolets National Medical University.

Methods

This is a retrospective analysis of 210 case histories of children with traumatic fractures of the lower jaw, from the age of 6 months-18 years old, carried out at the Department of Surgical Dentistry and Maxillofacial Surgery of Childhood, Bogomolets National Medical University, from January 2014 to December 2018.

Results

The most common cause of the mandibular fractures was falling 142 (67%). Mostly, qualified help was sought on the first day of injury (n = 103-49%). X-ray diagnostics was performed for all patients, but in different forms: orthopantomography was performed in 57 cases (27%), panoramic radiographs of the lower jaw in a direct projection - 17 (8%), and CT studies - in 136 (65%) children. The immobilization of fractured fragments of the lower jaw is mainly carried out using the double jaw splinting according to Tigerstedt 153 (73%), in combination with osteosynthesis - 29 (14%) cases.

Conclusion

Fractures of the lower jaw occurred more commonly between the ages of 7 and 17 years, the cause of which in most cases was a fall. The most common location of the mandibular fractures was-the condylar process. The most common method of fixing fragments of the lower jaw was double jaw splinting.

Open reduction and internal fixation of mandibular condylar fractures: A national inpatient sample analysis, 2005-2014

The purpose of this study was to compare outcomes of open reduction and internal fixation (ORIF) versus closed reduction (CR) for mandibular condylar fractures.Patients included in the National Inpatient Sample (NIS) database (2005-2014) who were admitted to the hospital for unilateral mandibular condylar fracture were included in the analysis. Patient characteristics and clinical outcomes were compared between those who received ORIF and those receiving CR. Logistic regression analysis was performed to estimate odds ratios (ORs) for each aspect of the main observed events.NIS data of 12,303 patients who underwent ORIF and 4310 patients who underwent CR were analyzed. Compared to CR, ORIF had an increased risk of longer hospital stay (adjusted OR [aOR] = 1.78, 95% confidence intervals [CIs] = 1.51-2.09), higher total medical cost (aOR = 2.57, 95% CI = 2.17-3.05), and hematoma development (aOR = 10.66, 95% CI = 1.43-75.59), but had a lower risk of having wound complications (aOR = 0.86, 95% CI = 0.79-0.93).Patients with mandibular condylar fractures who receive ORIF have greater risk of having an extended hospital stay, higher total medical costs, and hematoma development but lower risk of experiencing wound complications compared to those who receive CR.

Delayed Primary Closure of Traumatic Tension Wounds Using Plastic Straps and Kirschner Wires

Tension of the wound edges should be overcome with precise surgical planning, which is recognized as one of the major contributors to local complications by compromising circulation of the wound edges. In this article, it was aimed to present the clinical results of a surgical technique, in which the plastic straps and Kirschner wires are used for delayed primary closure of traumatic tension wounds. Depending on the assessment of the wound localization, wound dimension, and mobility of adjacent soft tissue, the technique was performed in 9 patients with a male to female ratio of 8:1. Gunshot injury was the leading cause (n = 5), and in most cases, the wounds were located at the lower extremities (n = 6). The mean time between performing the technique and closing the wound primarily and the mean hospitalization time were 4.8 ± 1.1 and 13.5 ± 3.9 days, respectively. In each case, wound closure and healing were achieved successfully without any serious complications. The presented technique provides advantages of using a low cost as well as a very simple equipment, improved and reliable stability during tightening process due to self-locking feature of the plastic straps, no donor site morbidity, short operating time with low rate of post-operative complications, and short hospitalization time. We recommend using this invaluable technique reliably for the treatment of traumatic tension wounds. However, further studies are needed for better evaluation of cosmetic and functional outcomes of the presented technique.