Open reduction and internal fixation obtains favorable clinical and radiographic outcomes for pediatric mandibular condylar fractures

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.

Characteristics of pediatric mandibular condylar fractures in Southwest China: A single-center and 12-year retrospective study

BACKGROUND/AIM

Mandibular condylar fractures in pediatric patients may exhibit distinct epidemiological characteristics attributed to their unique growth and development phase, as well as various anatomical, physiological, biomechanical, and behavioral factors that differentiate them from adults. This study aimed to investigate the demographics, injurious factors, classifications, clinical manifestations, and treatments of pediatric mandibular condylar fractures, as well as the concomitant injuries in maxillofacial and other body parts.

MATERIALS AND METHODS

This retrospective study analyzed the clinical data of 189 pediatric patients with mandibular condylar fractures between 2011 and 2022. Variables investigated included age, gender, timing of onset, causes, classification of condylar fracture, concomitant injuries, clinical manifestations, and treatment modalities.

RESULTS

A total of 189 patients, a higher proportion of boys compared to girls was observed, with the highest incidence rate in children aged 1-3 years. They occurred primarily in July, June, and September as well as on Saturdays and Sundays. The most prevalent cause of mandibular condylar fractures was falls from heights in 73 patients (38.62%). Pediatric patients exhibited a higher susceptibility to condylar head fractures. A significant majority (81.48%) of these fractures were accompanied by soft tissue injuries in the maxillofacial region, with the chin being particularly vulnerable to injury. In addition, 61.90% of pediatric patients experienced fractures in other areas of the maxillofacial region, with the mandibular symphysis being the most commonly affected site. Dental trauma predominantly occurred in the anterior region (44.97%). Notably, a substantial proportion (28.04%) of cases also presented with multiple systemic injuries.

CONCLUSIONS

The characteristics of pediatric mandibular condylar fractures exhibit distinct features in terms of age, gender, timing of onset, etiology, location and type, the presence of concomitant maxillofacial soft/hard tissue injuries and multiple systemic injuries, as well as clinical manifestations and treatment modalities. Therefore, clinicians should pay special attention to the diagnosis and treatment of pediatric condylar fractures.

Complications of Mandibular Fracture Repair

Mandible fracture management has evolved dramatically. Therefore, the variety of surgical complications associated with mandibular fractures, and their incidences, have continued to change as well. This article aims to assess the most common and most concerning complications that can occur secondary to management of mandibular fractures by examining categories of complication types. This article also explores factors and techniques associated with reduced rates of complications as well as the management of complications.

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.

Indications and complications regarding titanium osteosynthesis in pediatric maxillofacial trauma: A scoping review and critical appraisal

With the advent of biodegradable osteosynthesis material, titanium osteosynthesis for ORIF in pediatric maxillofacial trauma is not as indisputable as before. The aim of this study was to conduct a scoping review to assess the indications, complications of ORIF with titanium osteosynthesis material in pediatric maxillofacial trauma. A systematic search was conducted in PubMed/MEDLINE, Embase, Web of Science, Cochrane Library, gray literature (ICTRP and clinicaltrials.gov) for studies published until April 2022. 3436 studies were screened and finally 13 articles, compromising a sample of 340 pediatric patients were included after full text reading. Reported complications were infection (6.5% of population), malocclusion (5% of population) and dental maleruption (8% of population). Influence on future growth could not be assessed due to short and heterogeneous follow-up periods. Eight of the thirteen studies concluded to a positive and predictable outcome using titanium ORIF for displaced/complex pediatric maxillofacial fractures. Results of this review suggest that titanium ORIF for maxillofacial fractures in the pediatric population is a reliable treatment. The surgeon must be committed to following these patients longitudinally. Interpreting the results should, however, be done with great care, as most articles have a medium to high risk of bias and limited follow-up.

Outcomes of functional treatment of condylar mandibular fractures with an articular impact: a retrospective study of 108 children

INTRODUCTION

The treatment of fractures of the mandibular condylar process remains controversial, especially in children. The aim of this study was to assess the long-term clinical and radiographic outcomes of functional treatments for mandibular condylar fractures with an articular impact.

MATERIALS AND METHODS

Young patients (< 15 years of age) presenting with either a unilateral or a bilateral mandibular fracture of the condylar process were included in this retrospective study. The clinical analysis focused on investigation of joint amplitudes at 1, 2, 6, 12, and 24 months after the beginning of the treatment, and at the end of their physical growth for the long-term study. Other clinical parameters included temporomandibular joint (TMJ) disorders and facial asymmetry. Photographs of patients and panoramic X-rays were assessed to identify any growth disorders at the end of the follow-up.

RESULTS

One hundred and eight patients were included in this study, and 33 patients who were no longer undergoing mandibular growth at the time of the last follow-up were included in the long-term study. The mean age at the time of the trauma was 9.33 years, and the mean follow-up was 82.2 months. A significant improvement was observed in the maximal mouth opening (MMO), diduction, and propulsion in the first months after the trauma, reaching 44.31 mm (p < 0.0001), 10.50 mm (p = 0.0001), and 6.33 mm (p = 0.01), respectively, at 6 months. Three patients experienced a clinical posterior vertical insufficiency, one of which required a surgical procedure, while four patients exhibited a ramus asymmetry of up to 10 mm, albeit with no clinical consequences. One case of TMJ ankylosis was noted.

CONCLUSION

Our study suggests that functional treatment is appropriate for fractures of the mandibular condyle with an articular impact in children, as it promotes mandibular growth and good functional recovery. Children have to be followed up, however, until completion of growth.