Pediatric Mandibular Condylar Fractures With Concomitant Cervical Spine Injury: A Treatment Protocol for Prevention of Temporomandibular Joint Ankylosis

Mandibular Coronoid Process Hypertrophy: Diagnosis and 20-Year Follow-Up with CBCT, MRI and EMG Evaluations

Coronoid process hypertrophy (CPH) consists of an abnormal volumetric increment of the mandibular coronoid process; as this process grows gradually, the infratemporal space needed for the rotation and translation of the mandible is reduced, which results in a reduction of the range of mouth opening and lateral excursion, limiting mouth opening. The purpose of this case report was to describe a rare case of hypertrophy of coronoid processes with associated temporomandibular ankylosis, monitored for over 20 years. The patient was first visited when he had a facial trauma at the age of 4. Then he was followed through clinical, functional, instrumental, bi-dimensional and three-dimensional radiological evaluations up to the age of 24. Physical therapy was initiated at the age of 10 to improve the condition of the masticatory muscles, while at the age of 14, Transcutaneous Electrical Nerve Stimulations were performed to reduce muscle tension and, a bite plane was delivered to control the parafunctional activity of the jaw in the night and self-control instruction was provided for daytime habits. The adult patient has not accepted surgical intervention; thus, the future objective is to continue monitoring over the years to avoid a detrimental progression of the medical condition through physical and functional therapies while waiting for patient consent to surgery if needed.

Does closed treatment of paediatric mandibular condyle fractures result in restitutional remodelling?

The treatment of paediatric mandibular condylar fracture (PMCF) is typically non-operative. The purpose of this study was to determine if non-operative management of PMCF results in a new condylar process of normal morphology to regenerate after closed treatment (restitutional remodelling). The specific aim of the study was to observe restitutional remodelling (RM) in PMCF and review the literature. The investigators designed and implemented a retrospective study on paediatric patients (age<12) with unilateral or bilateral condyle fractures treated with non-operative treatment between January 2005 and July 2015. Patients with complete records and at least 1-year follow-up were included in the study. Primary outcome variable was RM and secondary outcome variables were occlusion, maximal incisal opening (MIO), displacement, infection, facial asymmetry, and signs of temporomandibular joint ankylosis (TMJA). The study evaluated 41 patients {n=57 PMCF, (m:f-35:6)} of unilateral (n=25) and bilateral (n=16) PMCF. Fractured condyles remodelled to normal morphology in all the cases at follow-up. The Wilcoxon test revealed a statistically significant difference in MIO from the preoperative value to postoperative (p=0.001). Occlusion (except 1) was satisfactory in all cases, at follow-up with no gross facial asymmetry. There was no sign of infection at the surgical site (anterior mandible). None of the patients showed signs of TMJA at follow-up. The result of the present study demonstrates that RM of condylar fracture occurs with non-operative management. Non-operative management should be the point of care in PMCF, owing to the rapid RM, bone regeneration, and satisfactory outcome. Review of the literature also supports closed treatment.

Comparison of outcome of open reduction and internal fixation versus closed treatment in pediatric mandible fractures-a retrospective study

The aim of the study was to compare the outcome and complications of open reduction and internal fixation (ORIF) with closed treatment, as well as to review the literature. This was a retrospective study on pediatric patients with mandible fracture. The primary objective was a comparison of outcomes in terms of bone healing, maximal incisal opening (MIO), and occlusion, and the secondary objective was to review complications. A total of 77 pediatric patients (age <12 years) were managed with closed treatment and 23 with ORIF. In all, 62 patients were found with a single fracture (22 patients with parasymphysis fracture and 21 with condyle fracture, followed by symphysis, angle, and body fracture) and 38 patients with more than one fracture, with symphysis and bilateral condyle fracture being the most common. Bone healing was observed in all the patients. Mean MIO was 26.9 ± 2.8 mm and 29.3 ± 1.7 mm in the closed and ORIF group, respectively, and the difference was statistically nonsignificant (p = 0.5). One patient (1.3%) had deranged occlusion, and mobility was observed in one patient (1.3%) in the closed treatment group. Infection and nerve paresthesia were not seen in any patient at follow-up. Although closed treatment is preferred, as it preserves the soft tissue and periosteum, a displaced mandible fracture especially with co-existing condylar fracture should be treated by ORIF.