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

When trauma bites back: a systematic review on direct orofacial macrotrauma and temporomandibular disorders

OBJECTIVES

Temporomandibular disorders (TMD) are musculoskeletal conditions with a multifactorial aetiology. The predictive role of direct orofacial macrotrauma in the development of TMD is considered controversial. This systematic review aims to elucidate the association between direct orofacial macrotrauma and TMD, and to identify potential factors involved in this relationship.

MATERIALS AND METHODS

A comprehensive literature search of PubMed, Embase, and Web of Science databases up to November 1, 2023, was performed in collaboration with a medical information specialist, identifying 2,047 unique studies. Of these, 139 met the inclusion criteria of this investigation.

RESULTS

Our synthesis of the literature indicates a consistent association between TMD and direct orofacial macrotrauma in adults, while this relationship appears less defined in paediatric and adolescent populations. The association shows robustness across various TMD diagnoses and trauma locations, remaining not only immediately following the direct orofacial macrotrauma but also after long time, despite other interventions. These outcomes could be due to the physical effect of the trauma, but they might be associated with the psychosocial effect of the trauma as well.

CONCLUSIONS

The evidence supports a robust, but complex, association between direct orofacial macrotrauma and TMD.

CLINICAL RELEVANCE

This finding underscores the importance of considering both physical and psychosocial sequelae of trauma in the clinical management of direct orofacial macrotrauma and TMD.

Management of Pediatric Mandibular Condyle Fractures: A Literature Review

This narrative review evaluates the literature on the management of mandibular condyle fractures in growing patients. It aims to illustrate some fundamental biological principles and to offer a series of considerations applicable to clinical practice. The discussion is based on 116 papers published in PubMed and two relevant textbooks. Condylar fractures may be overlooked, especially in pre-scholar children, where compliance is usually reduced. However, these injuries can have disabling sequelae such as ankyloses, facial deformities, malocclusion, and chronic pain in some patients if not diagnosed and managed correctly. Due to their significance, mandibular condyle fractures in children are a subject of considerable clinical interest. As of today, there is consensus about their treatment. Four management options are available: expectative (analgesia, soft food and follow-up), functional protocols (guiding elastics, orthodontic appliances and exercises), maxillomandibular fixation (MMF), and open reduction and internal fixation (ORIF). Nondisplaced and minimally displaced fractures should be treated expectantly; severely displaced non-comminuted fractures can be safely operated on if the expertise is available, even in patients with deciduous dentition. Moderately displaced fractures can be managed with functional protocols or operatively, depending on the background and know-how of the specialist. Functional protocols can achieve good outcomes, especially in patients with deciduous dentition. MMF should be foregone in children due to its many drawbacks.

Management of Mandibular Condyle Fractures in Pediatric Patients: A Multicentric Retrospective Study with 180 Children and Adolescents

Background: Mandibular condyle fractures in pediatric patients can lead to crippling sequelae such as ankylosis, pain and facial deformity if not managed properly. However, there is no consensus on the best approach for treating these fractures in children. Objective: This study aimed to describe the management of mandibular condyle fractures in growing patients across 14 maxillofacial departments worldwide. Methods: A retrospective multicenter study was conducted on children and adolescents aged 0 to 16 who had at least one mandibular condyle fracture. This study included patients who underwent expectant, closed, or open management and were treated over an 11-year period. Results: 180 patients had at least one mandibular condyle fracture, and 37 had a second condylar fracture. One hundred sixteen patients (65%) were males, and 64 (35%) were females (ratio 1.8:1). An expectant strategy was chosen in 51 (28%) patients, a closed treatment-stand-alone maxillomandibular fixation (MMF)-in 47 (26%), and open reduction and internal fixation (ORIF) was performed in 82 (46%) patients. The management varied significantly between the different departments (p < 0.0001). Significant differences were also identified between the fracture type (non-displaced, displaced or comminuted) and the management of the 180 patients with a single condylar fracture. Out of 50 non-displaced fractures, only 3 (6%) had ORIF, 25 (50%) had expectant management, and 22 (44%) had MMF. Out of 129 displaced fractures, 79 (62%) had ORIF, 25 (19%) had a soft diet, and 25 (19%) had MMF. Conclusions: Expectative management, MMF, and ORIF were all effective in treating pediatric mandibular condyle fractures, with a low incidence of complications and asymmetry.

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.

Characteristics, Treatment, and Prognosis of Pediatric Symphyseal/Parasymphyseal-Condylar Fractures

BACKGROUND

Pediatric condylar fractures combined with symphyseal or parasymphyseal fractures are common but challenging to manage. The authors present fracture characteristics, propose a treatment algorithm, and evaluate the treatment prognosis of pediatric symphyseal/parasymphyseal-condylar fractures.

METHODS

A retrospective review was conducted on pediatric patients who underwent treatment for symphyseal/parasymphyseal-condylar fractures in a trauma center between January of 2006 and January of 2021. Demographic and fracture characteristics were recorded. Complications and functional evaluations, including maximum interincisal opening, Helkimo anamnestic index, and clinical dysfunction index, were assessed after at least 1 year of follow-up.

RESULTS

After screening, 104 participants met the inclusion criteria. Among them, 50.96% received open reduction and internal fixation for symphyseal/parasymphyseal fractures and closed treatment for condylar fractures, 45.19% were treated by liquid diet and functional exercise, and the remaining 3.85% with severe malocclusion were treated with the assistance of orthodontic appliances. During follow-up, the average maximum interincisal opening of the patients increased from 17 ± 6.29 mm to 41.64 ± 6.33 mm. No subjective symptoms were observed in 86.54% of the patients and 79.81% showed no or mild clinical symptoms. Except for 1 patient who developed temporomandibular joint ankylosis, no other severe complication was reported. Postfracture remodeling of the nonfractured condyle was noted in 3 cases.

CONCLUSIONS

Pediatric symphyseal/parasymphyseal-condylar fractures present unique biomechanical and anatomic challenges that require special consideration during management. In this study, satisfactory functional prognosis was achieved following implementation of the treatment algorithm.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, IV.

Paediatric Mandibular Fracture Management - A Seven Year Retrospective Study

Introduction

Mandibular fractures are one of the most frequent and complex types of traumatic injuries of the maxillofacial region in children. Given significant long-term sequelae of inappropriate healing, adequate diagnosis and choice of management, which takes into account the patient's age and fracture characteristics, are paramount.

Methods

The data for this study were obtained from the medical records of patients treated in the Department of Surgical Dentistry and Paediatric Maxillofacial Surgery of the Bogomolets National Medical University from 2014 to 2020. Age, gender, fracture pattern and surgical treatment methods performed in these patients were recorded and analysed.

Results

A total of 302 children with 376 traumatic fractures of the mandible were managed during the study period. The largest number of fractures was found in the condylar processes region, 42%, and in the body of the mandible, 40%. The majority of patients were males and in the 13-17 age group (147 [49%] cases). Tigerstedt's maxillary-mandibular fixation splint was used in the majority of cases, alone or in the combination with open or internal fixation.

Discussion

Whilst the most common type of immobilisation in children in our series was Tigerstedt's maxillary-mandibular fixation splint, its use is limited to the variable bite period. Alternative fixation options are discussed.