1
|
Fracture fragment of the condyle determines the ramus height of the mandible in children with intracapsular condylar fractures treated conservatively. Sci Rep 2022; 12:19924. [PMID: 36402809 PMCID: PMC9675802 DOI: 10.1038/s41598-022-24463-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 11/15/2022] [Indexed: 11/21/2022] Open
Abstract
This study aimed to explore and impart understanding of bone remodelling in children with intracapsular fractures treated conservatively. Records of children (less than 12 years), who sustained intracapsular fractures and treated conservatively, were retrieved consecutively for the period of March 2011 to February 2016. Data about age, gender, date of injury, dates of admission and discharge, mechanism of trauma, location and pattern of fracture, other mandibular fractures, treatment methods and time of review were recorded and analysed. Image dates of pre- and post-treatments, including date of review, were also recorded. A total of 22 patients complete their follow-up and show bone remodelling process. During their follow-up, all the displaced condylar fragments fused with the ramus stump at the displaced position. Regardless of the type of conservative procedure, both treatments cannot promote the spontaneous fracture reduction in patients with intracapsular condylar fractures. During follow-up, the absorption of the lateral process of the condyle after the closed treatment becomes close to the 'horizontal absorption', until the height (or articular surface) of the lateral condylar process dropped and aligned to the articular surface of the medial process. In children with intracapsular condylar fractures, the fracture fragment of the condyle determines the ramus height of the mandible. Closed treatment cannot restore the fracture fragment. If the height of the fracture fragments dropped remarkably, then open reduction and rigid internal fixation become more suitable.
Collapse
|
2
|
Du C, Xu B, Zhu Y, Zhu M. Radiographic evaluation in three dimensions of condylar fractures with closed treatment in children and adolescents. J Craniomaxillofac Surg 2021; 49:830-836. [PMID: 34218975 DOI: 10.1016/j.jcms.2021.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 03/19/2021] [Accepted: 04/11/2021] [Indexed: 11/30/2022] Open
Abstract
The study aimed at investigating a new three-dimensional classification of healing morphology in condylar fractures in children and adolescents after closed treatment, and establish its association with fracture type and clinical outcomes. The medical records of children and adolescents with condylar fracture were reviewed, retrospectively. The clinical outcomes were assessed by mandibular deviation during mouth opening, Helkimo anamnestic index (Ai), and Helkimo clinical dysfunction index (Di). The condylar healing morphology was evaluated through three-dimensional CT images after 1-2 years of follow-up. In total, 96 patients with 142 condylar fracture sites were included in the study. Condylar healing morphology was classified into three main patterns: unchanged (21.13%), spherical (62.68%), and irregular (16.19% - including the three subtypes triangular, L-shaped, and Y-shaped). There was a significant difference in the distribution of the three main healing patterns among various fracture types (p = 0.0227). Irregular patterns occurred more frequently in adolescents than in children. In unilateral fractures, no obvious association was found between condylar healing morphology and clinical outcomes, including mandibular deviation during mouth opening (p = 0.162), Ai (p = 0.0991) and Di (p = 0.25). Most patients healing in different condylar patterns reached a good clinical outcome after 1-2 years. Although the healing morphology of condylar fractures in children and adolescents remained abnormal, good clinical outcome was achieved over the 2-year follow-up. Therefore, closed treatment remains a good approach.
Collapse
Affiliation(s)
- Changxin Du
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
| | - Bing Xu
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
| | - Yanfei Zhu
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China.
| | - Min Zhu
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China.
| |
Collapse
|
3
|
Li MX, Xing X, Li ZB, Li Z. Classification and treatment strategies for condylar fractures in children. Br J Oral Maxillofac Surg 2020; 59:776-782. [PMID: 34127324 DOI: 10.1016/j.bjoms.2020.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 09/04/2020] [Indexed: 11/27/2022]
Abstract
In this study, we aimed to describe a classification method (position and displacement (PD) classification) and the corresponding treatment strategies for condylar fractures in children, based on the anatomical position and displacement of the fractures. Moreover, we aimed to explore the effect of the treatment strategies for condylar fractures in children. Such fractures were classified into the following three types by PD classification: condylar head fracture (type A), mildly displaced condylar neck and base fracture (type B), and severely displaced condylar neck and base fracture (type C). According to this classification, we proposed the corresponding treatment strategy of closed treatment for types A and B fractures and open treatment for type C fractures. Eighty-four patients who had 123 condylar fractures (type A = 97, type B = 16, type C = 10) were included in this study. Type A fractures showed the restoration of normal function with favourable remodelling in the condyles. Types B and C fractures had good function and symmetry in the condylar angle and height of the condylar neck. The PD classification and corresponding treatment strategies may serve as a better option for the clinical treatment of condylar fractures in children.
Collapse
Affiliation(s)
- M-X Li
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and the Key Laboratory of Oral Biomedicine Ministry of Education, Wuhan, China; The Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - X Xing
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and the Key Laboratory of Oral Biomedicine Ministry of Education, Wuhan, China; The Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Z-B Li
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and the Key Laboratory of Oral Biomedicine Ministry of Education, Wuhan, China; The Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Z Li
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and the Key Laboratory of Oral Biomedicine Ministry of Education, Wuhan, China; The Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, China.
| |
Collapse
|
4
|
Cooney M, O'Connell JE, Vesey JA, Van Eeden S. Non-surgical management of paediatric and adolescent mandibular condyles: A retrospective review of 49 consecutive cases treated at a tertiary referral centre. J Craniomaxillofac Surg 2020; 48:666-671. [DOI: 10.1016/j.jcms.2020.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/23/2020] [Accepted: 05/23/2020] [Indexed: 11/28/2022] Open
|
5
|
Zhu Y, Zou Y, Wang S, Du C, Xu B, Zhu M. Three-dimensional evaluation of condylar morphology after closed treatment of unilateral intracapsular condylar fracture in children and adolescents. J Craniomaxillofac Surg 2020; 48:286-292. [DOI: 10.1016/j.jcms.2020.01.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 01/16/2020] [Accepted: 01/25/2020] [Indexed: 10/25/2022] Open
|
6
|
Zhou HH, Lv K, Yang RT, Li Z, Yang XW, Li ZB. Abduction of the condyle head leads to condylar resorption: A radiologic study in children with intracapsular fractures. Int J Pediatr Otorhinolaryngol 2019; 123:168-174. [PMID: 31112840 DOI: 10.1016/j.ijporl.2019.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/11/2019] [Accepted: 05/11/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This study aimed to explore and make an understanding of absorption existed in children with intracapsular fractures. METHODS The sample was composed of all children (less than 12 years) who presented with intracapsular fractures within a 5-year period (January 2011 to April 2016). Data about age, gender, date of injury, dates of admission and discharge, transfer and/or referral by other clinics or local facilities, mechanism of trauma, location and pattern of fracture, associated injuries, centimeter of mouth opening, treatment methods, image date of pre- and post-treatment (including time of review), position of condylar head in pre-treatment or post-treatment, and absorption of condylar head in pre-treatment or post-treatment were recorded and analyzed. Data analysis included the Chi-Square test, the Fisher exact test, and the t-test. Logistic regression analysis was utilized to control the confounding variables. Probabilities of p less than 0.05 were considered statistically significantly different. RESULTS In the 5 years records retrieved during this study, 93 children patients sustained a total of 140 condylar head fractures. Statistical analysis revealed that abduction of condylar process in post-treatment was highly related to the condylar absorption. Patients associated with other mandibular fractures were highly related to abduction of condylar process. Patients with condylar head fractures, the closer to the medial of the condylar process, the higher the risk of abduction of the condyle. No matter what kind of treatment method is used, it is very difficult to reverse the abduction of condylar process in children patients with intracapsular fractures efficaciously. CONCLUSION Abduction of condylar process in post-treatment was highly related to the condylar absorption. Patients associated with other mandibular fractures were highly related to abduction of condylar process. Children patients who presented with condylar head fractures, the closer to the medial of the condylar process the higher the risk of abduction of the condyle. Neither surgery nor conservative treatment can recover the abduction of condylar process efficaciously.
Collapse
Affiliation(s)
- Hai-Hua Zhou
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST), Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, Hubei, People's Republic of China; Department of Oral and Maxillofacial Surgery, College and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, People's Republic of China.
| | - Kun Lv
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST), Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, Hubei, People's Republic of China; Department of Oral and Maxillofacial Surgery, College and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Rong-Tao Yang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST), Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, Hubei, People's Republic of China; Department of Oral and Maxillofacial Surgery, College and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Zhi Li
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST), Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, Hubei, People's Republic of China; Department of Oral and Maxillofacial Surgery, College and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Xue-Wen Yang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST), Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, Hubei, People's Republic of China; Department of Oral and Maxillofacial Surgery, College and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Zu-Bing Li
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST), Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, Hubei, People's Republic of China; Department of Oral and Maxillofacial Surgery, College and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, People's Republic of China
| |
Collapse
|
7
|
How Does the Remodeling Capacity of Children Affect the Morphologic Changes of Fractured Mandibular Condylar Processes After Conservative Treatment? J Oral Maxillofac Surg 2018; 76:1279.e1-1279.e7. [DOI: 10.1016/j.joms.2018.01.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/30/2018] [Accepted: 01/31/2018] [Indexed: 11/21/2022]
|
8
|
|
9
|
Hamada M, Nomura R, Yano H, Masui A, Kokomoto K, Nakano K, Yura Y. Mandibular condyle fracture in Japanese girl and 10-year follow-up findings. PEDIATRIC DENTAL JOURNAL 2017. [DOI: 10.1016/j.pdj.2017.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
10
|
Theologie-Lygidakis N, Chatzidimitriou K, Tzerbos F, Gouzioti A, Iatrou I. Nonsurgical management of condylar fractures in children: A 15-year clinical retrospective study. J Craniomaxillofac Surg 2016; 44:85-93. [DOI: 10.1016/j.jcms.2015.11.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 10/16/2015] [Accepted: 11/23/2015] [Indexed: 11/28/2022] Open
|
11
|
Kim JH, Nam DH. Closed reduction of displaced or dislocated mandibular condyle fractures in children using threaded Kirschner wire and external rubber traction. Int J Oral Maxillofac Surg 2015; 44:1255-9. [PMID: 26117724 DOI: 10.1016/j.ijom.2015.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 04/27/2015] [Accepted: 06/04/2015] [Indexed: 10/23/2022]
Abstract
Most surgeons agree that closed treatment provides the best results for condylar fractures in children. Nevertheless, treatment of the paediatric mandibular condyle fracture that is severely displaced or dislocated is controversial. The purpose of this study was to investigate the long-term clinical and radiological outcomes following the treatment of displaced or dislocated condylar fractures in children using threaded Kirschner wire and external rubber traction. This procedure can strengthen the advantage of closed reduction and make up for the shortcomings of open reduction. From March 1, 2005 to December 25, 2011, 11 children aged between 4 and 12 years with displaced or dislocated mandibular condyle fractures were treated using threaded Kirschner wire and external rubber traction under portable C-arm fluoroscopy. All patients had unilateral displaced or dislocated condylar fractures. The follow-up period ranged from 24 to 42 months (mean 29.3 months). Normal occlusion and pain-free function of the temporomandibular joint, without deviation or limitation of jaw opening, was achieved in all patients. This closed reduction technique in displaced or dislocated condylar fractures in children offers a reliable solution in preventing the unfavourable sequelae of closed treatment and the open technique, such as altered morphology, functional disturbances, and facial nerve damage.
Collapse
Affiliation(s)
- J H Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University Hospital, Cheonan, Chungcheongnam-do, Republic of Korea.
| | - D H Nam
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University Hospital, Cheonan, Chungcheongnam-do, Republic of Korea
| |
Collapse
|
12
|
Conservative treatment of bilateral condylar fractures in children: case report and review of the literature. Int J Pediatr Otorhinolaryngol 2014; 78:1557-62. [PMID: 25048856 DOI: 10.1016/j.ijporl.2014.06.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Revised: 06/25/2014] [Accepted: 06/28/2014] [Indexed: 11/23/2022]
Abstract
Two children (11 year old) with bilateral condylar fractures associated with symphysis fracture were conservatively treated. Both of them were followed up for about 1 year. A review of 21 cases of bilateral condylar fracture available in the literature revealed the younger the patient, the better the outcome of TMJ function or in radiographic remodeling. However, the longer the time elapsed, the higher the incidence of remodeling deformity and dysfunction. Thus, it must be better that a close follow-up of bilateral condylar fracture in children should be continued until the end of growth period.
Collapse
|
13
|
Schiel S, Mayer P, Probst F, Otto S, Cornelius CP. Transoral Open Reduction and Fixation of Mandibular Condylar Base and Neck Fractures in Children and Young Teenagers—A Beneficial Treatment Option? J Oral Maxillofac Surg 2013; 71:1220-30. [DOI: 10.1016/j.joms.2013.03.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Revised: 03/25/2013] [Accepted: 03/26/2013] [Indexed: 10/26/2022]
|
14
|
Bruckmoser E, Undt G. Management and outcome of condylar fractures in children and adolescents: A review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 114:S86-S106. [DOI: 10.1016/j.oooo.2011.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2011] [Revised: 07/25/2011] [Accepted: 08/23/2011] [Indexed: 10/28/2022]
|
15
|
Feng Z, Li L, He D, Yang C, Qiu Y. Role of retention of the condylar cartilage in open treatment of intracapsular condylar fractures in growing goats: three-dimensional computed tomographic analysis. Br J Oral Maxillofac Surg 2012; 50:523-7. [DOI: 10.1016/j.bjoms.2011.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 09/08/2011] [Indexed: 11/29/2022]
|
16
|
Chrcanovic BR. Open versus closed reduction: mandibular condylar fractures in children. Oral Maxillofac Surg 2012; 16:245-255. [PMID: 22842853 DOI: 10.1007/s10006-012-0344-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Accepted: 07/16/2012] [Indexed: 06/01/2023]
Abstract
PURPOSE The purpose of the study was to review the literature regarding the evolution of current thoughts on management of mandibular condylar fractures (MCFs) in children. METHODS An electronic search in PubMed was undertaken in May 2012. The titles and abstracts from these results were read to identify studies within the selection criteria. Eligibility criteria included studies published in English or German from the last 20 years (from 1992 onwards) reporting clinical series of MCFs in children and adolescents until the age of 18. RESULTS The search strategy initially identified 542 studies. The references from 1992 onwards totaled 339 articles. Twenty-seven studies were identified without repetition within the selection criteria. Additional hand-searching yielded two additional papers. CONCLUSIONS Pediatric MCFs require thoughtful consideration in management to avoid significant growth disturbance. Early treatment is indicated in order to improve the chances for favorable development. Long-term follow-up is required, in order to properly treat late complications that may appear. Coronal computed tomography is helpful in substantiating the correct final diagnosis. Many studies show that conservative treatment (CTR) has satisfactory long-term outcome of jaw function, occlusion, and facial esthetics, despite a high frequency of radiological aberrations. Surgery before puberty should be reserved for exceptional cases such as missile injuries, in cases with extensive dislocation and lack of contact between the fragments, in cases with multiple midfacial fractures, in which the mandible has to serve as a guide to reposition the midfacial bones, and in cases which the dislocation of the fractured stump creates a functional impediment that cannot be resolved by CTR. As the craniofacial skeleton becomes more adult-like in its form at about 12 years of age, the decreased remodeling capacity in the adolescents may occasionally result in abnormally shaped condylar heads or shortened ramus heights that may lead to persistent malocclusion. Thus, the indication of open reduction and internal fixation increases with age.
Collapse
|
17
|
Zhao YM, Yang J, Bai RC, Ge LH, Zhang Y. A retrospective study of using removable occlusal splint in the treatment of condylar fracture in children. J Craniomaxillofac Surg 2012; 42:1078-82. [PMID: 22939640 DOI: 10.1016/j.jcms.2012.07.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 07/04/2012] [Accepted: 07/05/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Although the concept of conservative treatment for paediatric condylar fracture is well understood, there is still a lack of a recognized method for treating child patients with a condylar fracture. The purpose of this study was to investigate the effect of the removable occlusal splint in treating condylar fractures in children and adolescents. MATERIALS AND METHODS Forty children and adolescents with condylar fracture, aged 3-16, were included in this study. A removable occlusal splint with varying thickness was fabricated according to the age, developmental stage of the mandible, and degree of condylar dislocation. This was worn for 1-3 months, accompanied by functional exercises. Follow-up was carried out by clinical observation and panoramic X-ray. RESULTS Clinically satisfactory results with good occlusion were obtained in all the patients, along with unimpaired function and normal growth and development of the mandible. The panoramic image showed remodelling and reconstruction of the fractured condyles. CONCLUSIONS Our results confirm that conservative treatment has a satisfactory clinical outcome in treating condylar fracture in children. The removable occlusal splint is a promising approach for treating condylar fracture in children and adolescents.
Collapse
Affiliation(s)
- Yu-ming Zhao
- Department of Paediatric Dentistry (Head: Prof. Man Qin), Peking University School and Hospital of Stomatology, Beijing, China
| | - Jie Yang
- Department of Paediatric Dentistry (Head: Prof. Man Qin), Peking University School and Hospital of Stomatology, Beijing, China
| | - Rui-chun Bai
- Department of Paediatric Dentistry (Head: Prof. Man Qin), Peking University School and Hospital of Stomatology, Beijing, China
| | - Li-hong Ge
- Department of Paediatric Dentistry (Head: Prof. Man Qin), Peking University School and Hospital of Stomatology, Beijing, China
| | - Yi Zhang
- Department of Oral and Maxillofacial Surgery (Head: Prof. Yi Zhang), Peking University School and Hospital of Stomatology, Beijing, China.
| |
Collapse
|
18
|
Pinto PS, Meoded A, Poretti A, Tekes A, Huisman TAGM. The unique features of traumatic brain injury in children. review of the characteristics of the pediatric skull and brain, mechanisms of trauma, patterns of injury, complications, and their imaging findings--part 2. J Neuroimaging 2012; 22:e18-41. [PMID: 22303964 DOI: 10.1111/j.1552-6569.2011.00690.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Traumatic brain injury (TBI) is a major cause of morbidity and mortality in children. The unique biomechanical, hemodynamical, and functional characteristics of the developing brain and the age-dependent variance in trauma mechanisms result in a wide range of age specific traumas and patterns of brain injuries. Detailed knowledge of the main primary and secondary pediatric injuries, which enhance sensitivity and specificity of diagnosis, will guide therapy and may give important information about the prognosis. In recent years, anatomical but also functional imaging methods have revolutionized neuroimaging of pediatric TBI. The purpose of this article is (1) to comprehensively review frequent primary and secondary brain injuries and (2) to give a short overview of two special types of pediatric TBI: birth related and nonaccidental injuries.
Collapse
Affiliation(s)
- Pedro S Pinto
- Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Baltimore, MD, USA
| | | | | | | | | |
Collapse
|
19
|
Lekven N, Neppelberg E, Tornes K. Long-Term Follow-Up of Mandibular Condylar Fractures in Children. J Oral Maxillofac Surg 2011; 69:2853-9. [DOI: 10.1016/j.joms.2011.03.019] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Accepted: 03/15/2011] [Indexed: 12/01/2022]
|
20
|
|
21
|
Deleyiannis FWB, Vecchione L, Martin B, Jiang S, Sotereanos G. Open Reduction and Internal Fixation of Dislocated Condylar Fractures in Children. Ann Plast Surg 2006; 57:495-501. [PMID: 17060728 DOI: 10.1097/01.sap.0000226943.79337.bf] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to investigate the long-term clinical and radiologic outcomes of treating dislocated condylar fractures sustained in childhood with open reduction and internal fixation (ORIF). Six children 14 years or younger with a condylar neck or subcondylar fracture with dislocation of the condyle from the glenoid fossa were treated with ORIF. Patients were followed for 27 to 92 months post-ORIF (mean: 67.6 months) with routine clinical and radiologic examinations. On the dislocated side, all patients radiographically showed signs of remodeling of the condylar process and shortening of the ramus. Subsequent to their fractures, 3 patients were classified with Angle class II malocclusion, retrognathism, and deviation of the mandibular symphysis. Four patients had objective and/or subjective signs of temporomandibular (TMJ) dysfunction. Until open surgery demonstrates a consistent functional advantage, nonsurgical management should be considered the first treatment option for the dislocated pediatric condylar fracture.
Collapse
Affiliation(s)
- Frederic W-B Deleyiannis
- Cleft and Craniofacial Center, Division of Plastic & Reconstructive Surgery, Department of Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | | | | | | | | |
Collapse
|
22
|
Condyle and Ramus-Condyle Unit Fractures in Growing Patients: Management and Outcomes. Oral Maxillofac Surg Clin North Am 2005; 17:447-53. [DOI: 10.1016/j.coms.2005.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
23
|
|
24
|
Abstract
Pediatric craniofacial fractures are distinct from adult fractures because of the anatomical differences that result in unique fracture patterns and challenges in management. The unanswered question remains the outcome with regards to subsequent growth and development. Upon review of all primary craniofacial fractures treated at the Children's Hospital of Philadelphia, the authors find that the majority are associated with favorable long-term outcome. Severe centrofacial bony and cartilaginous injury may result ingrowth and developmental anomalies in up to 40% of patients.
Collapse
Affiliation(s)
- Davinder J Singh
- Division of Plastic Surgery, University of Pennsylvania School of Medicine, Philadelphia 19104, USA
| | | |
Collapse
|
25
|
Thorén H, Hallikainen D, Iizuka T, Lindqvist C. Condylar process fractures in children: a follow-up study of fractures with total dislocation of the condyle from the glenoid fossa. J Oral Maxillofac Surg 2001; 59:768-73; discussion 773-4. [PMID: 11429737 DOI: 10.1053/joms.2001.23369] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE The purpose of this study was to investigate the long-term clinical and radiologic outcome of nonsurgically treated, dislocated condylar fractures sustained during childhood. PATIENTS AND METHODS Dislocated condylar process fractures were diagnosed in 34 children aged 15 years or younger from 1980 to 1991. Of these, 26 had been treated nonsurgically and were asked to participate in a follow-up examination. Eighteen patients, representing 69% of the total sample, took part in the study. All patients underwent a clinical investigation with special emphasis on temporomandibular joint (TMJ) function. The patients also underwent a radiologic investigation, focusing on fracture remodeling and symmetry of the mandible. RESULTS After a follow-up period ranging from 4.8 to 16.4 years (mean, 8.6 years), 56% had some subjective symptoms, and 72% had some objective signs of TMJ dysfunction. In general, however, the symptoms and signs of dysfunction were very slight. No correlation was observed between the method of nonsurgical treatment and the clinical results. Radiologic investigation showed incomplete remodeling (76.5%) and asymmetry of the mandible (64.7%) in most patients. The asymmetry was slight, however, and could not be observed clinically. CONCLUSIONS Conservative treatment of dislocated condylar process fractures in children results in satisfactory long-term outcome of jaw function despite a high frequency of radiologically noted aberrations. Soft diet with immediate mobilization seems to be the treatment of choice.
Collapse
Affiliation(s)
- H Thorén
- Department of Oral and Maxillofacial Surgery, Helsinki University Central Hospital, Helsinki, Finland.
| | | | | | | |
Collapse
|