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Published on: January 23, 2018
Surgical treatment of displaced intraarticular pediatric condyle fractures
Aleš Vesnaver1, Vojko Didanovič1, Anže Birk1
1Department of Maxillofacial and Oral Surgery, University Medical Centre Ljubljana, Zaloška 2, 1000 Ljubljana, Slovenia.
Insights
Surgical treatment of displaced pediatric condyle fractures effectively restores temporomandibular joint (TMJ) anatomy and function. This approach promotes symmetrical facial growth, avoiding long-term adverse effects associated with conservative management.
Area of Science:
- Orthopedic Surgery
- Pediatric Dentistry
- Maxillofacial Surgery
Background:
- Conservative treatment of pediatric condyle fractures can lead to adverse effects on the temporomandibular joint (TMJ) and facial skeleton.
- Surgical intervention is analyzed for displaced intra-articular pediatric condyle fractures.
Purpose of the Study:
- To evaluate the outcomes of surgical treatment for displaced intra-articular condyle fractures in children.
- To assess the impact of surgery on TMJ function, facial symmetry, and condylar growth.
Main Methods:
- Open reduction and internal fixation (ORIF) with attention to the articular disc was performed on children with displaced intra-articular condyle fractures.
- Postoperative assessments included clinical evaluation of facial symmetry, mouth opening, TMJ pain, occlusion, and radiological assessment of fracture healing and condylar growth.
Main Results:
- Surgical treatment in 11 children (16 fractures) resulted in proper occlusion and maximal mouth opening (MMO) in all patients.
- Symmetrical growth and TMJ mobility were achieved in most patients, with only one experiencing mild asymmetry and limited mandibular movement.
- Minor complications included temporary facial nerve weakness and hardware issues, all resolved or managed successfully.
Conclusions:
- Surgical treatment effectively restores skeletal and soft-tissue anatomy in displaced intra-articular pediatric condyle fractures.
- This enables unaltered TMJ function and symmetrical growth of the condyles and facial skeleton.
- Surgical intervention is a viable option for managing complex pediatric condyle fractures.
Aim:
Conservative treatment of pediatric condyle fractures remains the generally accepted norm even today. However, longterm results of conservatively treated displaced pediatric condyle fractures often display adverse effects on the affected temporomandibular joint (TMJ), and also on the growing facial skeleton. We analyzed results of surgical treatment in pediatric intraarticular condyle fractures.
Patients And Methods:
Children with displaced intraarticular condyle fractures were treated surgically, with open reduction and internal fixation (ORIF). The articular disc was addressed in each case. Postoperatively, patients were controlled at 1 week, 1 month, 3-6 months, and yearly thereafter. Facial symmetry, maximal mouth opening (MMO), maximal lateropulsions, lateral chin deflection, TMJ pain, condylar translation, palpable pathological phenomena, occlusion and postoperative scars were assessed clinically. Fracture healing, condylar height, shape and growth were assessed radiologically. Possible surgical complications were also noted.
Results:
From 2016 through 2022, 14 children with 19 displaced intraarticular condyle fractures were treated surgically, of whom 11 children with 16 fractures enrolled in the survey. In all the fractures, the TMJ was opened, and all the fractures save one reduced and fixed. In 5 fractures (31 %), the articular disc was displaced and ruptured, and was reduced and sutured. The age range was 4-12 years (average 9.7 years). Follow up time was 2-8 years (average 5.1 years). All of the patients maintained proper occlusion and MMO. Only one patient with ORIF developed mild facial asymmetry, limited condylar translation, and limited contralateral lateropulsion of the mandible. In the patient where only exploration was performed, the condyle grew angulated (20O anteromedially) and its translation is slightly limited. In all the other patients, symmetrical growth and TMJ mobility were achieved. None of the patients presented with chewing difficulties or joint pain. There were 2 cases of postoperative facial nerve weakness, both of which completely resolved in 2 and 4 weeks. In 1 patient, the lag screw was removed after 2 months because of protrusion into the joint space. In another, a reoperation was performed 2 days after the initial surgery due to fragment malposition. No other intra- or postoperative complications were noted.
Conclusion:
Surgical treatment of displaced intraarticular pediatric condylar fractures restores skeletal and soft-tissue anatomy and thereby enables unaltered TMJ function and symmetrical growth of the condyles and the entire facial skeleton.
