Dislocated pediatric condyle fractures - should conservative treatment always be the rule?

J Craniomaxillofac Surg. 2020 Oct;48(10):933-941. doi: 10.1016/j.jcms.2020.08.001. Epub 2020 Aug 14.

Abstract

Aim: The results of conservative treatment of pediatric dislocated (luxative) condyle fractures are usually unsatisfactory. We therefore decided to present and analyze the results of surgical treatment of these fractures.

Patients and methods: Children with dislocated condyle fractures were treated surgically, with the approach always including opening the temporomandibular joint (TMJ). Postoperatively, patients had regular controls at 1 week, 1 month, 3 months, and 6 months, and then yearly thereafter. At each control visit, facial symmetry, maximal mouth opening, lateral chin deflection upon mouth opening, TMJ pain, condylar motion, palpable pathological phenomena, and occlusion were all checked clinically. Healing of the fracture site, condylar height, shape and growth were assessed on panoramic radiographs. Possible surgical complications were noted: temporary facial nerve palsy, development of a parotid salivary fistula, disturbance of auricle sensibility due to injury of the greater auricular nerve, miniplate fracture, intraoperative bleeding, postoperative hematoma formation, infection, and reoperation due to fragment malposition. The postoperative scars were assessed.

Results: Over the 6-year period from 2013 until the end of 2018, seven children with dislocated condyle fractures were treated surgically. Six of the seven patients were treated with open reduction and internal fixation, and the plates and screws were deliberately not removed. The age range of the patients was 1.5-14 years (average 6.1 years). Follow-up time was 15 months to 6 years. No growth disturbances or facial asymmetries were seen over this follow-up period, with all patients maintaining proper occlusion, joint movement, and mouth opening. Fracture healing and condylar growth were clearly demonstrated with serial control panoramic radiographs. Condylar height asymmetry was observed only in one case, in which only reduction of the fracture with no fixation was performed. In all other cases, condylar height was symmetric. None of the children presented with chewing difficulties or joint pain. No intra- or postoperative surgical complications were noted. The preauricular scars were all very discreet, and none of the patients or parents complained about them.

Conclusion: Surgical treatment in cases of dislocated (luxative) condylar fractures in children and small infants restores anatomy and thus securely enables further symmetric growth of the condyles, mandible, and the entire facial skeleton.

Keywords: Conservative fracture treatment; Facial symmetry; Pediatric condyle fracture; Surgical fracture treatment.

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Conservative Treatment
  • Follow-Up Studies
  • Fracture Fixation, Internal
  • Humans
  • Infant
  • Joint Dislocations / diagnostic imaging*
  • Joint Dislocations / surgery*
  • Joint Dislocations / therapy*
  • Mandibular Condyle / diagnostic imaging
  • Mandibular Condyle / surgery
  • Mandibular Fractures / diagnostic imaging*
  • Mandibular Fractures / surgery*
  • Treatment Outcome