Condylar fracture in a paediatric patient undergoing conservative and functional treatment: Case report

Trauma to the jaw can lead to fracture of the mandibular condyle. Prevalence in children is low and treatment should focus on possible long-term effects on facial bone and soft tissue growth. Trauma can result in dysfunction, facial asymmetry, mandibular retraction, dysfunction and stiffness of the temporomandibular joint. Clinical examination and imaging tests are essential to obtain an accurate diagnosis and an effective treatment to avoid possible complications. Treatment can be surgical or non-surgical, but non-surgical treatment is the method of choice in most cases. The aim of this study is to report a case of mandibular condylar fracture in a pediatric patient who underwent conservative and functional care who, with adequate monitoring by the Maxillofacial Surgery and Traumatology team and family, showed complete remodeling of the fractured bone and total recovery of the dental occlusion. Treatment in pediatric patients through conservative management allows an adequate range of mandibular movement and remodeling at the fracture site, but patient and family adherence to treatment is very important to obtain good results.

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Are You Overlooking Fractures of the Mandibular Condyle?

PEDIATRICS ◽

10.1542/peds.79.4.639 ◽

1987 ◽

Vol 79 (4) ◽

pp. 639-641

Author(s):

ROBERT W. T. MYALL ◽

GEORGE K. B. SANDOR ◽

CRYSTAL E. B. GREGORY

Keyword(s):

Soft Tissue ◽

Invasive Surgery ◽

Tissue Injury ◽

Soft Tissue Injury ◽

Mandibular Condyle ◽

Facial Asymmetry ◽

Dental Occlusion ◽

Condylar Fracture ◽

Oral And Maxillofacial Surgeon ◽

Rapid Deceleration

Fractures of mandibular condyle may be overlooked because attention is often focused on readily apparent soft tissue injury such as lacerations and abrasions. Clinical and radiographic signs are often subtle, but the injuries caused by rapid deceleration and listed in Table 2 will serve to alert the pediatrician to the possibility of such fractures. All children in these circumstances should be carefully examined for dental occlusion and the preauricular area palpated to help formulate a clinical diagnosis. Additional evidence is gained from the finding of deviation or limitation of the jaw upon opening or edema in the preauricular area. If any of these yield abnormal findings, a good quality series of mandibular radiographs will be needed to confirm the diagnosis. Overlooking a condylar fracture may commit a child to unsightly facial asymmetry, marked malocclusion, or ankylosis requiring invasive surgery for correction. Consultation with an oral and maxillofacial surgeon or other interested specialist should be sought while the patient is still in the emergency room.

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Surgical Reduction of Symphysis Fracture and Spontaneous Repositioning of the Mandibular Condyle: A Case Report

SOJ Dental and Oral Disorder ◽

10.53902/sojdod.2021.01.000512 ◽

2021 ◽

Vol 1 (3) ◽

Author(s):

Claudemir de Carvalho

Keyword(s):

Physical Examination ◽

Maxillofacial Surgery ◽

Mandibular Condyle ◽

Mouth Opening ◽

Dental Occlusion ◽

Glenoid Cavity ◽

Mandibular Movement ◽

Mandibular Symphysis ◽

Surgical Reduction ◽

Condyle Fracture

The condylar process is a more fragile area, which is usually fractured by indirect trauma. The objective of this study is to report the case of a 10-year-old patient who presented to the Maxillofacial Surgery and Traumatology Service of the Regional Hospital of Vale do Paraíba, in Taubaté-SP, Brazil. Physical examination revealed limited mandibular movement with painful symptoms, crossbite, and upper incisor avulsion. A face tomography showed a fracture of the mandibular symphysis (right side) and a fracture of the left condyle. Surgical reduction of the mandibular symphysis fracture was performed. After exposure and reduction of bone segments, maxillomandibular block, rigid internal fixation and conservative treatment for condyle fracture were performed. A soft liquid diet and weekly outpatient follow-up was adopted for the first two months. After 15 days of surgery, the patient had mild edema, slight limitation in mouth opening, sutures without dehiscence and without signs of infection. In the first control tomography, the treated fracture was adequately reduced and the fractured condyle remained with medial displacement in the glenoid cavity. After one year, on physical examination, the patient presented satisfactory dental occlusion, preserved mandibular movements and no signs of nerve damage. The tomography showed the fracture consolidated, and the left mandibular condyle well positioned in the glenoid cavity. After two years, the third tomography was performed, showing remodelling of the left mandibular condyle.

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Orthopedically Induced Condylar Growth in a Patient with Hemifacial Microsomia

The Cleft Palate-Craniofacial Journal ◽

10.1597/1545-1569_2003_040_0645_oicgia_2.0.co_2 ◽

2003 ◽

Vol 40 (6) ◽

pp. 645-650 ◽

Cited By ~ 1

Author(s):

S. Sidiropoulou ◽

K. Antoniades ◽

G. Kolokithas

Keyword(s):

Soft Tissues ◽

Early Stage ◽

Three Dimensional ◽

Mandibular Condyle ◽

Mouth Opening ◽

Facial Asymmetry ◽

Dental Occlusion ◽

Hemifacial Microsomia ◽

Functional Therapy ◽

Bone Apposition

Objective Hemifacial microsomia is a congenital abnormality that causes three-dimensional facial asymmetry, affection of the dental occlusion, and failure of growth of the midface in the growing child. This report outlines orthopedically induced condylar growth in a patient with hemifacial microsomia. Patient A 7-year-old girl with hemifacial microsomia, complete absence of the left mandibular condyle, and severe facial asymmetry was treated orthopedically in an early stage by means of a functional appliance. Functional therapy was instituted to stretch the deficient soft tissues to guide and promote skeletal growth and stimulate the affected areas. The treatment was completed with fixed appliances. Results The effect of the therapy was an excessive change in condylar growth in the affected side. Facial asymmetry was corrected and a symmetric mouth opening was established. Conclusions The treatment of patients with hemifacial microsomia should be initiated early enough so that the stimulus could in some degree normalize the deficient tissues and induce bone apposition, and in some cases surgical intervention could be avoided.

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MANDIBULAR CONDYLE FRACTURES

The Professional Medical Journal ◽

10.29309/tpmj/2016.23.06.1611 ◽

2016 ◽

Vol 23 (06) ◽

pp. 705-708

Author(s):

Syed Ghazanfar Hassan ◽

Dr. Salman Shams ◽

Mujeeb Rehman ◽

Suneel Kumar

Keyword(s):

Maxillofacial Surgery ◽

Mandibular Condyle ◽

University Hospital ◽

Condylar Fracture ◽

Common Etiology ◽

The Common ◽

Condyle Fracture ◽

Surgery Department ◽

Condylar Fractures ◽

Department Faculty

Objectives: To analyze frequency, gender, age, cause of injury and type/locationof Condylar fracture among patients reported at Liaquat university hospital Hyderabad. Settingof Study: This study was conducted at Oral & Maxillofacial Surgery Department, Faculty ofDentistry, Liaquat University Hospital, and Hyderabad. Period: 1st February 2013 to 31st January2015. Methodology: The statistics of 108 patients both males and females who had beenaffected with mandibular Condyle fracture were prospectively reviewed. Patient’s data includinggender, age, cause of injury, type of Condylar fracture were recorded on Proformas and thenprospectively analyzed. Results: Out of 108 patients 81(75%) male and 27 (25%) female wereaffected with mandibular Condylar fracture. The common age group was 2nd decade of life(11-20 years). Most common cause of injury was fall in 51 cases (47.2%) followed by RTA in43 cases (39.8%). Sub condylar fracture was most common type of fracture occurred i.e in56 cases (51.8%). Conclusion: Children’s are commonly affected with mandibular Condylefracture & fall was the most common etiology in our study sample that explains the associationbetween fall and Condylar trauma. The second common etiological factor was Road trafficaccident for Sub condylar fractures in our study sample.

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Parathyroid hormone promotes cartilage healing after free reduction of mandibular condylar fractures by upregulating Sox9

Experimental Biology and Medicine ◽

10.1177/15353702211027114 ◽

2021 ◽

pp. 153537022110271

Author(s):

Yuanyuan Jia ◽

Liuqin Xie ◽

Zhenglong Tang ◽

Dongxiang Wang ◽

Yun Hu ◽

...

Keyword(s):

Parathyroid Hormone ◽

Internal Fixation ◽

Early Stage ◽

Rabbit Model ◽

Mandibular Condyle ◽

Fracture Site ◽

Control Group ◽

Condylar Cartilage ◽

Cartilage Healing ◽

Experimental Group

After high fractures of the mandibular condyle, the insufficient blood supply to the condyle often leads to poor bone and cartilage repair ability and poor clinical outcome. Parathyroid hormone (PTH) can promote the bone formation and mineralization of mandibular fracture, but its effects on cartilage healing after the free reduction and internal fixation of high fractures of the mandibular condyle are unknown. In this study, a rabbit model of free reduction and internal fixation of high fractures of the mandibular condyle was established, and the effects and mechanisms of PTH on condylar cartilage healing were explored. Forty-eight specific-pathogen-free (SPF) grade rabbits were randomly divided into two groups. In the experimental group, PTH was injected subcutaneously at 20 µg/kg (PTH (1–34)) every other day, and in the control group, PTH was replaced with 1 ml saline. The healing cartilages were assessed at postoperative days 7, 14, 21, and 28. Observation of gross specimens, hematoxylin eosin staining and Safranin O/fast green staining found that every-other-day subcutaneous injection of PTH at 20 µg/kg promoted healing of condylar cartilage and subchondral osteogenesis in the fracture site. Immunohistochemistry and polymerase chain reaction showed that PTH significantly upregulated the chondrogenic genes Sox9 and Col2a1 in the cartilage fracture site within 7–21 postoperative days in the experimental group than those in the control group, while it downregulated the cartilage inflammation gene matrix metalloproteinase-13 and chondrocyte terminal differentiation gene ColX. In summary, exogenous PTH can stimulate the formation of cartilage matrix by triggering Sox9 expression at the early stage of cartilage healing, and it provides a potential therapeutic protocol for high fractures of the mandibular condyle.

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Effects of the condylar process fracture on facial symmetry in rats submitted to protein undernutrition

Acta Cirurgica Brasileira ◽

10.1590/s0102-86502011000200003 ◽

2011 ◽

Vol 26 (2) ◽

pp. 88-93 ◽

Cited By ~ 3

Author(s):

Lucimar Rodrigues ◽

Luciana Corrêa ◽

João Gualberto de Cerqueira Luz

Keyword(s):

Serum Proteins ◽

Mandibular Condyle ◽

Median Line ◽

Condylar Fracture ◽

Fracture Group ◽

Facial Symmetry ◽

Maxilla And Mandible ◽

The Right ◽

Condyle Fracture ◽

Cephalometric Measurements

PURPOSE: To investigate the facial symmetry of rats submitted to experimental mandibular condyle fracture and with protein undernutrition (8% of protein) by means of cephalometric measurements. METHODS: Forty-five adult Wistar rats were distributed in three groups: fracture group, submitted to condylar fracture with no changes in diet; undernourished fracture group, submitted to hypoproteic diet and condylar fracture; undernourished group, kept until the end of experiment, without condylar fracture. Displaced fractures of the right condyle were induced under general anesthesia. The specimens were submitted to axial radiographic incidence, and cephalometric mensurations were made using a computer system. The values obtained were subjected to statistical analyses among the groups and between the sides in each group. RESULTS: There was significative decrease of the values of serum proteins and albumin in the undernourished fracture group. There was deviation of the median line of the mandible relative to the median line of the maxilla, significative to undernutrition fracture group, as well as asymmetry of the maxilla and mandible, in special in the final period of experiment. CONCLUSION: The mandibular condyle fracture in rats with proteic undernutrition induced an asymmetry of the mandible, also leading to consequences in the maxilla.

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Bioactive Ceramic Scaffolds for Bone Tissue Engineering by Powder Bed Selective Laser Processing: A Review

Materials ◽

10.3390/ma14185338 ◽

2021 ◽

Vol 14 (18) ◽

pp. 5338

Author(s):

Nikhil Kamboj ◽

Antonia Ressler ◽

Irina Hussainova

Keyword(s):

Bone Tissue ◽

Laser Processing ◽

Selective Laser Sintering ◽

Fracture Site ◽

Tissue Growth ◽

Powder Bed ◽

Bioactive Scaffolds ◽

Bioactive Ceramics ◽

Binder Free ◽

Calcium Silicates

The implementation of a powder bed selective laser processing (PBSLP) technique for bioactive ceramics, including selective laser sintering and melting (SLM/SLS), a laser powder bed fusion (L-PBF) approach is far more challenging when compared to its metallic and polymeric counterparts for the fabrication of biomedical materials. Direct PBSLP can offer binder-free fabrication of bioactive scaffolds without involving postprocessing techniques. This review explicitly focuses on the PBSLP technique for bioactive ceramics and encompasses a detailed overview of the PBSLP process and the general requirements and properties of the bioactive scaffolds for bone tissue growth. The bioactive ceramics enclosing calcium phosphate (CaP) and calcium silicates (CS) and their respective composite scaffolds processed through PBSLP are also extensively discussed. This review paper also categorizes the bone regeneration strategies of the bioactive scaffolds processed through PBSLP with the various modes of functionalization through the incorporation of drugs, stem cells, and growth factors to ameliorate critical-sized bone defects based on the fracture site length for personalized medicine.

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Relationship of chronic rhinosinusitis with dental malocclusion: a prospective study

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20202215 ◽

2020 ◽

Vol 6 (6) ◽

pp. 1145

Author(s):

Jayant K. Sonone ◽

Gaurav S. Tikar ◽

Pallavi G. Thakare ◽

Sushil N. Meshram

Keyword(s):

Chronic Rhinosinusitis ◽

Social Acceptance ◽

Facial Asymmetry ◽

Public Health Issue ◽

Dental Occlusion ◽

Cross Sectional ◽

Anterior Crowding ◽

A Prospective Study ◽

Relationship Of ◽

Dental Malocclusion

Background: The purpose of this study was to find the effect of chronic rhinosinusitis on dental malocclusion. A malocclusion is defined as an irregularity of the teeth or a mal relationship of the dental arches beyond the range of what is accepted as normal. Malocclusion may not be life-threatening, but it is an important public health issue as it compromises the health of oral tissues and also can lead to psychological and social problems. There are numerous studies in the literature about prevalence of the dental malocclusion but there is no study regarding association of CRS and malocclusion. Several factors related to malocclusion, such as anterior crowding, midline malalignment, and facial asymmetry, have strong effects on the perception of facial aesthetics, which influence the psychological development and in turn, influence social acceptance and self‑perception.Methods: This was a prospective cross-sectional observational study was conducted from September 2015 to August 2017 and 57 patients with diagnosis of having chronic sinusitis, were evaluated for dental occlusion. Malocclusion is then classified by angle’s classification. Results: Most patients of chronic rhinosinusitis had dental malocclusion in grade II, followed by grade I, then grade III.Conclusions: While treating the patients of CRS one must keep in mind that he may have class II malocclusion which may cause gum disease, poor oral hygiene, impaired speech, mastication and aesthetics of face and need orthodontics management as well.

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Oral Rehabilitation of Patients with Ameloblastoma of the Mandible. Clinical Results in Three Patients with Different Bone Reconstruction Techniques

The Open Dentistry Journal ◽

10.2174/1874210601812011107 ◽

2018 ◽

Vol 12 (1) ◽

pp. 1107-1112

Author(s):

Shiva Raoufi-Danner ◽

Sterwin Carl ◽

Abtahi Jahan

Keyword(s):

Iliac Crest ◽

Facial Asymmetry ◽

Clinical Results ◽

Wide Resection ◽

Mandibular Movement ◽

Oral Rehabilitation ◽

Fibula Free Flap ◽

Different Types ◽

High Level ◽

Bone Height

Background: Ameloblastoma is the second most common odontogenic tumor. It shows a locally aggressive behavior, with a high level of recurrence. Wide resection of the jaw is recommended for treatment of ameloblastoma. However, radical surgery causes an abnormal mandibular movement, facial asymmetry, and masticatory dysfunction. Methods: Three cases of different types of ameloblastoma is presented, with different reconstruction techniques including Non-Vascularized Bone Graft (NVBG), Osteocutaneous Fibula Free Flap (OFFF), and Deep Circumflex Iliac Artery flap (DCIA). Results: In all three cases the tumor site was successfully reconstructed to obtain very good esthetic results as well as functional oral rehabilitation with implants and fixed prosthetics for optimal masticatory function. Conclusion: For reconstruction of the mandible, we prefer bone grafts from the iliac crest. The natural curvature and variable bone height offer a very good reconstruction of the defect.

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Is Perpendicular Double Two-Hole Plates Fixation Superior to Single Four-Hole Plate Fixation to Treat Mandibular Symphysis Fracture?—A Finite Element Study

Applied Sciences ◽

10.3390/app11188629 ◽

2021 ◽

Vol 11 (18) ◽

pp. 8629

Author(s):

Li-Ren Chang ◽

Ya-Pei Hou ◽

Ting-Sheng Lin

Keyword(s):

Finite Element ◽

Plate Fixation ◽

Mandibular Condyle ◽

Fracture Site ◽

Von Mises Stress ◽

Stress Concentrations ◽

Element Analysis ◽

Mandibular Symphysis ◽

Lower Border ◽

Von Mises

The effectiveness of a single four-hole plate (S4HP), perpendicularly oriented four-hole and two-hole plate (Per4H2HP), and perpendicularly oriented double two-hole plate (PerD2HP) for the fixation of a mandibular fracture was studied. A finite element analysis of the mandibular symphysis fractures treated with S4HP, Per4H2HP, and PerD2HP was performed. All surface nodes were fixed in the mandibular condyle region and occlusal muscle forces were applied. The maximal von Mises stress (MaxVMS) values of the plates, screws and screw holes were investigated. The displacement of the fracture site on the lower border of the mandibular symphysis was recorded. The displacement on the lower border of the fracture sites in the S4HP group was greater than that in the Per4H2HP group and the PerD2HP group. There was no eversion at the fracture site among all groups. Both the S4HP and Per4H2HP groups showed stress concentrations on the screws close to the fracture site. The MaxVMS increased when the number of screw holes on the mandibular anterior lower border decreased. The displacement of the fracture site and eversion with Per4H2HP and PerD2HP were far lower than those with S4HP. PerD2HP is a stable and green fixation technique for mandibular symphysis fractures.

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