Prospective Evaluation of Closed Treatment of Nondisplaced and Nondislocated Mandibular Condyle Fractures Versus Open Reposition and Rigid Fixation of Displaced and Dislocated Fractures in Children

Landes, Constantin A.; Day, Kai; Glasl, Bettina; Ludwig, Björn; Sader, Robert; Kovács, Adorján F.

doi:10.1016/j.joms.2007.06.667

« Previous Next »Journal of Oral and Maxillofacial Surgery
Volume 66, Issue 6 , Pages 1184-1193, June 2008

Prospective Evaluation of Closed Treatment of Nondisplaced and Nondislocated Mandibular Condyle Fractures Versus Open Reposition and Rigid Fixation of Displaced and Dislocated Fractures in Children

Constantin A. Landes, MD, DMD
- Assistant Professor, Oral-, Maxillofacial and Plastic-Facial Surgery, Frankfurt University Medical Center, Frankfurt, Germany.
- Address correspondence to Dr Landes: Oral-, Maxillofacial and Plastic-Facial Surgery, Frankfurt University Medical Center, Theodor-Stern-Kai 7, 60596 Frankfurt, Germany
Kai Day, DMD
- Research Fellow, Oral-, Maxillofacial and Plastic-Facial Surgery, Frankfurt University Medical Center, Frankfurt, Germany.
Bettina Glasl, DMD
- Consultant, Department of Orthodontics, Carolinum Foundation and Private Clinic, Frankfurt, Germany.
Björn Ludwig, DMD
- Consultant, Department of Orthodontics, Carolinum Foundation and Private Clinic, Frankfurt, Germany.
Robert Sader, MD, DMD, PhD
- Professor and Chairman, Oral-, Maxillofacial and Plastic-Facial Surgery, Frankfurt University Medical Center, Frankfurt, Germany.
Adorján F. Kovács, MD, DMD, PhD
- Professor, Oral-, Maxillofacial and Plastic-Facial Surgery, Frankfurt University Medical Center, Frankfurt, Germany.

Purpose

The purpose of the study was to evaluate open reposition and internal fixation of displaced or dislocated child mandibular condyle fractures, and closed treatment of nondisplaced, nondislocated fractures of the condyle with long-term follow-up outcomes.

Patients and Methods

Twenty-four patients less than 14 years of age were included from 2000 to 2005. Classes II to V after Spiessl and Schroll, eg, displaced or dislocated fractures were surgically treated; Class I and VI nondisplaced, nondislocated fractures were treated closed. At yearly intervals, facial symmetry, pain, nerve function, bone repositioning, scarring, and reossification were evaluated. Incisal opening, protrusion, laterotrusion and sonographic condylar translation were measured in mm.

Results

Nineteen (79%) patients presented for follow-up: Class I, 8; Class II, 3; Class III, 0; Class IV, 2; Class V, 5; and Class VI, 1. After 1 year, 11 patients (58%) presented for follow-up; after 2 years, 4 (21%) patients, and after 5 years, 4 (21%) patients presented for follow-up. The reasons for not presenting for follow-up given by the parents upon telephone interview were no symptoms and absent motivation. All patients exhibited sufficient opening; 1 Class IV patient had insufficient translation; 3 patients had opening deflection; 2 patients' partial facial nerve paresis subsided after 1 year; in 2 cases broken osteosyntheses were removed. Vertical and horizontal condyle support was successfully reconstructed; considerable bone resorption occurred in Class V; failure rate was 4 (17%). Of 5 Class V, 3 were failures (60%).

Conclusions

The evaluated treatment rationale attained 83% treatment success; Class V should be repositioned with careful mobilization to not risk impaired perfusion and considerable remodeling. Patient number is limited; a negative bias for follow-up can be supposed, eg, symptom-free patients avoided a follow-up interview. Prospectively small, rigid, mainly intraosseous and hopefully resorbable osteofixation should be assessed.