Characteristics, Treatment, and Prognosis of Pediatric Symphyseal/Parasymphyseal-Condylar Fractures.

BACKGROUND: Pediatric condylar fractures combined with symphyseal or parasymphyseal fractures are common but challenging to manage. The authors present fracture characteristics, propose a treatment algorithm, and evaluate the treatment prognosis of pediatric symphyseal/parasymphyseal-condylar fractures. METHODS: A retrospective review was conducted on pediatric patients who underwent treatment for symphyseal/parasymphyseal-condylar fractures in a trauma center between January of 2006 and January of 2021. Demographic and fracture characteristics were recorded. Complications and functional evaluations, including maximum interincisal opening, Helkimo anamnestic index, and clinical dysfunction index, were assessed after at least 1 year of follow-up. RESULTS: After screening, 104 participants met the inclusion criteria. Among them, 50.96% received open reduction and internal fixation for symphyseal/parasymphyseal fractures and closed treatment for condylar fractures, 45.19% were treated by liquid diet and functional exercise, and the remaining 3.85% with severe malocclusion were treated with the assistance of orthodontic appliances. During follow-up, the average maximum interincisal opening of the patients increased from 17 ± 6.29 mm to 41.64 ± 6.33 mm. No subjective symptoms were observed in 86.54% of the patients and 79.81% showed no or mild clinical symptoms. Except for 1 patient who developed temporomandibular joint ankylosis, no other severe complication was reported. Postfracture remodeling of the nonfractured condyle was noted in 3 cases. CONCLUSIONS: Pediatric symphyseal/parasymphyseal-condylar fractures present unique biomechanical and anatomic challenges that require special consideration during management. In this study, satisfactory functional prognosis was achieved following implementation of the treatment algorithm. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Effect of stainless-steel wire internal fixation on intracapsular condylar fracture.

OBJECTIVES: The aim of the study was to investigate the clinical effect of stainless-steel wire fixation on the early mouth-opening movement of an intracapsular fracture involving the condylar process. MATERIALS AND METHODS: In this study, patients who underwent mandibular condylar intracapsular fracture surgery in our hospital from 2012 to 2020 were selected as research subjects. A total of 44 patients received steel wire internal fixation treatment, 32 patients received titanium plate-and-nail rigid internal fixation, and 28 patients underwent conservative non-surgical treatment. RESULTS: For the patients in the stainless-steel wire group, the degree of mouth opening reached normal levels of 3.7 cm approximately 10 days after surgery. The recovery time for the patients in the titanium plate-and-nail rigid internal-fixation group was 21 days, while the patients in the conservative treatment group needed 60 days to recover. CONCLUSION: The treatment of fixation with a stainless-steel wire for intracapsular condylar fracture reduced the time taken to perform mouth-opening exercises and improved the recovery rate of patients.

OBJETIVO: Explorar el efecto clínico de la fijación de alambre de acero inoxidable en el movimiento temprano de apertura de la boca en la fractura interna del cóndilo. MÉTODO: Este estudio seleccionó a pacientes que se sometieron a cirugía de fractura intracapsular de cóndilo en nuestro hospital de 2012 a 2020 como sujetos de investigación. Un total de 44 pacientes recibieron tratamiento de fijación interna de alambre de acero, 32 recibieron placa de titanio y fijación interna con clavos, y 28 recibieron tratamiento conservador no quirúrgico. RESULTADOS: En los pacientes del grupo de alambre de acero inoxidable, alrededor de 10 días después de la cirugía el grado de apertura de la boca alcanzó un valor normal de 3.7 cm. El tiempo de recuperación de los pacientes en el grupo de fijación interna con clavos y placa de titanio fue de 21 días, mientras que los pacientes en el grupo de tratamiento conservador tardaron 60 días en recuperarse. CONCLUSIONES: La fijación con alambre de acero inoxidable para el tratamiento de la fractura intracapsular del cóndilo acorta el tiempo hasta la apertura de la boca y mejora la tasa de recuperación de los pacientes.

[Fractures of the mandibular condyle]. / Fracturen van het collum mandibulae.

A fracture of the mandibular condyle is a common fracture of the mandible. After the diagnosis has been made, there are various treatment options: wait and see, conservative or surgical. Which of these treatment options is best depends on several different factors and is often the subject of debate. A common complication of a fracture of the mandibular condyle is malocclusion. Malocclusion can cause problems - even in the long term - for which the patient often requires secondary treatment.

Transoral endoscopic assisted reduction and internal fixation of mandibular condylar neck fractures with short condylar segment.

This study aimed to assess the reliability and safety of transoral endoscopic-assisted reduction internal fixation (TERIF) for treating short-segment condylar neck fractures (CNF), including hardware removal. Patients with displaced CNF and short condylar segments treated using TERIF were included in the study. Clinical evaluation covered dental occlusion, range of mouth opening, deviation during mouth opening, protrusion, laterotrusion, pain, and chewing. Radiological evaluation was used to assess fracture displacement, angulation, head dislocation, postoperative reduction, fixation stability, and bone healing. The same technique was used to treat 15 patients with 18 CNF and short condylar segments. Hardware removal was performed for nine fractures in eight patients after fracture healing using the same approach. All patients regained satisfactory, pain-free mouth opening with no deviation and complete bone healing. Computed tomographic images displayed adequate reduction and stable fixation during the follow-up period for all patients. No temporary or permanent facial nerve impairment occurred in any of the patients. TERIF is a reliable and safe treatment for CNF with short condylar segments, even in the presence of head dislocation, medial override, and malunited fractures; hardware can be safely removed after healing using the same approach.

Effect of tranexamic acid on postoperative blood loss.

The aim of this article was to evaluate the efficacy of tranexamic acid (TXA) to reduce blood loss after maxillofacial fracture surgery. Clinical data were collected retrospectively on patients with unilateral fractures of the zygomaticomaxillary complex (ZMC) or mandibular condyle. Patients were then further divided into TXA and control groups according to whether or not TXA was used after surgery. The amount of postoperative blood loss was evaluated by negative pressure drainage volume. Data were statistically analysed. In patients with unilateral ZMC fractures, total postoperative blood loss in the TXA group was about 30 ml less than that in the control group (p = 0.006). It was significantly less on the first and second postoperative days. However, in patients with unilateral mandibular condylar fractures, there was no significant difference between the TXA and control groups (p = 0.917). TXA can reduce postoperative bleeding in patients with ZMC fractures, and the optimal usage time is on the first and second postoperative days. For patients with mandibular condylar fractures, TXA may not be used.

Biomechanical evaluation of various rigid internal fixation modalities for condylar-base-associated multiple mandibular fractures: A finite element analysis.

Condylar-base-associated multiple mandibular fractures are more prevalent than single ones. Direct trauma to mandibular symphysis, body or angle are prone to induce indirect condylar fracture. However, little is known about the effects of various rigid internal fixation modalities in condylar base for relevant multiple mandibular fractures, especially when we are confused in the selection of operative approach. Within the finite element analysis, straight-titanium-plate implanting positions in condylar base contained posterolateral zone (I), anterolateral zone (II), and intermediate zone (III). Von Mises stress (SS) in devices and bone and mandibular displacement (DT) were solved, while maximum values (SSmax and DTmax) were documented. For rigid internal fixation in condylar-base-and-symphysis fractures, I + II modality exhibited least SSmax in screws and cortical bone and least DTmax, I + III modality exhibited least SSmax in plates. For rigid internal fixation in condylar-base-and-contralateral-body fractures, I + III modality exhibited least SSmax in screws and cortical bone, I + II modality exhibited least SSmax in plates and least DTmax. For rigid internal fixation in condylar-base-and-contralateral-angle fractures, I + III modality exhibited least DTmax. The findings suggest that either I + II or I + III modality is a valid guaranty for rigid internal fixation of condylar base fractures concomitant with symphysis, contralateral body or angle fractures.

Abordagem cirúrgica em fratura de sínfise e côndilo mandibular bilateral em paciente pediátrico: um relato de caso / Surgical approach for syphysis and bilateral mandibular condyle fracture in a pediatric patient: a case report

As indicações de tratamento das fraturas mandibulares em paciente pediátrico variam em conservador, fixação não rígida e interna rígida. Alterações no crescimento ósseo, disfunções na articulação temporomandibular e assimetrias faciais podem ser decorrentes ao insucesso do tratamento. O objetivo deste trabalho consiste em relatar abordagem cirúrgica em fratura de sínfise e côndilo mandibular bilateral em paciente pediátrico. Paciente gênero feminino, 09 anos de idade, foi encaminhada ao Hospital Geral do Estado - Bahia vítima de queda de nível, cursando com trauma em face. Apresentou queixa principal, referida pela progenitora, de dificuldades em fechar a boca. Ao exame físico, a paciente apresentou mobilidade atípica à manipulação da mandíbula, mordida aberta anterior, equimose sublingual, ausência das unidades dentárias 74 e 75, com abertura bucal regular e suturas em posição em região de mento. Ao exame de imagem de tomografia computadorizada da face, pôde-se notar sinais sugestivos de fratura em região de sínfise e côndilos mandibulares bilateral. Após diagnóstico das fraturas, a paciente foi submetida à cirurgia sob anestesia geral para redução e fixação das mesmas. Realizou-se acessos em ferimento na região mentual e retromandibular bilateral com posterior síntese das fraturas utilizando fixação interna rígida com placas do sistema 2.0mm, associada a odontossíntese na fratura de sínfise. Ao acompanhamento periódico, a eleição do tratamento cirúrgico para fraturas mandibulares em pacientes pediátricos, pode permitir segurança no crescimento ósseo mandibular e facial(AU)

The indications for treatment of mandibular fractures in pediatric patients vary from conservative, non-rigid fixation and rigid internal fixation. Changes in bone growth, temporomandibular joint disorders and facial asymmetries may be due to treatment failure. The objective of this work is to report a surgical approach to bilateral symphysis and mandibular condyle fractures in a pediatric patient. Female patient, 9 years old, was sent to the State General Hospital - Bahia, victim of a fall in level, suffering from trauma to the face. She presented a main complaint, mentioned by her mother, of difficulties in closing her mouth. On physical examination, the patient presented atypical mobility when manipulating the jaw, anterior open bite, sublingual ecchymosis, absence of dental units 74 and 75, with regular mouth opening and sutures in position in the chin region. When examining the computed tomography image of the face, signs suggestive of fracture in the region of the symphysis and bilateral mandibular condyles were noted. After diagnosis of the fractures, the patient underwent surgery under general anesthesia to reduce and fix them. Access was performed on a wound in the mental and bilateral retromandibular region with subsequent synthesis of the fractures using rigid internal fixation with 2.0mm system plates, associated with odontosynthesis in the symphysis fracture. With periodic monitoring, the choice of surgical treatment for mandibular fractures in pediatric patients can allow for safe mandibular and facial bone growth(AU)

Management of Mandibular Condylar Sagittal Fracture Accompanied by Lateral Condylar Crest Defect.

BACKGROUND: The sagittal fracture of the mandibular condyle can be fixed with absorbable long screws. Absorbable long screws are generally inserted from the lateral crest of the condyle and are as close as possible to the medial pole of the condyle to obtain sufficient retention force. However, in clinical practice, patients with locally comminuted condylar fractures and partial defects in the lateral crest are often encountered. We validated the use of absorbable plates and long screws to fix mandibular condylar fractures with lateral crest defects, and postoperative follow-up showed good results. METHODS: The preoperative design indicated that if conventional long screws were used, more soft tissue need to be pulled downward to achieve the appropriate drilling angle. If an absorbable plate was used, the degree of downward pulling of soft tissue was smaller, which can better protect the parotid gland tissue and facial nerve. The surgery was performed according to the preoperative design, using an absorbable plate scheme. RESULTS AND DISCUSSION: Postoperative CT confirmed a stable anatomical reduction of condyle. Four-month follow-up showed that the patient's facial shape, occlusion, and mouth opening were all good. Follow-up CT showed good fracture healing. It is feasible to use absorbable plates and long absorbable screws to fix mandibular condylar sagittal fracture accompanied by lateral condylar crest defect.

Ultrasound-guided arthrocentesis for condylar head fracture: a technical report.

OBJECTIVES: Double puncture arthrocentesis (DPA) of the temporomandibular joint (TMD) is considered an effective preservative option for managing mandibular condylar head fractures. However, the procedure is commonly performed by a traditional "blind" method using anatomical characteristics. In the present study, an ultrasonography (US) device was applied for the treatment of a case with a fractured mandibular condyle. METHODS: A 79-year-old female was diagnosed right side condylar head fracture complaining pain of right TMD and reduced mouth opening range: inter-incisor distance of 20 mm. Since the fracture position was high and inoperable, the decision was made to perform DPA of the TMD. The US probe was positioned parallel and slightly oblique to the major axis of the mandibular ramus. Both the posterior and anterior insertions into the joint space were performed according to the axis mentioned above, which enabled the operator to visualize the entirety of the needle. RESULTS: The device offered safety and ensured accuracy by providing real-time visual aid to the surgeon. The procedure provided an early increase in the inter-incisor distance (31 mm) and pain relief. CONCLUSIONS: Hence, for the preservative treatment of mandibular condylar head fractures, based on the present study, we recommend US-guided arthrocentesis as a safe, feasible, and effective therapeutic option instead of the conventional "blind" method.

A single-centre retrospective 10-year experience of the rhombic 3D condylar fracture plate for open reduction and internal fixation of condylar neck and base fractures.

Fractures of the mandibular condyle account for a significant proportion of mandibular fractures. The specific functional loads require particular specifications for the implant design used for open reduction and internal fixation of such fractures. The clinical and radiographic outcomes in patients treated using a single rhombic 3D condylar fracture plate for open reduction and internal fixation at a single institution, and who fulfilled the inclusion and exclusion criteria, are presented. The primary outcome variables were: occlusion, maximum interincisal distance and mandibular excursion at 1, 3, and 6 months postoperatively, and radiographic measurements for mandibular height and gonion angle. In total, 263 patients were included, of whom 173 (65.8%) were male and 90 (34.2%) female. The mean age was 40.4 ± 18.9 years. There was satisfactory occlusion in 98.9% of patients at the 6-month follow-up, and a significant improvement in all parameters for mandibular excursion (p < 0.001), with a reduced ramus height and an increase in the gonion angle on the fractured side. Excellent clinical and radiographic results were achieved using the rhombic-shaped implant, deeming it appropriate for the osteosynthesis of mandibular condyle fractures.

Evaluation of the Efficacy of Three Times Titanium Plate Gradual Fixation Method in the Treatment of Extracapsular Condylar Fractures.

OBJECTIVE: An improved method of treating inwardly dislocated mandibular extracapsular condylar fracture-three times titanium plate gradual fixation method was introduced, and the clinical efficacy of this method was evaluated. METHODS: Twenty patients with extracapsular condylar fractures who underwent surgical treatment using the three times titanium plate gradual restoration and fixation method in the Department of Oral Craniomaxillofacial Surgery of the Ninth People's Hospital of Shanghai from November 2020 to June 2023 were selected as the study subjects. RESULTS: After condylar restoration 22 sides reached healing and 1 side was basically healed; in 3 months after the operation, the degree of opening the mouth and the type of the opening of the mouth reached normal, and 1 case had mildly poor occlusion, which required to be further adjusted through orthodontics, and there was no temporomandibular function disorder or facial nerve function damage. CONCLUSION: Three times of gradual fixation with a titanium plate can make the condylar process achieve precise and stable repositioning, and make the surgical process orderly, and it is a kind of reliable fixation method for extracapsular condylar fractures.

Temporomandibular joint degenerative changes following mandibular fracture: a computed tomography-based study on the role of condylar involvement.

OBJECTIVES: This study assessed the incidence of postfracture radiological temporomandibular joint (TMJ) degeneration in patients with different types of mandibular fractures, focusing on the impact of condylar fractures. METHODS: This retrospective review included patients diagnosed as having mandibular fractures from 2016 to 2020 who had undergone initial computed tomography (CT) and a follow-up CT scan at least 1-month postfracture. Patient demographics, fracture details, treatment methods, and radiological signs of TMJ degeneration on CT were analyzed to identify risk factors for postfracture TMJ degeneration, with a focus on condylar head fracture and non-head (condylar neck or base) fractures. RESULTS: The study included 85 patients (mean age: 38.95 ± 17.64 years). The per-patient analysis indicated that the incidence of new radiologic TMJ degeneration on CT was significantly the highest (p < 0.001) in patients with condylar head fractures (90.91%), followed by those with non-head condylar fractures (57.14%), and those without condylar involvement (24.49%). The per-joint analysis indicated nearly inevitable degeneration (93.94%) in 33 TMJs with ipsilateral condylar head fractures. For the remaining 137 TMJs, multivariate logistic regression revealed that other patterns (ipsilateral non-head, contralateral, or both) of condylar fractures (odds ratio (OR) = 3.811, p = 0.007) and the need for open reduction and internal fixation (OR = 5.804, p = 0.005) significantly increased the risk of TMJ degeneration. CONCLUSIONS: Ipsilateral non-head condylar fractures and contralateral condylar fractures are associated with a high risk of postfracture TMJ degeneration. Indirect trauma plays a vital role in postfracture TMJ degeneration.

Characteristics of pediatric mandibular condylar fractures in Southwest China: A single-center and 12-year retrospective study.

BACKGROUND/AIM: Mandibular condylar fractures in pediatric patients may exhibit distinct epidemiological characteristics attributed to their unique growth and development phase, as well as various anatomical, physiological, biomechanical, and behavioral factors that differentiate them from adults. This study aimed to investigate the demographics, injurious factors, classifications, clinical manifestations, and treatments of pediatric mandibular condylar fractures, as well as the concomitant injuries in maxillofacial and other body parts. MATERIALS AND METHODS: This retrospective study analyzed the clinical data of 189 pediatric patients with mandibular condylar fractures between 2011 and 2022. Variables investigated included age, gender, timing of onset, causes, classification of condylar fracture, concomitant injuries, clinical manifestations, and treatment modalities. RESULTS: A total of 189 patients, a higher proportion of boys compared to girls was observed, with the highest incidence rate in children aged 1-3 years. They occurred primarily in July, June, and September as well as on Saturdays and Sundays. The most prevalent cause of mandibular condylar fractures was falls from heights in 73 patients (38.62%). Pediatric patients exhibited a higher susceptibility to condylar head fractures. A significant majority (81.48%) of these fractures were accompanied by soft tissue injuries in the maxillofacial region, with the chin being particularly vulnerable to injury. In addition, 61.90% of pediatric patients experienced fractures in other areas of the maxillofacial region, with the mandibular symphysis being the most commonly affected site. Dental trauma predominantly occurred in the anterior region (44.97%). Notably, a substantial proportion (28.04%) of cases also presented with multiple systemic injuries. CONCLUSIONS: The characteristics of pediatric mandibular condylar fractures exhibit distinct features in terms of age, gender, timing of onset, etiology, location and type, the presence of concomitant maxillofacial soft/hard tissue injuries and multiple systemic injuries, as well as clinical manifestations and treatment modalities. Therefore, clinicians should pay special attention to the diagnosis and treatment of pediatric condylar fractures.

Mandibular condylar fractures: a 5-year retrospective analysis comparing open versus closed reduction.

BACKGROUND: Mandibular fractures are common facial fractures, and contemporary management of mandibular condylar fractures is controversial. The purpose of this study was to compare the outcomes of patients who sustained a mandibular condylar fracture between 2016 and 2020, who were managed by either open or closed techniques. The outcomes of this study were: post-operative facial nerve function, occlusion, and maximal mouth opening. METHODS: This study is a retrospective multicentre cohort study which assessed clinical records for 246 patients with mandibular condyle fractures in three hospitals in Perth, Western Australia. The primary outcome measure was changes in post-operative facial nerve function. RESULTS: One hundred and thirty-two patients underwent open reduction and internal fixation (ORIF), and 114 patients had closed management. The overall rate of temporary facial nerve injury following ORIF was 3.28%. The overall rate of permanent facial nerve injury was 0.82%. Sialocoele occurred in 2.46% of all patients who underwent ORIF. 6.14% of patients had persisting malocclusion across both groups. There was a statistically significant association between the degree of fragment shortening and facial nerve injury (P = 0.0063), with more facial nerve changes in the group with 5 mm or greater of fragment shortening. CONCLUSIONS: There is still significant debate over the management of mandibular condylar injuries. This study demonstrates a similar rate of temporary and permanent facial nerve injury as previously described, as well as a similar rate of sialocoele occurrence. Further prospective studies may provide clarity about important characteristics that will help guide decision making for mandibular condylar fractures.

The "low preauricular" transmasseteric anteroparotid (TMAP) technique as a standard way to treat extracapsular condylar fractures.

Condylar fracture treatment is a debated topic among maxillofacial surgeons. Various surgical techniques are used today, each one with advantages and disadvantages. The aim of this study is to present and evaluate our technique adopted for treatment of any type of extracapsular condylar fractures. Between 2020 and 2022, 16 condylar fractures were treated. In two patients with bilateral condylar fractures, the present technique was compared to the mini-retromandibular approach. All the patients were checked for clinical and radiological outcomes, facial nerve injury, scar visibility and presence of salivary complications. Dental occlusion was always restored, and facial nerve damage or salivary disorders were not observed. The skin incision, limited to the caudal two-thirds of the auricle, made the scar almost invisible and greatly improved the surgical field in the condylar neck area, facilitating the treatment. The proposed technique provides easier internal fixation for both neck and base condylar fractures with good cosmetic results, ensuring better protection of the facial nerve and parotid gland. The surgical technique described has not shown disadvantages in terms of operational difficulty, results, and complications. This novel surgical technique could represent a new choice in the treatment of extracapsular condylar fractures, although further studies are needed to support this new proposal.

How good is good enough? Lessons learned from review of outcomes of 50 patients following extraoral open reduction and internal fixation of condylar neck and base fractures at a regional major trauma centre.

The management of mandibular fractures is routine owing to their frequency, particularly those of the mandibular condyle, which are invariably common. Notwithstanding disparities in the literature, the international consensus towards which fractures of the mandibular condyle benefit from open surgical intervention is almost universally accepted. Closed reduction or non-operative management may be utilised in certain circumstances. Whilst outcome research has addressed complications with respect to operative side effects, outcomes related to the quality of bone repair and the setting in which this is delivered have not been universally addressed. The aim of this study was to determine the predictability of translating an indicated operative treatment plan into an acceptable functional result. We evaluated the outcomes of 59 extracapsular condylar fractures in 50 patients who were treated by extraoral open reduction and internal fixation (ORIF) between March 2021 and August 2022. We reviewed demographic data, surgical approach, and plating strategy, and critically evaluated the clinical and radiological outcomes. Whilst we found that the quality of reduction was not universally perfect, the majority were within tolerance, which we set according to the Strasbourg Osteosynthesis Research Group (SORG) definition for minimal displacement (<2 mm overlap and 10° angulation). The cohort had good functional occlusion and minimal long-term postoperative complications. Two patients required re-operation for non-union, and we discuss causality in these cases. In conclusion, we found that ORIF of condylar neck and base fractures is predictable in real-time surgical practice with respect to functional outcome. However, if imperfectly reduced, there is a small risk of non-union.

[Management of traumatic temporomandibular joint ankylosis: a perspective].

Traumatic injury to the temporomandibular joint (TMJ) was the most common cause of TMJ ankylosis (85%), while sagittal fracture of the mandibular condyle was identified as the high risk fracture pattern. TMJ disc displacement is one of the prerequisite factors of TMJ ankylosis. The severe damage and close contacts of both the articular surface of glenoid fossa and condyle were also crucial pathogenic factors in the development of TMJ ankylosis. The mechanism and development of TMJ ankylosis may be similar to hypertrophic non-union, and the persistence of radiolucent zone within the ankylotic callus governs the clinical and pathological process of TMJ ankylosis. In type Ⅰ traumatic TMJ ankylosis, repositioning of the displaced disk is required, while the preservation of pseudo-joint is essential in the management of the type Ⅱ traumatic TMJ ankylosis. Nevertheless, the rate of TMJ reankylosis still remains high. Higher rate of TMJ reankylosis was observed in paediatric population, bilateral involvement of TMJ ankylosis, and in cases with reconstruction of mandibular condyle with coronoid process.

Control of Mandibular Width With 3D Printed Occlusal Splint in Children With Multiple Mandibular Fractures.

BACKGROUND: The fracture of mandibular symphysis combined with bilateral condylar fractures often leads to changes in the width of the mandible, which significantly widens the face of the child. Therefore, it is necessary to reposition the mandible through accurate adduction. METHODS: To ensure that the mandible can be accurately repositioned, a 3D printed occlusal splint was used. Bilateral maxillomandibular fixation screws were implanted. The 3D printed occlusal splint was located on the maxillary dentition and fixed to the maxillomandibular fixation screws with wire loops. The reference basis for adduction is to make the mandibular dentition located in the occlusal splint. The absorbable plate was contoured according to the restored model and fixed at the fracture site. The 3D printed occlusal splint was retained in the maxillary dentition for two months. RESULTS AND DISCUSSION: Postoperative computed tomography showed that the mandible had been adducted according to the preoperative design. Two months of follow-up showed that the child's facial development, mouth opening type, occlusion, and range of motion were good. It is especially suitable for children with mandibular symphyseal fractures accompanied by bilateral condylar fractures.

Acrylic "lollipop" for jaw rehabilitation after release of joint ankylosis in paediatric patients.

Falls are a leading cause of injuries to the temporomandibular joint (TMJ) in the paediatric age group. In low- and middle-income nations, after injury to a child's chin, a careful clinical examination of the mandible and TMJ is sometimes omitted. Paediatric mandibular condylar fractures tend to shatter the relatively narrow condylar head, leading to ankylosis to the skull base, which leads to debilitating progressive deformity.1 Early surgical release is then the sole modality of treatment and needs to be followed up by several weeks of active mouth-opening exercises to prevent re-ankylosis, which are crucial in the immediate post-operative period. Unfortunately, as patient cooperation is low owing to uncomfortable jaw mobilization, we fabricated a simple acrylic appliance which is easy to use.

The Comparison of Functional Outcomes in Patients With Unilateral or Bilateral Intracapsular Mandibular Condylar Fractures After Closed or Open Treatment: A 10-Year Retrospective Study.

BACKGROUND: The treatment strategies for mandibular condylar head fractures, also known as intracapsular condylar fractures (ICFs), have not been concluded. We humbly present our treatment outcomes and share our experience in our department. AIMS AND OBJECTIVES: The aim of this study was to compare the functional outcomes between closed reduction (CR) and open reduction and internal fixation (ORIF) for management of unilateral or bilateral ICFs. MATERIALS AND METHODS: This 10-year retrospective cohort study included 71 patients with 102 ICFs who were treated in our department from May 2007 to August 2017. Nine patients mixed with extracapsular fractures were excluded; thus, 62 patients with 93 ICFs were included. All patients received treatment by the senior surgeon in Chang Gung Memorial Hospital, Linkou Branch, Taiwan. The patient's basic data, fracture morphologies, associated injuries, managements, complications, and maximal mouth opening (MMO) measurement at 1, 3, 6, and 12 months postoperative were reviewed for analysis. RESULTS: Among the 93 fractures, 31 (50%) were bilateral and 31 were unilateral (50%). Based on He's classification, 45 (48%) had type A fracture, 13 (14%) had type B, 5 (5%) had type C, 20 (22%) had type M, and 10 (11%) had no displacement. Maximal mouth opening of 37 mm in unilateral cases after 6 months was significantly higher than the 33-mm MMO in bilateral cases. In addition, the MMO in the ORIF group was significantly higher than that of the CR group in 3 months postoperative. Univariate (odds ratio, 4.92; P = 0.01) and multivariate (odds ratio, 4.76; P = 0.027) analyses revealed CR as an independent risk factor for trismus development compared with ORIF. Malocclusion was observed in 5 patients in both CR and ORIF groups. In addition, 1 patient developed temporomandibular joint osteoarthritis in the CR group. No surgical-related temporary or permanent facial nerve palsy was observed. CONCLUSIONS: Open reduction and internal fixation for condylar head fracture provided better recovery in MMO than CR, and the MMO recovery was less in bilateral condylar head fracture than unilateral condylar head fracture. Open reduction and internal fixation in ICFs have a lower risk for trismus development and should be the treatment of choice in selected cases.