Condylar fractures are more common among mandibular fractures in children. For a long time, condylar fractures in children have been widely concerned by scholars both at home and abroad, not only because of their high incidence, but also because children are in the growth phase, and condylar fractures may affect the development of the mandible and the function of the temporomandibular joint, leading to severe temporomandibular joint ankylosis and sleep apnea syndrome, with serious effects on the patient’s facial shape, occlusion and masticatory function.
The current classification of condylar fractures in children is the same as that of adults. That is, they are simply divided into three categories.
① Condylar head fractures, also known as intracapsular fractures ;
② Condylar neck fractures;
(iii) subcondylar fractures. The latter two are also known as extracapsular fractures.
Extracapsular fractures are further divided into four categories according to the degree of displacement of the fracture fragment.
Class I: no significant displacement of the fracture fragment;
Class II: fracture fragment displaced away from the fracture line;
Class III: fracture fragment displaced or overlapping but still in the articular socket;
Class IV: the fracture fragment is dislocated and the fracture fragment is not in the articular fossa.
In the treatment of condylar fractures, the terms conservative treatment or closed reduction were commonly used in the past. Currently, the concepts of closed treatment and open reduction have been proposed internationally. Closed treatment refers to treatment that does not involve open surgery to reveal the fracture. Open reduction refers to surgical open reduction and fixation. There is still a great debate about the treatment of condylar fractures in children, with most physicians using closed treatment and fewer reports of open repositioning.
1. Closed treatment methods: There are many methods of closed treatment, including restrictive diet therapy, passive mouth opening training, intermaxillary fixation, jaw question traction, arch splint fixation, elastic traction, jaw pad therapy, movable orthotic therapy and physical therapy. A standard treatment model has not yet been formed.
2.Open repositioning method: The surgical method of open repositioning is the same as that of adults, and the surgical maneuvers are: preauricular incision, posterior mandibular incision, submandibular incision and intraoral incision. The intraoral approach is less frequently used due to limited exposure and is only used for low condylar fractures with a small degree of displacement.
There are no criteria regarding the successful treatment of condylar fractures in children.
After studying the relevant literature, our department proposes the following criteria for reference.
1.After the treatment of condylar fracture in children, there should be normal temporomandibular joint function and normal growth and development of the condyle.
2. Restoration of the pre-injury occlusal relationship;
3.Normal mouth opening;
4.No pain in the joint area or no more severe than before the injury;
5.Less postoperative complications.