Study to Compare Different Modalities in the Management of Paediatric Mandibular Condylar Fractures: A Meta-Analysis

Document Type : Original Article

Authors

The Department of Plastic, Burn and Maxillofacial Surgery, Faculty of Medicine, Ain Shams University

Abstract

Background: Mandibular condylar and subcondylar fractures
are common among pediatrics. They are important to
be appropriately managed for their effect on the normal growth
of the mandible and the associated complications. Given these
concerns, it is unsurprising to note the variety of treatment
approaches including; conservative, closed reduction with
arch bar application, and open reduction with internal fixation
by plates & screws. This reflects the need to appropriately
select the convenient modality according to age, displacement
of the fractured segments, and presence of malocclusion.
Objective: To compare the functional outcomes of different
modalities in the management of pediatric condylar and
subcondylar fractures.
Patients and Methods: This systematic review was done
on ten retrospective and cohort studies published in the English
language, from any geographical location, between 2010 and
2021. A total of 626 patients aged less than 15-year-old with
condylar and sub-condylar fractures, associated with or without
other mandibular fractures, managed with conservative management,
closed reduction with application of arch bar or
MMF, and open reduction with internal fixation by plates &
screws.
Results: Pediatric patients managed by conservative
management and physiotherapy yielded a significant improvement
in occlusion and mouth opening with fewer complications
within a reasonable period of 2-4 weeks to achieve functional
recovery. On applying closed reduction with arch bar application
or MMF, the mouth opening was improved up to >35mm
without significant malocclusion or any other complications.
It needed about 4-8 weeks for functional recovery to be
achieved. In surgical intervention for open reduction and
internal fixation, Malocclusion was noted in 2.8% of patients
compensated with the growth of the mandible and teeth
eruption. In addition, there were significant postoperative
complications noted in some patients.
Conclusion: Based on the studies, all modalities in the
management of pediatric condylar and sub-condylar fractures
are clinically accepted and can be applied. However, the point
of negotiation is the indications for each modality and the
associated possible complications. Conservative management
and closed reduction with MMF application prevent the risk
375
of some functional complications that may occur with the
invasive surgical intervention

Keywords

Main Subjects

References

1- Bera R.N., Kumar J.A., Kanojia S., Boojar F.M.A., Chauhan
N. and Hirani M.S.: How far we have come with the
Management of Condylar Fractures? A Meta-Analysis of
Closed Versus Open Versus Endoscopic Management.
Journal of Maxillofacial and Oral Surgery, 1-16, 2021.
2- Mabrouk A., Helal H., Mohamed A. and Mahmoud N.:
Incidence, etiology, and patterns of maxillofacial fractures
in Ain-Shams University, Cairo, Egypt: A 4-year retrospective
study. Craniomaxillofacial Trauma & Reconstruction,
7 (3): 224-232, 2014.
380 Vol. 46, No. 4 / Different Modalities in the Management of Paediatric Mandibular Condylar Fractures
3- Li J., Yang H. and Han L.: Open versus closed treatment
for unilateral mandibular extra-capsular condylar fractures:
A meta-analysis. Journal of Cranio-Maxillofacial Surgery,
47 (7): 1110-1119, 2019.
4- Kamel G.N., De Ruiter B.J., Baghdasarian D., Mostafa
E., Levin A. and Davidson E.H.: Establishing a protocol
for closed treatment of mandibular condyle fractures with
dynamic elastic therapy. Plastic and Reconstructive Surgery
Global Open, 7 (12), 2019.
5- Cooney M., O'Connell J.E., Vesey J.A. and Van Eeden
S.: Non-surgical management of paediatric and adolescent
mandibular condyles: A retrospective review of 49 consecutive
cases treated at a tertiary referral centre. Journal
of Cranio-Maxillofacial Surgery, 48 (7): 666-671, 2020.
6- Khiabani K., Zinhaghayegh B. and Amirzade-Iranaq M.H.:
Does Dynamic Intermaxillary Fixation With Elastics
Improve Outcomes Following Unilateral Condylar Fracture?.
Journal of Oral and Maxillofacial Surgery, 79 (1):
192-199, 2021.
7- Skroch L., Fischer I., Meisgeier A., Kozolka F., Apitzsch
J. and Neff A.: Condylar remodeling after osteosynthesis
of fractures of the condylar head or close to the *-
temporomandibular joint. Journal of Cranio-Maxillofacial
Surgery, 48 (4): 413-420, 2020.
8- Pontell M.E., Niklinska E.B., Braun S.A., Jaeger N., Kelly
K.J. and Golinko M.S.: Resorbable Versus Titanium Rigid
Fixation for Pediatric Mandibular Fractures: A Systematic
Review, Institutional Experience and Comparative Analysis.
Craniomaxillofacial Trauma & Reconstruction,
19433875211022573, 2021.
9- Sriraam K.G. and Vignesh K.R.A.: Diagnosis and management
of mandibular condyle fractures. In Oral and
Maxillofacial Surgery. Intech Open, 2021.
10- Steed M.B.: Advances in the Management of Mandibular
Condylar Fractures, An Issue of Atlas of the Oral &
Maxillofacial Surgery. Elsevier Health Sciences, Vol. 25,
No. 1, 2017.
11- Bae S.S. and Aronovich S.: Trauma to the pediatric
temporomandibular joint. Oral and Maxillofacial Surgery
Clinics, 30 (1): 47-60, 2018.
12- Adity B., Yadav P., Bhutia O., Roychoudhury A. and
Bhalla A.S.: Comparison of outcome of open reduction
and internal fixation versus closed treatment in pediatric
mandible fractures-a retrospective study. Journal of Cranio-
Maxillofacial Surgery, 49 (3): 196-205, 2021.
13- Asim M.A., Ibrahim M.W., Javed M.U., Zahra R. and
Qayyum M.U.: Functional outcomes of open versus closed
treatment of unilateral mandibular condylar fractures. J.
Ayub Med. Coll Abbottabad, 31 (1): 67-71, 2019.
14- Swanson E.W., Susarla S.M., Ghasemzadeh A., Mundinger
G.S., Redett R.J., Tufaro A.P. and Dorafshar A.H.: Application
of the mandible injury severity score to pediatric
mandibular fractures. Journal of Oral and Maxillofacial
Surgery, 73 (7): 1341-1349, 2015.
15- Kao R., Rabbani C.C., Patel J.M., Parkhurst S.M., Mantravadi
A.V., Ting J.Y. and Shipchandler T.Z.: Management
of mandible fracture in 150 children across 7 years in a
US tertiary care hospital. JAMA Facial Plastic Surgery,
21 (5): 414-418, 2019.

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