Management of Mandibular Condyle Fractures in Pediatric Patients: A
Multicentric Retrospective Study with 180 Children and Adolescents
Journal Reading Erlis Marisa Supervisor :
drg. Santi Anggraini, MARS, Sp.BMM., Subsp.
COM(K)
JOURNAL
IDENTIFICATIO
N
Introduction
Pediatric
maxillofacial fractures
represent up to 15% of the total maxillofacial
fractures in children and adults
management strategies
•
expectative
management(analgesia, soft food and follow-up)
•
functional protocols with guiding elastics or with orthodontic
appliances and exercises
•
maxillomandibular fixation (MMF),
•
open reduction and internal fixation (ORIF)
to assess
whether there were
differences in the outcomes between
expectant management with a soft diet, closed
treatment with
MMF, and open
surgery (ORIF)
in the study
sample.
OBJECTIVES
This study aimed to describe the
management of mandibular condyle
fracturesin growing patients across 14
maxillofacial departments worldwide
METHODS
Retrospective multicentric study
14 department OMFS world wide in Asia and Europe 1 January 2011 to 31
December 2021
• aged 0 to 16
• complete clinical and radiological records
• having at least one mandibular condyle fracture
• that underwent either expectant, closed, or open management
• minimum follow-up was six months.
Study Design Population
Location & Time
Exclusion Criteria
the absence of condylar
fractures
age older than 17
Additional non- condylar
mandibular
fractures (ramus, body,
parasymphysis and symphysis) and
craniofacial
fractures
RESULT
EPIDEMIOLOGY
01
02
03
04
ETIOLOGY
MANAGEMENT OPTIONS
COMPLICATION
180 (42%) patients : one mandibular condyle
fracture
37 (9%) patients : second condylar fracture.
65% : male 35% : female
Epidemiologi
ETIOLOGY
No significant difference was found in the type of management (expectant, closed or ORIF)
Nosignificant difference
was observed between
the type of management
and outcome
Discussion
A study of 424 pediatric patients with mandibular fractures found that 42% had one condylar fracture, and 9% had two, which is consistent with previous research highlighting the high frequency of condylar fractures. the leading cause of injury in preschool children, whereas road traffic accidents (RTAs)
Treatment approaches for pediatric mandibular condylar fractures (ORIF) is typically reserved for severe cases, such as dislocation into the cranial fossa or severe malocclusion.
In contrast, some European countries, like Austria and Slovenia, favor ORIF even in young children, citing better outcomes following surgery. These differing approaches highlight varying opinions on the optimal treatment for these fractures.
01
02
Discussion
Closed management, often involving MMF, was used in some cases but is discouraged in children due to its risks, such as tooth damage and
discomfort. Light guiding elastics were preferred for functional rehabilitation, particularly in younger patients. The study found no
significant difference in complications between the three management strategies (expectant, closed, or ORIF). However, different units favored different protocols based on their traditions and expertise. The study also highlighted limitations, including the lack of functional protocols,
confounding factors like additional mandibular fractures, and a short follow-up period.
In conclusion, no single management strategy emerged as superior, and the key to successful treatment lies in appropriate decision-making and expertise. The study's strength lies in its multicentric approach, offering insights from diverse regions and practices.
03
In the study, 51 patients (28%) received expectant management, 47 (26%) were treated with closed maxillomandibular fixation
(MMF), and 82 (46%) underwent open reduction and internal fixation (ORIF). Management strategies varied significantly
between departments (p < 0.0001) and also differed based on fracture type (non-displaced, displaced, or comminuted) in the 180 patients with a single condylar fracture. Among 50 non- displaced fractures, 6% had ORIF, 50% had expectant
management, and 44% had MMF. Among 129 displaced fractures, 62% had ORIF, 19% had a soft diet, and 19% had MMF. The study concluded that expectant management, MMF, and ORIF were all effective treatments for pediatric mandibular condylar fractures, with low rates of complications and asymmetry
Conclusions
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Answer
Arah pertumbuhan mandibula, atau rahang bawah, terjadi dalam beberapa arah utama yang memengaruhi perkembangan dan bentuk wajah secara keseluruhan. Berikut adalah arah pertumbuhan utama dari mandibula:
1. Vertikal (Ke bawah): Pertumbuhan vertikal pada mandibula berkontribusi terhadap tinggi rahang bawah. Pusat tumbuh di bagian kondilus mandibula, yang terletak di sendi temporomandibular (TMJ), memainkan peran penting dalam pertumbuhan vertikal. Hal ini membantu dalam
menambah ketinggian wajah bagian bawah.
2. Anterior (Ke depan): Pertumbuhan anterior pada mandibula mengarah ke depan, yang
memperpanjang panjang rahang bawah. Arah ini penting dalam pengaturan gigitan dan posisi gigi. Jika pertumbuhan anterior berlebihan atau kurang, bisa memengaruhi bentuk wajah, seperti menyebabkan rahang bawah menonjol atau terlalu mundur.
3. Lateral (Ke samping): Pertumbuhan lateral pada mandibula terjadi di sepanjang bagian tubuh rahang bawah, memperlebar rahang ke sisi kiri dan kanan. Arah pertumbuhan ini penting untuk memastikan bahwa rahang bawah cukup luas untuk menampung gigi-gigi permanen, yang juga memengaruhi keseimbangan wajah secara keseluruhan.
Proses pertumbuhan ini berlangsung secara dinamis selama masa kanak-kanak dan remaja, dengan pengaruh faktor genetik, hormonal, dan lingkungan. Setelah masa pertumbuhan selesai, biasanya sekitar usia 18 hingga 25 tahun, pertumbuhan mandibula akan melambat atau berhenti.
Pusat tumbuh kembang mandibula adalah area di dalam tulang mandibula (rahang bawah) yang berfungsi untuk pertumbuhan dan perkembangan tulang tersebut selama masa pertumbuhan. Pada umumnya, tulang mandibula memiliki beberapa pusat tumbuh, yang memengaruhi panjang dan bentuk rahang bawah.
Pusat tumbuh utama mandibula terdapat di dua area utama:
1. Pusat Tumbuh di Kondilus Mandibula: Kondilus adalah bagian dari mandibula yang
berhubungan dengan sendi temporomandibular (TMJ) dan terletak di bagian belakang rahang bawah. Pusat tumbuh di sini berperan penting dalam pertumbuhan vertikal dan mempengaruhi perkembangan ketinggian rahang.
2. Pusat Tumbuh di Tuberositas Mandibula: Area ini berperan dalam pertumbuhan anterior (ke depan) dan lateral (ke samping) dari mandibula.
Pertumbuhan mandibula terjadi seiring dengan perkembangan individu, terutama selama masa kanak-kanak dan remaja. Pada usia dewasa, pusat tumbuh ini mulai berkurang aktifnya, karena pertumbuhan tulang cenderung berhenti saat seseorang mencapai kedewasaan fisik.
Tumbuh kembang mandibula sangat penting untuk penataan gigi dan pengaturan gigitan yang baik.
Ketidakseimbangan atau gangguan dalam pertumbuhan pusat-pusat tumbuh ini bisa mempengaruhi bentuk wajah, susunan gigi, dan hubungan antara rahang atas dan bawah.
