35 Condylar Fractures in 29 Children: Demographics, Treatment, Outcomes, and Long-Term Growth
Wendy Chen, MD, MS, Jack E. Brooker, MD, John Henry Y. Pang, MD, Wei Wei Lee, MD, Lindsay A. Schuster, DMD, MS, Joseph E. Losee, MD.
University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Background: The condyle has been described as an important growth center for the mandible. Fractures to the condyle could affect occlusal relationships, jaw growth, and orofacial functions. To date, few reports have assessed long-term growth after pediatric condylar fractures.
Methods: This is a retrospective study at our institution (2000-2016) reviewing pediatric condylar fractures with greater than 1yr follow-up cephalograms. Bolton cephalometric standards served as controls.
Results: Twenty-nine patients (18 male, 11 female; average age at injury 7.5yo, average f/u 63mos) were identified, representing a variety of injury mechanisms, sustaining a variety of condylar fractures (comminuted n=8, displaced n=9). Management was largely conservative (rest/PT, n=18; external stabilization, n=6; closed reduction with elastics/MMF, n=10; ORIF, n=1). Complications were minor (slight deviations from dental midline/occasional clicking at TMJ, n=19; hardware malposition, n=1).
Cephalograms were compared to Bolton cephalometric norms. Average differences were calculated for SNA (3.7deg), SNB (2.9deg), ANB (2.3deg), gonial angle (6.3deg), ramal height (0.7cm), body length (0.5cm). SNB, ANB, ramal height, and body length values were within the range of Bolton norm standard deviations. Frontal cephalograms were used to internally compare hemimandibles. The average ratios of ramal height, body length, and Ar-Me distances were, respectively, 1.01, 0.94, and 1.00, indications minimal differences between hemimandibles.
Conclusion: We present the longest-duration follow-up found in current literature assessing mandible growth in patients who suffered condylar fractures prior to skeletal maturity. Our cohort demonstrates minimal operative intervention, minimal complications, and no obvious growth abnormalities. Our data challenges the growth disturbances reported in existing pediatric condylar fracture literature.
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