CONDYLAR FRACTURES IN CHILDREN - A STUDY.
The purpose of the study was to highlight the etiology, age, gender and site distribution, treatment options available and complications occurring as a result of condylar fractures in growing children.
This retrospective study was carried out on a total of 57 patients from Jan 2008 to Oct 2009 at the department of oral and maxillofacial surgery, Khyber College of Dentistry, Peshawar, Khyber Pakhthunkhwa province of Pakistan. Fifty seven patients were recruited in this study. The male to female ratio was 1.6:1. Fall was the most common cause of condylar fractures i.e., (73.7%). The peak incidence of condylar fracture was high among 6-10 years age group i.e. 26 (45.6%). Forty one patients (71.9%) had unilateral condylar fractures and (28.1%) had bilateral. Maxillomandibular fixation (MMF) was performed in 28 patients (49.2%) to correct occlusal disturbance, minor deviations and to reduce the pain associated with it, while occlusion was disregarded in 29 patients (50.8%) but were put on close follow up. Overall 41 patients (71.9%) were treated successfully with conservative treatment approach but 16 patients (28.1%) have reported after 1-2 years with complications of temporomandibu-lar joint (TMJ) Ankylosis.
Among these 10 patients (62.5%) had unilateral TMJ Ankylosis. Gap arthroplasty with disc interpositioning was performed in patients with established complication of temporomandibular joint ankylosis.
Key words: Khyber College of Dentistry, Children, Condylar fractures, Peshawar
Maxillofacial injuries are less common in children, however condylar fractures are reported by many authors as common site of injury.1, 2 Facial fractures in children comprise less than 15% of all the fractures.3, 4. Their incidence increases as children begin their school.5 Boys are more prone to maxillofacial fractures than girls. Male to female ratio ranges from 3.5:1.6
Fall constitutes the most frequent cause of condy-lar fractures in children.7, 8, 9 Other causes include road traffic accidents (RTA), Bicycles, Sports injuries and child abuse.10 Condylar fractures in children are often undiagnosed and so the true incidence is likely to be higher than that reported in literature.11 Traumatic injuries of the temporomandibular joint (TMJ) are often overlooked as they can apparently occur with relatively little pain, few clinical signs and insufficient reaction by a child to alert an adult to the seriousness of the injury. Therefore, it is an essential part of pediatric facial traumatology.12
If condylar fractures occur in children prior to the completion of growth and if they are not properly managed then they can result in growth disturbances and asymmetry. It may also result in various temporo-mandibular joint (TMJ) disorders such as TMJ ankylo-sis, dysfunction, malocclusion, chronic dislocation and pain on the injured side.13 TMJ Ankylosis is a common condition in developing countries. High condylar (in-tra-capsular) and dislocated fractures of condyle.
This study was carried out on a total of 57 patients to determine etiology, age, gender, site distribution and complications of condylar fractures in children. For this purpose the records of properly diagnosed and treated patients were taken from the oral and maxillo-facial department of Khyber College of Dentistry, Peshawar from January 2008 to October 2009. All patients with the condylar fracture and below 16 years of age were included in this study. Patients with condylar fracture and associated maxillofacial fratures like, Lefort Maxillary fractures, Zygomatic Complex fractures, Nasal bone fractures, panfacial trauma and Mandibular symphysis, body and angle fratures were excluded. The Oral and Maxillofacial Surgical Unit of Khyber College of Dentistry is a tertiary care center in the region of Khyber Pakhtunkhwa. This unit receives patients from entire region and also from far flung areas like Federally Administered Tribal Area (FATA) and Afghanistan.
During the study period, 57 patients reported to the Department of Oral and Maxillofacial Surgery, with isolated condylar fracture. Among 57 patients 35 (61%) were male and 22 (39%) were female. The male to female ratio was 1.6:1 (Fig 1).
The age of the patients ranged from 2 years to 16 years with the mean age of 14.25 years SD + 3.14. The peak incidence of condylar fracture was found at the age of 6-10 years i.e., in 26 cases (45.6%). The incidence of condylar fracture showed decrease with increasing age of the child i.e., n= 8 (14.0%) (Table 1). The causes of condylar fractures in the order of frequency were as, falls 42 (73.7%), birth trauma 8 (14.0%) and road traffic accidents (RTA) 7 (12.2%) (Table 2).Unilateral condylar fractures were more common than bilateral condylar fractures i.e. 41 (71.9%) and 16 (28.1%) respectively.
TABLE 1: AGE GROUPS OF PATIENTS WITH CONDYLAR FRACTURE
Age Range###Number of###%
1 to 5 years###10###17.5%
6 to 10 years###26###45.6%
11 to 15 years###13###22.8%
TABLE 2: CAUSES OF CONDYLAR FRACTURE
TABLE 3. COMPLICATIONS OF CONDYLAR FRACTURES
TMJ ankylosis###8 36.###36%
Condylar injuries and fractures have gained special attention in Pediatric Dentistry because of high inci-dence in relation to adults. They are caused due to falls, RTAs, sports injuries and interpersonal violence.1 Although the fracture of condyle is regarded as safety mechanism as the impact of force is dissipated at the head of condyle and do not reach the cranium, but the complications like restricted mouth opening, occlusal disturbance, growth abnormality, asymmetry of face, breathing problem, mal-alignments of teeth, emo-tional stress, and psychological problems have given boast to the importance of condylar injuries during childhood. In children the proportion of condylar frac-ture is higher up to 50%.3, 4
According to the present study, males were pre-dominantly affected with condylar fracture as com-pared to females. A probable reason was that boys are more boisterous than girls and spend more time out-doors. Al Abosi et al 6 showed the male to female ratio of 3.5-1.
Fall was the leading cause of condylar fractures in children (73.7%). Adekeye5 and Ahmad 19 has also re-ported fall as a leading cause of condylar fractures in children.
This study showed the incidence was higher be-tween the age of 6- 10 years (45.6%) as they are exposed to unsafe playing environment. When they begin school-ing, RTA, sports injuries and interpersonal violence resulted for condylar fractures in children. Morgan7 and Amaratunga20 signify this age to be highly susceptibe to condylar injuries.
The present study showed that 71.9% of patients had unilateral condylar fractures while, 28.1% had bilateral fractures. The study is consistent with the international studies when it comes to site distribution of condylar fracture i.e., 80% of the condylar fractures were unilateral while only 20% were bilateral.21, 22
Various treatment options like conservative ap-proach. Open reduction and close follow up were sug-gested to restore the functional occlusion and facial symmetry in children. Non-surgical management was the mainstay of treatment of condylar injuries. All children with minimal displacement of fractured condy-lar process were advised to use soft diet, analgesics, and occlusion was disregarded in this group of patients. If pain and malocclusion was persistent then maxillo-mandibular fixation (MMF) for 7 to 10 days was another treatment option which was done in 49.2% of patients. Amaratunga20, Stroble,23 has also emphasized conser-vative treatment approach especially in children of growing age.
Limited mouth opening and deviation of jaw was found in 16 patients (28.1%) after 1-2 years with a history of trauma to the condylar region. TMJ ankylo-sis was the most common complication seen in 8 cases (36.36.0%). Of the total 8 patients with TMJ ankylosis 6 (75%) developed unilateral and 2 (25%) developed bilateral ankylosis. Gap arthroplasty with disc interpositioning was instituted in all the patients with established TMJ ankylosis. Irrum et al 24, Roychaudry et al25 have also preferred gap arthroplsty with disc interpositioning to restore function and esthetics in children. All the patients were advised to strictly follow the follow up schedule to monitor the deve-loping sequelae of condylar fractures in growing children
The authors are very thankful to the staff of the Department of Oral and Maxillofacial Surgery of Khyber College of Dentistry, Peshawar for their co-operation regarding the completion of this study.
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|Author:||Murad, Nida; Khan, Muslim; Din, Qiam Ud; Shah, Syed Murad Ali|
|Publication:||Pakistan Oral and Dental Journal|
|Date:||Dec 31, 2010|
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