SCREW-BASED INTERMAXILLARY TRACTION COMBINED WITH OCCLUSAL SPLINT FOR TREATMENT OF PEDIATRIC MANDIBULAR CONDYLAR FRACTURE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WUYang ,  LONGXing , DENGMohong , CAIHengxing , MENGQinggong , LIBo

Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan Hubei, 430079, P. R. China;

Corresponding author：

LONGXing, Email: longxing_china@hotmail.com

Keywords：

Pediatric mandibular condylar fracture; Intermaxillary traction; Screws; Occlusal splint; Children

DOI：

10.7507/1002-1892.20150086

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Objective To evaluate the effectiveness of the screw-based intermaxillary traction combined with occlusal splint in the treatment of pediatric mandibular condylar fracture. Methods Between June 2005 and December 2013, 35 pediatric patients with 49 mandibular condylar fractures were treated, and the clinical data were retrospectively reviewed. There were 25 boys and 10 girls, aged 3-13 years (mean, 7.3 years). The injury causes included falling (18 cases), traffic accident (14 cases), and violence (3 cases). The time between injury and treatment was 2-30 days (mean, 6.8 days). Restricted mouth opening was observed, and the maximal mouth opening was (22.74±7.22) mm except 3 patients who were too young to measure. Condylar fractures were located at the left (12 cases), at the right (9 cases), at bilateral (14 cases) based on the sites; and fractures were classified as intra-capsular (35 fractures), neck (10 fractures), and subcondylar (4 fractures) based on the fracture line. Four self-drilling titanium screws were inserted into the alveolar bone of both maxilla and mandible. After screw inserting, an occlusal splint with a fulcrum was used on the affected side and elastic band was put to perform anterior intermaxillary traction. After 1 month, the screws and splint were removed. Follow-up examinations were carried out on schedule. Results All the patients were followed up from 6 months to 8 years and 10 months (median, 71 months). No screw-related complication occurred in the others except one case of screw loosening. The postoperative maximal mouth opening was (38.82±2.02)mm. Mild joint noise was found in 4 cases and opening deviation occurred in 6 cases. Radiographic results demonstrated complete condyle remodeling was achieved in 24 cases (32 fractures), and moderate remodeling in 11 cases (17 fractures) at last follow-up. Conclusion The screw-based intermaxillary traction combined with occlusal splint might be an effective method for pediatric mandibular condylar fracture. The screw-related complications may be avoided by careful preoperative investigations.

Citation： WUYang, LONGXing, DENGMohong, CAIHengxing, MENGQinggong, LIBo. SCREW-BASED INTERMAXILLARY TRACTION COMBINED WITH OCCLUSAL SPLINT FOR TREATMENT OF PEDIATRIC MANDIBULAR CONDYLAR FRACTURE. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(4): 397-401. doi: 10.7507/1002-1892.20150086 Copy

1.	Singhal R, Singh V, Bhagol A, et al. Pediatric maxillofacial injuries--if a new look is required? Int J Pediatr Otorhinolaryngol, 2013, 77(8):1333-1336.
2.	Xiang GL, Long X, Deng MH, et al. A retrospective study of temporomandibular joint ankylosis secondary to surgical treatment of mandibular condylar fractures. Br J Oral Maxillofac Surg, 2014, 52(3):270-274.
3.	Chrcanovic BR. Open versus closed reduction:mandibular condylar fractures in children. Oral Maxillofac Surg, 2012, 16(3):245-255.
4.	Boffano P, Roccia F, Schellino E, et al. Conservative treatment of unilateral displaced condylar fractures in children with mixed dentition. J Craniofac Surg, 2012, 23(5):e376-378.
5.	Tabrizi R, Langner NJ, Zamiri B, et al. Comparison of nonsurgical treatment options in pediatric condylar fractures:rigid intermaxillary fixation versus using guiding elastic therapy. J Craniofac Surg, 2013, 24(3):e203-206.
6.	Sforza C, Ugolini A, Sozzi D, et al. Three-dimensional mandibular motion after closed and open reduction of unilateral mandibular condylar process fractures. J Craniomaxillofac Surg, 2011, 39(4):249-255.
7.	Liu CK, Meng FW, Tan XY, et al. Clinical and radiological outcomes after treatment of sagittal fracture of mandibular condyle (SFMC) by using occlusal splint in children. Br J Oral Maxillofac Surg, 2014, 52(2):144-148.
8.	Glazer M, Joshua BZ, Woldenberg Y, et al. Mandibular fractures in children:analysis of 61 cases and review of the literature. Int J Pediatr Otorhinolaryngol, 2011, 75(1):62-64.
9.	Loukota RA, Eckelt U, De Bont L, et al. Subclassification of fractures of the condylar process of the mandible. Br J Oral Maxillofac Surg, 2005, 43(1):72-73.
10.	Gilhuus-Moe O. Fractures of the mandibular condyle in the growth period. Histologic and autoradiographic observations in the contralateral, nontraumatized condyle. Acta Odontol Scand, 1971, 29(1):53-63.
11.	Bruckmoser E, Undt G. Management and outcome of condylar fractures in children and adolescents:a review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol, 2012, 114(5 Suppl):S86-S106.
12.	Long X, Li X, Cheng Y, et al. Preservation of disc for treatment of traumatic temporomandibular joint ankylosis. J Oral Maxillofac Surg, 2005, 63(7):897-902.
13.	Zhao YM, Yang J, Bai RC, et al. A retrospective study of using removable occlusal splint in the treatment of condylar fracture in children. J Craniomaxillofac Surg, 2014, 42(7):1078-1082.
14.	Arthur G, Berardo N. A simplified technique of maxillomandibular fixation. J Oral Maxillofac Surg, 1989, 47(11):1234.
15.	Jones DC. The intermaxillary screw:a dedicated bicortical bone screw for temporary intermaxillary fixation. Br J Oral Maxillofac Surg, 1999, 37(2):115-116.
16.	Landtwing K. Evaluation of the normal range of vertical mandibular opening in children and adolescents with special reference to age and stature. J Maxillofac Surg, 1978, 6(3):157-162.
17.	Lekven N, Neppelberg E, Tornes K. Long-term follow-up of mandibular condylar fractures in children. J Oral Maxillofac Surg, 2011, 69(11):2853-2859.
18.	Güven O, Keskin A. Remodelling following condylar fractures in children. J Craniomaxillofac Surg, 2001, 29(4):232-237.
19.	Strobl H, Emshoff R, Röthler G. Conservative treatment of unilateral condylar fractures in children:a long-term clinical and radiologic follow-up of 55 patients. Int J Oral Maxillofac Surg, 1999, 28(2):95-98.
20.	Thorén H, Iizuka T, Hallikainen D, et al. Radiologic changes of the temporomandibular joint after condylar fractures in childhood. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1998, 86(6):738-745.

1. Singhal R, Singh V, Bhagol A, et al. Pediatric maxillofacial injuries--if a new look is required? Int J Pediatr Otorhinolaryngol, 2013, 77(8):1333-1336.
2. Xiang GL, Long X, Deng MH, et al. A retrospective study of temporomandibular joint ankylosis secondary to surgical treatment of mandibular condylar fractures. Br J Oral Maxillofac Surg, 2014, 52(3):270-274.
3. Chrcanovic BR. Open versus closed reduction:mandibular condylar fractures in children. Oral Maxillofac Surg, 2012, 16(3):245-255.
4. Boffano P, Roccia F, Schellino E, et al. Conservative treatment of unilateral displaced condylar fractures in children with mixed dentition. J Craniofac Surg, 2012, 23(5):e376-378.
5. Tabrizi R, Langner NJ, Zamiri B, et al. Comparison of nonsurgical treatment options in pediatric condylar fractures:rigid intermaxillary fixation versus using guiding elastic therapy. J Craniofac Surg, 2013, 24(3):e203-206.
6. Sforza C, Ugolini A, Sozzi D, et al. Three-dimensional mandibular motion after closed and open reduction of unilateral mandibular condylar process fractures. J Craniomaxillofac Surg, 2011, 39(4):249-255.
7. Liu CK, Meng FW, Tan XY, et al. Clinical and radiological outcomes after treatment of sagittal fracture of mandibular condyle (SFMC) by using occlusal splint in children. Br J Oral Maxillofac Surg, 2014, 52(2):144-148.
8. Glazer M, Joshua BZ, Woldenberg Y, et al. Mandibular fractures in children:analysis of 61 cases and review of the literature. Int J Pediatr Otorhinolaryngol, 2011, 75(1):62-64.
9. Loukota RA, Eckelt U, De Bont L, et al. Subclassification of fractures of the condylar process of the mandible. Br J Oral Maxillofac Surg, 2005, 43(1):72-73.
10. Gilhuus-Moe O. Fractures of the mandibular condyle in the growth period. Histologic and autoradiographic observations in the contralateral, nontraumatized condyle. Acta Odontol Scand, 1971, 29(1):53-63.
11. Bruckmoser E, Undt G. Management and outcome of condylar fractures in children and adolescents:a review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol, 2012, 114(5 Suppl):S86-S106.
12. Long X, Li X, Cheng Y, et al. Preservation of disc for treatment of traumatic temporomandibular joint ankylosis. J Oral Maxillofac Surg, 2005, 63(7):897-902.
13. Zhao YM, Yang J, Bai RC, et al. A retrospective study of using removable occlusal splint in the treatment of condylar fracture in children. J Craniomaxillofac Surg, 2014, 42(7):1078-1082.
14. Arthur G, Berardo N. A simplified technique of maxillomandibular fixation. J Oral Maxillofac Surg, 1989, 47(11):1234.
15. Jones DC. The intermaxillary screw:a dedicated bicortical bone screw for temporary intermaxillary fixation. Br J Oral Maxillofac Surg, 1999, 37(2):115-116.
16. Landtwing K. Evaluation of the normal range of vertical mandibular opening in children and adolescents with special reference to age and stature. J Maxillofac Surg, 1978, 6(3):157-162.
17. Lekven N, Neppelberg E, Tornes K. Long-term follow-up of mandibular condylar fractures in children. J Oral Maxillofac Surg, 2011, 69(11):2853-2859.
18. Güven O, Keskin A. Remodelling following condylar fractures in children. J Craniomaxillofac Surg, 2001, 29(4):232-237.
19. Strobl H, Emshoff R, Röthler G. Conservative treatment of unilateral condylar fractures in children:a long-term clinical and radiologic follow-up of 55 patients. Int J Oral Maxillofac Surg, 1999, 28(2):95-98.
20. Thorén H, Iizuka T, Hallikainen D, et al. Radiologic changes of the temporomandibular joint after condylar fractures in childhood. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1998, 86(6):738-745.

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Chinese Journal of Reparative and Reconstructive Surgery

SCREW-BASED INTERMAXILLARY TRACTION COMBINED WITH OCCLUSAL SPLINT FOR TREATMENT OF PEDIATRIC MANDIBULAR CONDYLAR FRACTURE

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