The study of the effect of mandibular growth and function in pediatric unilateral condyle fractures

Jin-Kyu Sang; Jae-Hoon Lee

doi:10.5125/jkaoms.2011.37.6.448

Journal List > J Korean Assoc Oral Maxillofac Surg > v.37(6) > 1032501

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Sang and Lee: The study of the effect of mandibular growth and function in pediatric unilateral condyle fractures

Original Article

J Korean Assoc Oral Maxillofac Surg 2011;37(6):448-456.

Published online: 10 January 2011

DOI: https://doi.org/10.5125/jkaoms.2011.37.6.448

The study of the effect of mandibular growth and function in pediatric unilateral condyle fractures

Jin-Kyu Sang, Jae-Hoon Lee

Department of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University, Choenan, Korea

Jae-Hoon Lee Department of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University 29, Anseo-dong, Cheonan, 330-714, Korea TEL: +82-41-550-1991-3 FAX: +82-41-551-8988 E-mail: lee201@dankook.ac.kr

Received 9 June 2011 Revised 31 August 2011 Accepted 12 October 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Introduction

Condylar fractures are common in the maxillofacial region, comprising 29–40 percent of all mandibular fractures, accounting for about 20–62 percent). Previous studies reported that pediatric condylar fractures can cause disorders in facial growth and function, and the treatment methods have been controversial. Recently, conservative treatment has shown good results in skeletal growth and functional recovery but the conservative treatment of pediatric condylar fractures has shown unpredictable and undesirable results in some cases, such as facial asymmetry and temporomandibular joint disorder. This study examined the specific age groups and specific mandibular condylar fracture type in growing children treated conservatively in the past.

Materials and Methods

Eighteen patients (10 men and 8 women) who received conservative treatment for unilateral condylar fractures in Dankook University Dental Hospital between 2000 to 2007 were followed up for a mean period of 7.2 years.

Results

In the survey of 18 pediatric patients who received conservative treatment for condylar fractures, the incidence of temporomandibular dysfunction and growth disturbance was 45% and 35%, respectively.

Conclusion

In all complications, the symptoms observed most frequently was mouth opening displacement of the mandible exceeding 2 mm. The other complications of functional and growth disturbance included facial asymmetry concentrated along specific condylar types. Complications including facial asymmetry and functional and growth disturbances showed an increasing tendency according to the specific fracture types. Functional and growth disturbances in the undisplaced condylar fracture type showed a lower incidence(P<0.05). Functional and growth disturbances differed according to the fracture type, which has poor relationship with articular fossa and condyle(P<0.05). Functional and growth disturbance in the cases of the high-level condylar fracture type showed a higher incidence(P<0.05). The functional and growth disturbances of the fracture types were similar in the fragment-contact and non-contact groups(P>0.05).

Keywords: Child, Mandibular fractures, Mandibular condyle, Growth disorders, Temporomandibular joint disorders

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Fig. 1.

Ramal height analysis. (A: superior point of condyle, D: gonial angle, RL: ramal line, ML: mandibular plane) Jin-Kyu Sang et al: The study of the effect of mandibular growth and function in pediatric unilateral condyle fractures. J Korean Assoc Oral Maxillofac Surg 2011

Fig. 2.

Frontal cephalometric analysis (evaluation of asymmetry). (Co: condylon, Ag: gonial angle, Me: menton, MSR: midsagittal reference line at crista galli, Cg: crista galli) Jin-Kyu Sang et al: The study of the effect of mandibular growth and function in pediatric unilateral condyle fractures. J Korean Assoc Oral Maxillofac Surg 2011

Fig. 3.

Condylar fracture types according to modified Spiessel & Schroll classification. A. Undisplaced extracapsular fracture (I). B. Displaced extracapsular fracture with contact between the fragments (II). C. Displaced extracapsular fracture without contact between the fragments (III). D. Severely displaced intracapsular fracture with contact between the fragments (IV). E. Severely displaced intracapsular fracture without contact between the fragments (V). F. Undisplaced intracapsular fracture (condylar head fracture) (VI). Jin-Kyu Sang et al: The study of the effect of mandibular growth and function in pediatric unilateral condyle fractures. J Korean Assoc Oral Maxillofac Surg 2011

Table 1.

Patients with respect age, sex and type of condylar fracture

Sex	Follo-up period	Age	Fx. side	Fx. type
F	8	9	Lt. condyle, Rt. Body	V
F	9	7	Rt. condyle	IV
F	9	8	Rt. condyle	I
M	8	8	Rt. condyle	V
F	10	6	Lt. condyle	III
M	10	6	Rt. condyle, symphysis	III
M	7	9	Lt. condyle, symphysis	VI
M	9	7	Lt. condyle, symphysis	VI
M	5	14	Rt. condyle, symphysis	V
F	6	15	Rt. condyle, symphysis	II
F	5	12	Rt. condyle, symphysis	I
F	6	14	Rt. Condyle	IV
M	8	14	Lt. condyle, Lt. body	II
M	7	15	Lt. condyle	II
F	6	11	Lt. condyle	IV
M	8	11	Rt. condyle, symphysis	I
M	5	14	Lt. condyle, symphysis	VI
M	3	15	Rt. condyle, symphysis	IV

(Fx: Fracture, F: female, M: male, Rt: right, LT: left)

Jin-Kyu Sang et al: The study of the effect of mandibular growth and function in pediatric unilateral condyle fractures. J Korean Assoc Oral Maxillofac Surg 2011

Table 2.

Patients classification according to age and types of fracture displacement (N=18)

Age groups (year)	Type of fracture displacement¹						Total
Age groups (year)	I	II	III	IV	V	VI	Total
6–10	1	0	2	1	2	2	8
11–15	2	3	0	3	1	1	10
Total	3	3	2	4	3	3	18

¹ according to modified Spiessel & Schroll classification. Values are number of cases. Jin-Kyu Sang et al: The study of the effect of mandibular growth and function in pediatric unilateral condyle fractures. J Korean Assoc Oral Maxillofac Surg 2011

Table 3.

Etiology of mandibular fractures

Etiology	Age groups (year)		Total
Etiology	6–10	11–15	Total
Traffic accident	1	3	4
Fall down	5	4	9
Interpersonal	0	4	4
Others	1	0	1

Jin-Kyu Sang et al: The study of the effect of mandibular growth and function in pediatric unilateral condyle fractures. J Korean Assoc Oral Maxillofac Surg 2011

Table 4.

Clinical evaluation of temporomandibular joint (TMJ) dysfunction classified with age groups

Age groups (year)	MO limitation <40 mm	Laterotrusion <6 mm	Protrusion <6 mm	MO deviation >2 mm	TMJ sound	TMJ pain
6–10	−	37.5 (3)	37.5 (3)	50.0 (4)	12.5 (1)	−
11–15	−	33.3 (4)	8.3 (1)	83.3 (9)	41.7 (4)	−

(MO: mouth opening) Values are % (number of cases). Jin-Kyu Sang et al: The study of the effect of mandibular growth and function in pediatric unilateral condyle fractures. J Korean Assoc Oral Maxillofac Surg 2011

Table 5.

Statistical analysis of functional disturbance according to age groups

Age groups (year)	Number of patients (%)	Functional disturbance	P-value
6–10	8 (40)	11	0.695
11–15	10 (60)	18	0.695

Fisher's exact test. (significance, P<0.05) Jin-Kyu Sang et al: The study of the effect of mandibular growth and function in pediatric unilateral condyle fractures. J Korean Assoc Oral Maxillofac Surg 2011

Table 6.

Clinical evaluation of growth disturbance classified with age groups

Age groups (year)	Anterior openbite	Posterior premature contact	Midline deviation	Chin deviation	Facial asymmetry
6–10	12.5 (1)	12.5 (1)	37.5 (3)	25.0 (2)	25.0 (2)
11–15	−	16.6 (2)	33.3 (4)	33.3 (4)	33.3 (4)

Values are % (number of cases). Jin-Kyu Sang et al: The study of the effect of mandibular growth and function in pediatric unilateral condyle fractures. J Korean Assoc Oral Maxillofac Surg 2011

Table 7.

Statistical analysis of growth disturbance according to age groups

Age groups (year)	Number of patients (%)	Growth disturbance	P-value
6–10	8 (44)	9	0.845
11–15	10 (56)	14	0.845

Table 8.

Clinical evaluation of temporomandibular joint (TMJ) dysfunction classified with fracture types

Fx. type	Laterotrusion <6 mm	Protrusion <6 mm	MO deviation >2 mm	TMJ sound	Total
I	0	0	2	0	2
II	1	0	2	0	3
III	0	0	1	0	1
IV	3	1	4	3	11
V	3	3	3	2	11
VI	0	0	1	0	1

(MO: mouth opening) Values are number of cases. Jin-Kyu Sang et al: The study of the effect of mandibular growth and function in pediatric unilateral condyle fractures. J Korean Assoc Oral Maxillofac Surg 2011

Table 9.

Clinical evaluation of growth disturbance classified with fracture types

Fx. type	Anterior openbite	Posterior premature contact	Midline deviation	Chin deviation	Facial asymmetry	Total
I	0	0	0	0	0	0
II	0	0	0	0	0	0
III	0	0	1	1	0	2
IV	0	0	3	3	3	9
V	1	2	3	2	3	11
VI	0	0	0	0	0	0

(Fx: Fracture) Values are number of cases. Jin-Kyu Sang et al: The study of the effect of mandibular growth and function in pediatric unilateral condyle fractures. J Korean Assoc Oral Maxillofac Surg 2011

Table 10.

Statistical analysis of functional disturbance and growth disturbance according to fracture types between the undisplaced group and the displaced group

	Number of patients (%)	Functional disturbance	Growth disturbance	P-value
Undisplaced	7 (35)	3	0	0.013
Displaced	13 (65)	26	22	0.013

Table 11.

Statistical analysis of functional disturbance and growth disturbance according to fracture types between the group of poor condyle-fossa relationship and the others

	Number of patients (%)	Functional disturbance	Growth disturbance	P-value
The others	13 (65)	7	2	0.031
The others	13 (65)	7	2	0.031

Table 12.

Statistical analysis of functional disturbance and growth disturbance according to fracture types between the high-level fracture group and the low-level fracture group

	Number of patients (%)	Functional disturbance	Growth disturbance	P-value
High level	11 (55)	23	20	0.027
Low level	9 (45)	6	2	0.027

Table 13.

Statistical analysis of functional disturbance and growth disturbance according to fracture types between the fragment-contact group and the noncontact group

	Number of patients (%)	Functional disturbance	Growth disturbance	P-value
Contact	5 (25)	12	13	0.736
Non-contact	15 (75)	17	9	0.736

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