Conservative treatment of unilateral condylar fractures in children: a long-term clinical and radiologic follow-up of 55 patients

Abstract

The purpose of this prospectively designed study was the long-term clinical and radiological evaluation of conservatively treated unilateral condylar fractures in children. Fifty-five children aged between 2 1/2 and 9 3/4 years, presenting with a singular unilateral fracture of the mandibular condyle, were treated in a nonsurgical-functional way using an intraoral myofunctional appliance. In the follow-up period, patients were investigated by standardized clinical examination and by evaluation of panoramic radiographs taken immediately post-traumatically, after 6, 12, 24, 48 and 72 weeks, and then yearly through the period of growth. With a satisfactory clinical course in all patients, there was no instance of functional disturbance or mandibular asymmetry after the respective follow-up periods. The radiographs showed a fairly good shape of the condyle (no or only slight condylar deformity) in the 47 patients of the 2-6 year age group. In the eight patients of the 7-10 year age group presenting with a class II or III condylar fracture, healing was characterized by incomplete condylar regeneration, resulting in a moderate condylar deformity in two cases, a definite reduction in condylar neck height in two cases, and a hypertrophic condylar deformity in four cases. The positive results of this study confirm the concept of a nonsurgical-functional approach in children presenting with various types of unilateral fractures of the mandibular condyle. Condylar remodeling was the mode of fracture healing in instances of displaced and dislocated condylar fractures.

Functional Treatment of a Child with Extracapsular Mandibular Fracture

“…Conservative approaches in treating condylar fracture include physiotherapy, intermaxillary fixation (IMF) [18, 30], and functional appliances (e.g., activator) [31]. …”

Balancing pro- and anti-inflammatory CD4+ T helper cells in the intestine

“…In particular, Tr1-cell supernatant diminishes the capacity of monocytes to stimulate Th1-cell responses and blocks the differentiation and maturation of DCs via IL-10 [90]. TGF- down-regulates the functions of APCs [91] and inhibits the proliferation and cytokine production by T cells [92]. Therefore, the suppressive effects of Tr1 cells are reversed by the addition of anti-IL10 and anti-TGF- neutralizing antibodies [85,93,94] …”

Facial symmetry evaluation after experimentally displaced condylar process fracture in methotrexate treated rats

“…However, there is some concern regarding skeletal changes, represented by mandibular asymmetry [7][8][9] .…”