TEMPOROMANDIBULAR-JOINT MORPHOLOGY IN CHILDREN AFTER TREATMENT OF CONDYLAR FRACTURES WITH FUNCTIONAL APPLIANCE THERAPY - A FOLLOW-UP-STUDY USING SPIRAL COMPUTED-TOMOGRAPHY

The consequences of treating fractures of the temporomandibular joint in children by means of functional appliance therapy remain controvers ial. In this retrospective study we evaluated the temporomandibular jo int morphology of 19 children and adolescents who had sustained a tota l of 21 condylar fractures between three and nine years previously and who had been treated in this way. Restoration of function was assesse d clinically by measurement of mandibular movements, and palpation and auscultation of the joint. Spiral CT was used for the radiological ex amination with 2D and 3D reconstructions. Eleven patients with 13 frac tures of different types showed restoration of normal function with fa vourable remodelling. The remaining eight patients had only good funct ion with a deformed condyle and significant asymmetry in condylar angl e and length of the condylar neck. Four of these cases had also develo ped bony spurs, neoarthrosis and a bifid condyle. On the basis of thes e results, spiral CT imaging appears to be a valuable diagnostic aid i n cases of condyle fractures where severe morphological changes are no t recognized in earlier conventional X-ray examinations. The authors r ecommend a quantitative and qualitative analysis of the temporomandibu lar joint in order to encourage patients' compliance and, in cases of poor cooperation, to extend the treatment time.