Long-term results of nonsurgical management of condylar fractures in children

Twenty-five patients with 28 condylar or subcondylar fractures, sustained d uring their growth period and treated nonsurgically, have been followed for an average period of 15 years. The fractures were classified as intracapsu lar, high condylar neck and low condylar neck fractures, In 5 patients, two weeks of intermaxillary fixation, followed by elastic traction in order to achieve a proper occlusion, was applied. All the other patients were treat ed by instruction, exercises and observation. In 4 patients, subsequent ort hodontic treatment was provided. It is not advocated to perform orthodontic aftercare as a routine action in all patients. Satisfaction with the treat ment results, as measured on a Visual analogue scale (VAS), was very high. The masticatory function of all patients at last follow-up was good to exce llent. From this study it appears that especially the commonly occurring hi gh condylar fractures (64%) show good regeneration tendency as observed on radiographs. Low condylar and intracapsular fractures may give rise to some asymmetry. In 4 cases this asymmetry was clearly visible to the experience d observer, but did not concern the patient. One patient (low condylar neck fracture) showed obvious malocclusion and facial asymmetry, which needed t o be corrected by orthognathic surgery. Unfortunately, it is impossible to predict which type of fracture is at risk of facial asymmetry. It is conclu ded that nonsurgical management of condylar fractures of the mandible in ch ildren is still the method of choice.