| Purpose: 1.To retrospectively analyze the epidemiological characteristics of 73 children with condylar fractures,investigate its causes,distribution and clinical outcomes.2.To explore the effects of closed treatment and open reduction on the treatment of condylar fractures in children,so as to provide evidence for the selection of clinical practice.3.To investigate the influence of facial symmetry in children with unilateral condylar fracture by three-dimensional measurements.Method: 1.This study conducted a retrospective analysis of the medical records of 73 pediatric condylar fracture patients who were treated at Shanghai Ninth People’s Hospital from 2018 to 2022 with a follow-up period of more than 6 months.Statistical analysis was performed on patients’ age,sex,injurious factors,combined fracture,fracture type,treatment modality,complications.2.The medical records of 66 pediatric condylar fracture patients with more than 12 months follow-up were retrospectively reviewed.They were divided into two groups according to the treatment modality,20 in the surgical group and 46 in the conservative group.The above cases were examined by questionnaire,clinical examination,and spiral CT of the whole head.The treatment effects,temporomandibular joint function,imaging results of the two groups were compared for statistical analysis.3.22 cases with unilateral condylar fracture follow-up time of more than 2 years was collected.Three-dimensional virtual skulls were reconstructed from DICOM data and measuring points were defined with Simplant Pro 11.04 software,and the depth of glenoid,the condylar length,width,height,and the height of ramus and deviation of pogonion were measured.Result: 1.Among the 73 children,the male to female ratio was 1.61:1,the causes of injury were self-falls(56.16%),traffic accidents(20.55%),falls injury(17.81%),and others(5.48%).The type of concomitant fracture is the chin(83.72%),the body(6.98%),the ramus(4.64%),and others(4.66%).Intracapsular fractures were the most numerous,accounting for 74% of all fracture types.Seventy sides were treated with closed treatment and 33 with surgery.Complications were present in 25 patients,12% of the children had joint snapping,56% had lateral movement limitation,and 3cases developed joint ankylosis.2.In terms of subjective symptoms,80.43% of the cases in the closed treatment group were Ai 0,which were no complaints of discomfort.A small number of patients consciously were clicking.70% of patients in the open reduction group had Ai 0,and some patients had symptoms of a joint noise.In terms of clinical disturbance,78.26% of the children in the closed treatment group had TMJ dysfunction as no disturbance or mild disturbance,mainly showing restricted lateral movement.75% of patients in the open reduction group had obstructed or mild impairment of temporomandibular function,again with lateral movement limitation.Temporomandibular function was non-impaired or mildly impaired in 75% of the patients in the open reduction group,and the main manifestation was similarly restricted lateral movement.A total of 27 sides were reconstructed in the surgically treated group with complete remodeling of 9 sides,incomplete remodeling of 11 sides,and poor remodeling of 7 sides.3.In terms of three-dimensional measurement,the depth of the temporomandibular joint fossa on the unaffected side was greater than that on the affected side in children treated with closed treatment,and the difference was statistically significant.The transverse and anteroposterior diameter of the condyle on the healthy side are shorter than the affected side,the height of the condyle on the healthy side is longer than the affected side,the height of ramus on the healthy side is longer than that of the affected side,and the bony pogonion point is deviated toward the affected side.In the surgical treatment group,there were no significant differences in depth of the temporal fossa and the transverse and anterior diameter of the condyle between two sides,the height of the condyle on the healthy side was longer than that on the affected side,the height of ramus on the healthy side was higher than that of the affected side,and the bony pogonion point was deviated to the affected side.Conclusions: 1.The incidence of condylar fractures is high in children,especially under 12 years old,and more in men than women.The fracture type is mostly intracapsular fracture,and type A is the main one.Natural falls are the main cause of injury.Condylar fractures are often combined with other site fractures,with the chin being the most common.In cases with severe displacement,the treatment modality should be carefully selected and close follow-up should be carried out in order to deal with possible complications.2.In children with condylar fractures treated with either open reduction or closed treatment,the two modalities have a good outcome,there is no difference in the subjective sensation and functional movement of patients after treatment and before injury,and there is little difference between condylar morphological structure and normal condyle.3.Three-dimensional measurement of CT reconstructed images revealed that,the child had hyperostosis of the temporomandibular fossa after closed treatment,which resulted in shallow articular fossa.The height development of the condyle is poor compared with the healthy side,and there is hyperostosis in the transverse and sagittal directions of the condyle.The mandibular ramus length was higher on the healthy side than on the affected side,with little bony pogonion point deviation.There was no significant difference in the depth of the temporal fossa bilaterally after open reduction treatment.The affected side of condyle height development was worse than the healthy side,and there was no significant difference between the transverse and sagittal directions of condyles.The mandibular ramus length was higher on the healthy side than on the affected side,with little bony pogonion point deviation.In conclusion,after treatment of condylar fractures in children,the growth ability of the condyle was different from that of the normal side,but through the temporomandibular fossa osteosynthesis and vertical ingrowth of the mandibular ramus to compensate for the insufficient condylar height,so the bony pogonion point deviation was not great and the symmetry of the mandible was restored well. |
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