Background: Mandibular condylar and subcondylar fractures
are common among pediatrics. They are important to
be appropriately managed for their effect on the normal growth
of the mandible and the associated complications. Given these
concerns, it is unsurprising to note the variety of treatment
approaches including; conservative, closed reduction with
arch bar application, and open reduction with internal fixation
by plates & screws. This reflects the need to appropriately
select the convenient modality according to age, displacement
of the fractured segments, and presence of malocclusion.
Objective: To compare the functional outcomes of different
modalities in the management of pediatric condylar and
subcondylar fractures.
Patients and Methods: This systematic review was done
on ten retrospective and cohort studies published in the English
language, from any geographical location, between 2010 and
2021. A total of 626 patients aged less than 15-year-old with
condylar and sub-condylar fractures, associated with or without
other mandibular fractures, managed with conservative management,
closed reduction with application of arch bar or
MMF, and open reduction with internal fixation by plates &
screws.
Results: Pediatric patients managed by conservative
management and physiotherapy yielded a significant improvement
in occlusion and mouth opening with fewer complications
within a reasonable period of 2-4 weeks to achieve functional
recovery. On applying closed reduction with arch bar application
or MMF, the mouth opening was improved up to >35mm
without significant malocclusion or any other complications.
It needed about 4-8 weeks for functional recovery to be
achieved. In surgical intervention for open reduction and
internal fixation, Malocclusion was noted in 2.8% of patients
compensated with the growth of the mandible and teeth
eruption. In addition, there were significant postoperative
complications noted in some patients.
Conclusion: Based on the studies, all modalities in the
management of pediatric condylar and sub-condylar fractures
are clinically accepted and can be applied. However, the point
of negotiation is the indications for each modality and the
associated possible complications. Conservative management
and closed reduction with MMF application prevent the risk
375
of some functional complications that may occur with the
invasive surgical intervention