Journal of Pediatric Surgery Case Reports 71 (2021) 101905

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Journal of Pediatric Surgery Case Reports

Surgical treatment of a mandibular condyle fracture

Mohamed Raiteb b, *, Sanaa Elmrini b, Fatemazahra Azami Hassani b, Bahaa Razem b,
Faiçal Slimani a, b
a Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, B.P 5696, Casablanca, Morocco
b Oral and Maxillofacial Surgery Department, CHU Ibn Rochd, B.P 2698, Casablanca, Morocco

ARTICLE INFO ABSTRACT

Keywords: The condylar region is the most frequent anatomical site for mandibular fractures in children. Most surgeons opt
Pediatric for functional treatment which is not satisfactory in the long term because of the appearance of facial asymmetry
Condyle and TMJ dysfunction, hence the interest in surgical management of displaced condylar fractures.
Surgical approaches
In this article, we will describe the case of a 7-year-old child who fell from a height and sustained a subcondy-
lar fracture with anteromedial dislocation. The clinical examination revealed a disorder of the dental articulation
with laterodeviation. A panoramic radiograph was done which confirmed the fracture and then we performed a
CT scan with 3D reconstruction which informed us about the degree of displacement of the fracture. The treat-
ment was surgical with a mini TCP plate which allowed the correction of all these clinical manifestations.
We believe that surgical treatment of displaced mandibular condyle fractures in children is still essential to
avoid long-term complications.

1. Introduction
The condyle is the center of growth and development of the
mandible in children and adolescents. Fractures of the mandibular
condyle are quite frequent, constituting 36% of mandibular fractures
according to Bertrand [1]. The mechanism is dominated by falls and
road accidents. Diagnosis is based on the tripod: interrogation, clinical
examination and imaging. (see Figs. 1 and 2)
They must be evoked each time there is a chin wound, especially in
children.
There is no universal classification system for fractures of the
mandibular condylar process [2]. Their therapeutic management can
be functional, orthopedic and/or surgical. The prognosis is serious in
the absence of treatment (risk of ankylosis of the temporomandibular
joint and growth disorders).
Condyle fractures in children constitute a real challenge for the
maxillofacial surgeon due to the lack of standardized consensus, which
leaves the debate still open between conservative (risk of keeping a fa-
cial asymmetry, dysfunction of the TMJ) or surgical treatments (risk of
osteonecrosis of the head, facial paralysis, mandibular growth, scar).
We present the case of a 7-year-old child with a right condylar frac-
ture treated by osteosynthesis.
This case report has been reported in line with the SCARE Criteria
[3].
2. Case report
Child aged 07 years, second of two siblings, with a well monitored
pregnancy and a vaginal delivery, vaccinated according to the national
vaccination program and who was presented to the emergency room af-
ter a fall from height with a chin impact point, the clinical examination
showed a good mouth opening with laterodeviation to the right, Articu-
lar disorder with premature molar contact on the right and left molar
gap, pain in the right temporomandibular joint due to the pressure of
the mandibular symphysis, good projection of the bony reliefs of the
face with preservation of the sensitivity of the trigeminal territories and
good ocular motility.
Panoramic radiography and CT scan of the facial mass with 3D re-
construction showed an upper right sub-condylar fracture with antero-
medial dislocation of the condyle.
5 days later, the patient was operated on by the head of department
(who has more than 15 years of experience) and benefited from a reduc-
tion and osteosynthesis of the fracture with a 4-hole TCP mini-plate and
the installation of a suction drain. Then, the patient was seen by the

* Corresponding author.
E-mail address: dr.raitebmohamed@gmail.com (M. Raiteb).

https://doi.org/10.1016/j.epsc.2021.101905
Received 11 April 2021; Received in revised form 3 May 2021; Accepted 6 May 2021
Available online 13 May 2021
2213-5766/© 2021 Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
M. Raiteb et al. Journal of Pediatric Surgery Case Reports 71 (2021) 101905

The main causes of fractures in children are accidental falls during

group games, falling off bicycles, and accidents on public roads.
The treatment was classified as conservative if no intervention took
place, patients in this case were managed by simple measures such as a
mild diet.
Closed treatment consists of immobilizing the patient's dental joint
with arches or screws. This treatment is indicated in case of disorder of
the detentary joint or displacement and/or significant shortening of the
condyle fracture.
This method varies according to the patient's age and dental condi-
tion. The blockage will be maintained for 7–10 days.
Open treatment involves open reduction and fracture fixation using
standard non-absorbable mini plates.
3 types of plates were used: a standard Mini plate, a Mini L plate
with bridge and a Mini TCP condylar plate.
The treatment must be differentiated according to several parame-
ters, such as the degree of displacement or dislocation, the level of frac-
ture, the presence of dental malocclusion and mandibular dysfunction
[4].
Our patient benefited from an open reduction with osteosynthesis
Fig. 1. View of the reduced and fixed dislocated condylar fracture, performed
by the RISDON MODIFIED approach.
with a TCP mini plate.
A 1999 review by Kempers [5] reveals that pre-auricular, sub-
mandibular and intra-oral routes are preferred in that order. In 2005,
Wilson described a transmasseteric pre-parotid approach with a preau-
ricular incision and surface dissection of the SMAS to the pre-parotid re-
gion before approaching the fracture site through the masseter [6].
The main problem associated with the use of transfacial approaches
is the incidence of facial nerve damage and scarring [7].
Fractures in this region can be complicated by growth disorders, fa-
cial asymmetry, malocclusion, limited mouth opening and bone ankylo-
sis, [7].
There is no consensus on the treatment of these fractures. Whether it
is the closed treatment or the surgical approach with internal fixation,
the long-term results are unsatisfactory [8,9].
Several new surgical methods and technologies are emerging to
change the treatment paradigm for MCF with the efforts of surgeons.
Surgical approaches including the preauricular approach, submandibu-
lar approach, retromandibular approach, and oral approach with endo-
scopic-assisted reduction had been developed to deal with appropriate
types of MCF [10].

4. Conclusion

We believe that even at a young age surgery should be indicated

Fig. 2. A : Panoramic radiograph showing the right subcondylar fracture, B: 3D whenever the condyle is dislocated or highly displaced in order to re-
reconstruction showing the fracture and the anteromedial dislocation of the duce the fracture and ensure long-term facial symmetry and good occlu-
condyle. sion.

hospital dietician before his discharge and who prescribed a progres- Patient Consent
sive diet adapted to his condition.
The postoperative follow-up was simple and there were no signs of Consent to publish the case report was not obtained. This report
facial paresis or paralysis, or of hemmoragia or infection. The patient does not contain any personal information that could lead to the identi-
was seen at D3, D10 and D30, and at the check-up it was found that the fication of the patient.
laterodeviation had disappeared and the joint had returned to normal,
the pain in the temporomandibular joint had disappeared, there was no Funding
cracking or pain at the opening, the healing of the approach was good
and the vertical height of the mandibular branch was restored on the No funding or grant support.
panoramic control x-ray.
Authorship
3. Discussion
All authors attest that they meet the current ICMJE criteria for Au-
Pediatric facial fractures represent up to 15% of the fractures thorship.
treated by maxillofacial surgeons [3].
Clinically, the children present a notion of falling on the chin, limi-
tation of the mouth opening, pain with regard to the temporomandibu-
lar joint and disorders of the dental joint.

2
M. Raiteb et al.
Declaration of competing interest
The authors declare that they have no known competing financial
interests or personal relationships that could have appeared to influ-
ence the work reported in this paper.
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